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Sharp R, Xu Q, Pumpa R, Elliott L, Corsini N, Marker J, Altschwager J, Ortmann A, Turner L, Jin L, Ullman A, Esterman A. Supportive care needs of adults living with a peripherally inserted central catheter (PICC) at home: a qualitative content analysis. BMC Nurs 2024; 23:4. [PMID: 38163877 PMCID: PMC10759691 DOI: 10.1186/s12912-023-01614-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are common vascular access devices inserted for adults undergoing intravenous treatment in the community setting. Individuals with a PICC report challenges understanding information and adapting to the device both practically and psychologically at home. There is a lack of research investigating the supportive care needs of individuals with a PICC to inform nursing assessment and the provision of additional supports they may require to successfully adapt to life with a PICC. The aim of this study was to identify the supportive care needs of adults with cancer or infection living with a PICC at home. METHOD Qualitative, semi-structured interviews were used to identify supportive care needs of adults living with a PICC at home. Participants were recruited from cancer and infectious diseases outpatient units. Two researchers independently analysed transcripts using content analysis. RESULTS A total of 15 participants were interviewed (30-87 years old). There were 5 males and 10 females interviewed, 9 participants had a cancer diagnosis and most lived in a metropolitan area. Many participants lived with a partner/spouse at home and three participants had young children. Participants identified supportive care needs in the following eight categories (i (i) Adapting daily life (ii) Physical comfort (iii) Self-management (iv) Emotional impact (v) Information content (vi) Understanding information (vii) Healthcare resources and (viii) Social supports. CONCLUSIONS Adults living with a PICC at home report a broad range of supportive care needs. In addition to practical and information needs, health consumers may also require support to accept living with a device inside their body and to assume responsibility for the PICC. These findings may provide nurses with a greater understanding of individual needs and guide the provision of appropriate supports.
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Affiliation(s)
- Rebecca Sharp
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia.
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia.
| | - Qunyan Xu
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Robyn Pumpa
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia
| | - Lisa Elliott
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia
| | - Nadia Corsini
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
| | - Julie Marker
- Cancer Voices South Australia, Adelaide, Australia
| | | | - Alanna Ortmann
- Metropolitan Referral Unit, SA Health, Adelaide, Australia
| | | | - Lili Jin
- South Australia Medical Imaging (SAMI)/ Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia
| | - Amanda Ullman
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Adrian Esterman
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Elliott L. Efficient automated matching of protein structural entities from a database to partitioned cryo-EM maps. Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322094104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Fritzsching B, Contoli M, Porsbjerg C, Buchs S, Larsen JR, Elliott L, Romano M, Freemantle N. Need for longitudinal studies to assess the real-world effectiveness of allergy immunotherapy in patients with allergic rhinitis and asthma - Authors´ reply. Lancet Reg Health Eur 2022; 17:100388. [PMID: 35494214 PMCID: PMC9046862 DOI: 10.1016/j.lanepe.2022.100388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Benedikt Fritzsching
- Paediatric Pulmonology and Allergy, Children's Doctor Service, Heidelberg, Germany
| | - Marco Contoli
- Respiratory Section, Department of Translational Medicine, University of Ferrara, Italy
| | - Celeste Porsbjerg
- Department of Respiratory Medicine, Bispebjerg Hospital, University of Copenhagen, Denmark
| | | | | | | | | | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, UK
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Richards E, Elliott L, Jackson B, Panesar A. Longitudinal integrated clerkship evaluations in UK medical schools: a narrative literature review. Educ Prim Care 2022; 33:148-155. [PMID: 35105274 DOI: 10.1080/14739879.2021.2021809] [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: 10/19/2022]
Abstract
PURPOSE Longitudinal Integrated Clerkships (LICs) are a recognised model of curriculum design used internationally as an alternative to traditional block rotations in medical schools that have been shown to offer a multitude of educational benefits. As a relatively new development in the United Kingdom (UK), it is not yet clear whether these benefits will translate into a UK healthcare context. This article provides an early review of evaluations of UK LIC programmes. METHODS A narrative literature review of LIC programme evaluations in UK medical schools. RESULTS UK students and faculty found value in the LIC programmes with reported benefits including continuity of relationships, increased responsibility and purpose for students, a patient-centred approach and development of professional skills. However, students and GP tutors expressed initial anxieties adapting to the newness of the programme design and preparedness for exams. CONCLUSIONS UK LIC programmes appear to be offering benefits for UK medical students and faculty members including personal and professional development in line with international literature. However, the current data is limited with significant gaps that need addressing for the impacts to be fully realised.
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Affiliation(s)
| | - L Elliott
- School of Primary Care, Yorkshire and Humber, UK
| | - B Jackson
- University of Sheffield, Sheffield, UK
| | - A Panesar
- University of Sheffield, Sheffield, UK
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Fritzsching B, Contoli M, Porsbjerg C, Buchs S, Larsen JR, Elliott L, Rodriguez MR, Freemantle N. Long-term real-world effectiveness of allergy immunotherapy in patients with allergic rhinitis and asthma: Results from the REACT study, a retrospective cohort study. Lancet Reg Health Eur 2021; 13:100275. [PMID: 34901915 PMCID: PMC8640513 DOI: 10.1016/j.lanepe.2021.100275] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Allergen immunotherapy (AIT) is the only causal treatment for respiratory allergy. Long-term real-life effectiveness of AIT remains to be demonstrated beyond the evidence from randomised controlled trials (RCTs). Methods REACT (Real world effectiveness in allergy immunotherapy) is a retrospective cohort study using claims data between 2007 and 2017. Study eligibility was a confirmed diagnosis of allergic rhinitis (AR), with or without asthma, and AIT. To ensure comparable groups, AIT-treated subjects were propensity score matched 1:1 with control subjects, using characteristic and potential confounding variables. Outcomes were analysed as within (pre vs post AIT) and between (AIT vs control) group differences across 9 years of follow-up (ClinicalTrial.gov: NCT04125888). Findings 46,024 AIT-treated subjects were matched with control subjects and 14,614 were included in the pre-existing asthma cohort. AIT-treated subjects were 29·5 (16·3) years and 53% were male. Compared to pre-index year, AIT was consistently associated with greater reductions compared to control subjects in AR and asthma prescriptions, including both asthma controller and reliever prescriptions. Additionally, the AIT group had significantly greater likelihood of stepping down asthma treatment (P <0·0001). In addition to the reduction in asthma treatment in the AIT group, a greater reduction in severe asthma exacerbations was demonstrated (P<0·05). Reductions in pneumonia with antibiotic prescriptions, hospitalisations, and duration of inpatients stays were all in favour of AIT. Interpretation The study extends the existing RCT evidence for AIT by demonstrating longer-term and sustained effectiveness of AIT in the real world. Additionally, in patients with concurrent asthma, AIT was associated with reduced likelihood of asthma exacerbations and pneumonia. Funding The study was funded by ALK A/S.
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Key Words
- AIT, allergy immunotherapy
- AR, allergic rhinitis
- Allergic rhinitis
- Allergy
- Allergy immunotherapy
- Asthma
- Effectiveness
- FU, follow-up
- HDM, house dust mite
- HRU, health care resource utilisation
- ICS, inhaled corticosteroids
- INCS, intranasal corticosteroids
- LABA, long-acting beta2-agonists
- PSM, propensity score matching
- RCT, randomised clinical trial
- RWE, real world evidence
- Real-world evidence
- Retrospective cohort study
- Rx, prescription
- SABA, short-acting beta2-agonists
- SCIT, subcutaneous immunotherapy
- SLIT, sublingual immunotherapy
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Affiliation(s)
- Benedikt Fritzsching
- Paediatric Pulmonology and Allergy, Children's Doctor Service, Heidelberg and University of Heidelberg, Germany
| | - Marco Contoli
- Respiratory Section, Department of Translational Medicine, University of Ferrara, Italy
| | - Celeste Porsbjerg
- Department of Respiratory Medicine, Bispebjerg Hospital, University of Copenhagen, Denmark
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Elliott L, Coulman K, Blencowe NS, Qureshi MI, Lee KS, Hinchliffe RJ, Mouton R. A systematic review of reporting quality for anaesthetic interventions in randomised controlled trials. Anaesthesia 2020; 76:832-836. [PMID: 33150618 PMCID: PMC8246731 DOI: 10.1111/anae.15294] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 12/31/2022]
Abstract
Interventions from randomised controlled trials can only be replicated if they are reported in sufficient detail. The results of trials can only be confidently interpreted if the delivery of the intervention was systematic and the protocol adhered to. We systematically reviewed trials of anaesthetic interventions published in 12 journals from January 2016 to September 2019. We assessed the detail with which interventions were reported, using the Consolidated Standards of Reporting Trials statement for non‐pharmacological treatments. We analysed 162 interventions reported by 78 trials in 18,675 participants. Detail sufficiently precise to replicate the intervention was reported for 111 (69%) interventions. Intervention standardisation was reported for 135 (83%) out of the 162 interventions, and protocol adherence was reported for 20 (12%) interventions. Sixty (77%) out of the 78 trials reported the administrative context in which interventions were delivered and 36 (46%) trials detailed the expertise of the practitioners. We conclude that bespoke reporting tools should be developed for anaesthetic interventions and interventions in other areas such as critical care.
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Affiliation(s)
- L Elliott
- Department of Anaesthesia, Bristol Centre for Surgical Research, Bristol, UK
| | - K Coulman
- Department of Vascular Surgery, Bristol Centre for Surgical Research, Bristol, UK
| | - N S Blencowe
- Department of Vascular Surgery, Bristol Centre for Surgical Research, Bristol, UK
| | - M I Qureshi
- Department of Vascular Surgery, Bristol Centre for Surgical Research, Bristol, UK
| | - K S Lee
- Bristol Centre for Surgical Research, Bristol, UK
| | | | - R Mouton
- North Bristol NHS Trust, Bristol, UK
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Morley RL, Elliott L, Rees J, Rudd S, Mouton R, Hinchliffe RJ. Scoping review of mode of anaesthesia in emergency surgery. Br J Surg 2020; 107:e17-e25. [PMID: 31903585 DOI: 10.1002/bjs.11424] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/03/2019] [Accepted: 10/10/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Emergency surgery encompasses more than 50 per cent of the surgical workload; however, research efforts are disproportionally low. The mode of anaesthesia used during emergency surgery may affect outcomes, but the extent of research and the impact of the different modes of anaesthesia used are unclear. METHODS MEDLINE and Embase were searched using scoping review methodology with a rapid systematic search strategy, identifying any study comparing locoregional (local, nerve block, subarachnoid, epidural) anaesthesia with general anaesthesia. All studies describing outcomes of emergency surgery with differing modes of anaesthesia were identified. Excluded were: studies published before 2003, studies enrolling patients aged less than 18 years and studies using sedation only. RESULTS Forty-two studies were identified, describing 11 surgical procedures. Most publications were retrospective cohort studies (32). A very broad range of clinical and patient-reported outcomes were described, with wide variation in the outcomes reported in different studies. CONCLUSION Reporting of mode of anaesthesia is inconsistent across different procedures and is often absent. There is a need for directed research efforts to improve the reporting standards of anaesthesia interventions, to understand the role of different modes of anaesthesia in specific emergency surgical procedures, and to standardize outcome reporting using core outcome sets.
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Affiliation(s)
- R L Morley
- Centre for Surgical Research, University of Bristol, Bristol, UK.,Vascular Surgery, Bristol, UK
| | - L Elliott
- Centre for Surgical Research, University of Bristol, Bristol, UK.,General Surgery, University Hospital Bristol NHS Foundation Trust, Bristol, UK
| | - J Rees
- Centre for Surgical Research, University of Bristol, Bristol, UK.,General Surgery, University Hospital Bristol NHS Foundation Trust, Bristol, UK
| | - S Rudd
- Library and Knowledge Service, Bristol, UK
| | - R Mouton
- Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - R J Hinchliffe
- Centre for Surgical Research, University of Bristol, Bristol, UK.,Vascular Surgery, Bristol, UK
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Toth B, Morley W, Elliott L, Li R. Involving patients’ relatives and ward staff in prompting of bedside exercises is well received. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.166] [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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Armstrong RA, Wilson C, Elliott L, Fielding CA, Rogers CA, Caskey FJ, Hinchliffe RJ, Mouton R, Rooshenas L. Regional anaesthesia practice for arteriovenous fistula formation surgery. Anaesthesia 2020; 75:626-633. [PMID: 32030735 PMCID: PMC7187449 DOI: 10.1111/anae.14983] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 01/01/2023]
Abstract
We conducted a survey and semi‐structured qualitative interviews to investigate current anaesthetic practice for arteriovenous fistula formation surgery in the UK. Responses were received from 39 out of 59 vascular centres where arteriovenous access surgery is performed, a response rate of 66%. Thirty‐five centres reported routine use of brachial plexus blocks, but variation in anaesthetic skill‐mix and practice were observed. Interviews were conducted with 19 clinicians from 10 NHS Trusts including anaesthetists, vascular access and renal nurses, surgeons and nephrologists. Thematic analysis identified five key findings: (1) current anaesthetic practice showed that centres could be classified as ‘regional anaesthesia dominant’ or ‘local anaesthesia/mixed’; (2) decision making around mode of anaesthesia highlighted the key role of surgeons as frontline decision makers across both centre types; (3) perceived barriers and facilitators of regional block use included clinicians’ beliefs and preferences, resource considerations and patients’ treatment preferences; (4) anaesthetists’ preference for supraclavicular blocks emerged, alongside acknowledgement of varied practice; (5) there was widespread support for a future randomised controlled trial, although clinician equipoise issues and logistical/resource‐related concerns were viewed as potential challenges. The use of regional anaesthesia for arteriovenous fistula formation in the UK is varied and influenced by a multitude of factors. Despite the availability of anaesthetists capable of performing regional blocks, there are other limiting factors that influence the routine use of this technique. The study also highlighted the perceived need for a large multicentre, randomised controlled trial to provide an evidence base to inform current practice.
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Affiliation(s)
| | - C Wilson
- Population Health Sciences, University of Bristol, Bristol, UK
| | - L Elliott
- Bristol Centre for Surgical Research, University of Bristol, Bristol, UK
| | - C A Fielding
- Trainee Advanced Clinical Practitioner, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - C A Rogers
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - F J Caskey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - R J Hinchliffe
- Bristol Centre for Surgical Research, University of Bristol, Bristol, UK
| | - R Mouton
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - L Rooshenas
- Population Health Sciences, University of Bristol, Bristol, UK
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Romano M, James S, Farrington E, Perry R, Elliott L. Correction to: The impact of perennial allergic rhinitis with/without allergic asthma on sleep, work and activity level. Allergy Asthma Clin Immunol 2020; 16:12. [PMID: 32042287 PMCID: PMC7001264 DOI: 10.1186/s13223-020-0408-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Morris JL, Letson HL, Elliott L, Grant AL, Wilkinson M, Hazratwala K, McEwen P. Evaluation of bacteriophage as an adjunct therapy for treatment of peri-prosthetic joint infection caused by Staphylococcus aureus. PLoS One 2019; 14:e0226574. [PMID: 31877146 PMCID: PMC6932802 DOI: 10.1371/journal.pone.0226574] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/28/2019] [Indexed: 12/11/2022] Open
Abstract
Phage therapy offers a potential alternate strategy for the treatment of peri-prosthetic joint infection (PJI), particularly where limited effective antibiotics are available. We undertook preclinical trials to investigate the therapeutic efficacy of a phage cocktail, alone and in combination with vancomycin, to reduce bacterial numbers within the infected joint using a clinically-relevant model of Staphylococcus aureus-induced PJI. Infected animals were randomised to 4 treatment groups, with treatment commencing 21-days post-surgery: bacteriophage alone, vancomycin alone, bacteriophage and vancomycin, and sham. At day 28 post-surgery, animals were euthanised for microbiological and immunological assessment of implanted joints. Treatment with phage alone or vancomycin alone, led to 5-fold and 6.2-fold reductions, respectively in bacterial load within peri-implant tissue compared to sham-treated animals. Compared to sham-treated animals, a 22.5-fold reduction in S. aureus burden was observed within joint tissue of animals that were administered phage in combination with vancomycin, corresponding with decreased swelling in the implanted knee. Microbiological data were supported by evidence of decreased inflammation within the joints of animals administered phage in combination with vancomycin, compared to sham-treated animals. Our findings provide further support for phage therapy as a tolerable and effective adjunct treatment for PJI.
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Affiliation(s)
- Jodie L. Morris
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Hayley L. Letson
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Lisa Elliott
- AusPhage Pty Ltd, Townsville, Queensland, Australia
| | - Andrea L. Grant
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Matthew Wilkinson
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Kaushik Hazratwala
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Peter McEwen
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
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Tesch F, Sydendal Grand T, Wuestenberg E, Elliott L, Schmitt J, Kuster D. Healthcare costs associated with allergic rhinitis, asthma allergy immunotherapy. Eur Ann Allergy Clin Immunol 2019; 52:164-174. [PMID: 31818082 DOI: 10.23822/eurannaci.1764-1489.126] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Allergic rhinitis (AR) and asthma are chronic diseases in which the airways become inflamed in response to allergens. Allergy immunotherapy (AIT) is recommended for those unable to manage symptoms using pharmacotherapy. This study estimated healthcare costs and utilisation for patients with AR and asthma. Mean annual outpatient visits, pharmaceutical costs and inpatient hospitalisations were calculated for 2010 and 2014, with pharmaceutical and inpatient costs stratified by AIT use. AR and asthma patients had a 35% higher mean number of physician visits and up to 90% higher mean pharmaceutical costs compared to controls. The cost of pharmaceuticals and inpatient hospitalisations were 54% lower in those prescribed AIT. Further research is recommended to understand the reasons for these cost differences.
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Affiliation(s)
- F Tesch
- TU Dresden, Center for Evidence-based Healthcare, Dresden, Germany
| | | | | | | | - J Schmitt
- TU Dresden, Center for Evidence-based Healthcare, Dresden, Germany
| | - D Kuster
- TU Dresden, Center for Evidence-based Healthcare, Dresden, Germany
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Romano M, James S, Farrington E, Perry R, Elliott L. The impact of perennial allergic rhinitis with/without allergic asthma on sleep, work and activity level. Allergy Asthma Clin Immunol 2019; 15:81. [PMID: 31827545 PMCID: PMC6896721 DOI: 10.1186/s13223-019-0391-9] [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] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/14/2019] [Indexed: 11/10/2022] Open
Abstract
Background Allergic respiratory diseases such as allergic rhinitis (AR) and allergic asthma (AA) are common conditions that can influence sleep and daytime functioning. However, the significance of this impact is unclear—particularly in perennial allergy sufferers. This study investigates the impact of perennial allergy on sleep, daily activities and productivity. Methods Adults with self-reported or physician-diagnosed perennial AR aged ≥ 18 years were recruited in Denmark, France, Germany and Sweden. Allergy sufferers were identified using online panels closely matching national population characteristics for each country. Impact on sleep, work, productivity and activity (by the Work, Productivity and Activity Index) were analysed. Descriptive analyses were conducted. Results In total, 511 subjects with perennial AR (47.4% also with seasonal allergy) completed the survey. Most subjects (77.5%) had a physician-diagnosis of AR; 46.4% were diagnosed with both AA and AR. Most subjects (65.2%) reported sensitisation to house dust mites. Of all subjects, 66.0% reported sleep problems. Subjects with sleep problems woke, on average, 3.8 times per night, with 92.0% taking 15+ min to fall asleep (22.2% took 60+ min). Upon waking at night, 40.8% struggled to get back to sleep, and 69.2% had difficulties waking in the morning due to tiredness. Disturbances in daily functioning due to sleep issues were reported in 85.5–95.0% of subjects with sleep problems across all aspects investigated. Overall work and activity impairment were 53.3% and 47.1%, respectively. Sleep issues were more frequent (78.1% vs 54.7%) in those diagnosed with both AR and AA compared to AR alone, and more burdensome, with a greater impact on daily functioning (47.0% vs 33.3%) and impairment in work and activity (62.0% and 54.9% vs 39.3% and 35.2%, respectively). Of all subjects, 20.5% were receiving AIT at the time of the survey; of these, 36.4% reported moderate or great improvement in sleep due to allergy treatment. Conclusions In perennial AR sufferers, sleep problems are common and impact on daily functioning, with results indicating a greater burden in those with both AR and AA compared to AR alone.
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16
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Domdey A, Njue A, Nuabor W, Lyall M, Heyes A, Elliott L. Allergy immunotherapies for allergic rhinitis: systematic review and assessment of evolving quality. Eur Ann Allergy Clin Immunol 2019; 51:147-158. [PMID: 31187972 DOI: 10.23822/eurannaci.1764-1489.100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Background. Heterogeneity in the design and quality of trials evaluating allergy immunotherapies (AITs) limits their comparability, making it difficult for physicians, patients, and payers to select the best treatment option. Methods. This systematic review evaluated the quality of randomised controlled trials (RCTs) of registered grass AITs using the National Institute of Health and Care Excellence checklist. Results. 17 of 44 unique RCTs (38.6%) (sample size range: 18-1,501 subjects) were subcutaneous grass immunotherapy trials and 27 (61.4%) were sublingual grass immunotherapy trials (Allergovit, 5 trials; Alutard, 8; Grazax, 13; Oralair, 6; Staloral, 8; Pollinex, 2; Phostal and Purethal, 1 each). Three trials (6.8%; all Grazax) fulfilled every quality criterion. Quality assessments revealed inconsistencies in study quality and reporting. Study quality trended towards improvement over time, particularly after 2009. Conclusions. When as-sessing grass AIT, it is important to focus not only on endpoints but also on the quality of evidence.
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Affiliation(s)
- A Domdey
- ALK-Abelló, Hørsholm, Denmark.,Current affiliation, Lundbeck A/S, Copenhagen, Denmark
| | - A Njue
- RTI Health Solutions, Manchester, United Kingdom
| | - W Nuabor
- RTI Health Solutions, Manchester, United Kingdom
| | - M Lyall
- RTI Health Solutions, Manchester, United Kingdom
| | - A Heyes
- RTI Health Solutions, Manchester, United Kingdom
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17
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Lv G, Li Z, Elliott L, Schmidt MJ, MacWilliams MP, Zhang B. Impact of tetracycline-clay interactions on bacterial growth. J Hazard Mater 2019; 370:91-97. [PMID: 28954700 DOI: 10.1016/j.jhazmat.2017.09.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 08/24/2017] [Accepted: 09/16/2017] [Indexed: 06/07/2023]
Abstract
Antibiotics are extremely effective against bacterial infections due to their selective toxicity for bacteria rather than the host. Extensive use and misuse of antibiotics resulted in significant increases in antibiotic levels in aquatic and soil environments. Bacteria exposed to antibiotics with low concentrations may develop antibiotic resistance. In this study a swelling 2:1 clay mineral montmorillonite (MMT) and a non-swelling 1:1 clay mineral kaolinite were premixed with tetracycline (TC) of varying concentrations. The gram-negative bacteria Escherichia coli (E. coli) and Salmonella enterica (S. enterica) of both TC sensitive and TC resistant strains were tested for their growth in the presence TC-loaded clay minerals of different amounts and under different physico-chemical conditions. The antimicrobial activity of TC was significantly decreased in the presence of MMT. In the absence of MMT, no bacteria growth was found at a TC concentration 0.25mg/mL and above. On the contrast, in the presence of MMT, 50% growth was still found for a TC resistant E. coli at a TC concentration of 5mg/g. The influence of kaolinite was to a lesser degree. These results suggest that antimicrobial agents present in clayey soils could be responsible for possible mutation of bacteria of high antibiotic resistance.
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Affiliation(s)
- Guocheng Lv
- Beijing Key Laboratory of Materials Utilization of Nonmetallic Minerals and Solid Wastes, National Laboratory of Mineral Materials, School of Materials Science and Technology, China University of Geosciences, Beijing 100083, China
| | - Zhaohui Li
- Beijing Key Laboratory of Materials Utilization of Nonmetallic Minerals and Solid Wastes, National Laboratory of Mineral Materials, School of Materials Science and Technology, China University of Geosciences, Beijing 100083, China; Department of Geosciences, University of Wisconsin - Parkside, Kenosha, WI 53141-2000, USA.
| | - Lisa Elliott
- Department of Biological Sciences, University of Wisconsin - Parkside, Kenosha, WI 53141-2000, USA
| | - Monica J Schmidt
- Department of Biological Sciences, University of Wisconsin - Parkside, Kenosha, WI 53141-2000, USA
| | - Maria P MacWilliams
- Department of Biological Sciences, University of Wisconsin - Parkside, Kenosha, WI 53141-2000, USA
| | - Baogang Zhang
- School of Water Resources and Environment, China University of Geosciences Beijing, Key Laboratory of Groundwater Circulation and Evolution (China University of Geosciences Beijing), Ministry of Education, Beijing 100083, China.
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18
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Ahasan MS, Kinobe R, Elliott L, Owens L, Scott J, Picard J, Huerlimann R, Ariel E. Bacteriophage versus antibiotic therapy on gut bacterial communities of juvenile green turtle, Chelonia mydas. Environ Microbiol 2019; 21:2871-2885. [PMID: 31037801 DOI: 10.1111/1462-2920.14644] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 04/24/2019] [Accepted: 04/27/2019] [Indexed: 12/13/2022]
Abstract
Green turtles are endangered marine herbivorous hindgut fermenters that contribute to a variety of marine ecosystems. Debilitated turtles are often rehabilitated in turtle hospitals. Since accurate diagnosis of disease is difficult, broad-spectrum antibiotics are routinely used as a general treatment, potentially causing collateral damage to the gut microbiome of the patient. Here, we evaluated the concept of the application of bacteriophage (phages) to eliminate targeted intestinal bacteria as an alternative to a broad-spectrum antibiotic (enrofloxacin) in clinically healthy, captive green turtles. Additionally, the impact of a broad-spectrum antibiotic (enrofloxacin) and phage therapy on the gut bacterial communities of green turtles was evaluated. Gut bacterial communities in faecal samples were analysed by sequencing the V1-V3 regions of the bacterial 16S rRNA. Bacteria-specific phage cocktails significantly (P < 0.05) reduced targeted Acinetobacter in phage-treated turtles during the therapy. Compared to control, no significant difference was observed in the bacterial diversity and compositions in phage-treated turtles. In contrast, bacterial diversity was significantly (P < 0.05) reduced in antibiotic-treated turtles at day 15 and throughout the trial. The alteration in the bacterial microbiota of antibiotic-treated turtles was largely due to an increase in abundance of Gram-positive Firmicutes and a concurrent decrease in Gram-negative Bacteroidetes, Proteobacteria and Verrucomicrobia. Additionally, we observed the relative abundance of several bacteria at lower taxonomic level was much less affected by phages than by antibiotics. These data offer the proof of concept of phage therapy to manipulate transient as well as indigenous bacterial flora in gut-related dysbiosis of turtles.
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Affiliation(s)
- Md Shamim Ahasan
- College of Public Health, Medical, and Veterinary Sciences, James Cook University, Townsville, Queensland, 4811, Australia.,Department of Infectious Diseases and Immunology, College of Veterinary Medicine, University of Florida, Gainesville, FL, 32608, USA
| | - Robert Kinobe
- College of Public Health, Medical, and Veterinary Sciences, James Cook University, Townsville, Queensland, 4811, Australia
| | - Lisa Elliott
- AusPhage, 10 Heather Avenue, Rasmussen, Queensland, 4811, Australia
| | - Leigh Owens
- College of Public Health, Medical, and Veterinary Sciences, James Cook University, Townsville, Queensland, 4811, Australia
| | - Jenni Scott
- College of Public Health, Medical, and Veterinary Sciences, James Cook University, Townsville, Queensland, 4811, Australia
| | - Jacqueline Picard
- College of Public Health, Medical, and Veterinary Sciences, James Cook University, Townsville, Queensland, 4811, Australia
| | - Roger Huerlimann
- Centre for Sustainable Tropical Fisheries and Aquaculture, James Cook University, Townsville, Queensland, 4811, Australia
| | - Ellen Ariel
- College of Public Health, Medical, and Veterinary Sciences, James Cook University, Townsville, Queensland, 4811, Australia
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19
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Seddon JL, Wadd S, Wells E, Elliott L, Madoc-Jones I, Breslin J. Drink wise, age well; reducing alcohol related harm among people over 50: a study protocol. BMC Public Health 2019; 19:240. [PMID: 30819125 PMCID: PMC6394010 DOI: 10.1186/s12889-019-6525-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/08/2019] [Indexed: 11/20/2022] Open
Abstract
Background Evidence suggests that the use of alcohol among older adults (defined as those aged 50+) has increased in recent years, with people aged 55–64 now more likely to exceed the recommended weekly guidelines than any other age group. Methods/ design This is a quasi-experimental study with a before-after design. A postal questionnaire will be sent to 76,000 people aged 50 and over registered with a general practice in five different ‘demonstration’ (intervention) and control areas in the UK. Multiple interventions will then be delivered in demonstration areas across the UK. At the end of the programme, a postal questionnaire will be sent to the same individuals who completed it pre-programme to establish if there has been a reduction in alcohol use, at-risk drinking and alcohol related problems. Qualitative interviews with clients and staff will explore how the interventions were experienced; how they may work to bring about change and to identify areas for practice improvements. Discussion This study protocol describes a multi-level, multi-intervention prevention-to-treatment programme which aims to reduce alcohol-related harm in people aged 50 and over.
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Affiliation(s)
- J L Seddon
- Substance Misuse and Ageing Research Team, Tilda Goldberg Centre for Social Work and Social Care, University of Bedfordshire, Park Square, Luton, Bedfordshire, LU1 3NJ, UK.
| | - S Wadd
- Substance Misuse and Ageing Research Team, Tilda Goldberg Centre for Social Work and Social Care, University of Bedfordshire, Park Square, Luton, Bedfordshire, LU1 3NJ, UK
| | - E Wells
- Drink Wise, Age Well Programme, Furnival House, 48 Furnival Gate, Sheffield, S1 4QP, UK
| | - L Elliott
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, UK
| | | | - J Breslin
- Drink Wise, Age Well Programme, 34 Argyll Arcade, Buchanan Street, Glasgow, G2 8BD, UK
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20
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Morris J, Kelly N, Elliott L, Grant A, Wilkinson M, Hazratwala K, McEwen P. Evaluation of Bacteriophage Anti-Biofilm Activity for Potential Control of Orthopedic Implant-Related Infections Caused byStaphylococcus aureus. Surg Infect (Larchmt) 2019; 20:16-24. [DOI: 10.1089/sur.2018.135] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Jodie Morris
- Orthopaedic Research Institute of Queensland, Townsville, Australia
- College of Medicine, Division of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Natasha Kelly
- College of Public Health Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | | | - Andrea Grant
- Orthopaedic Research Institute of Queensland, Townsville, Australia
| | | | | | - Peter McEwen
- Orthopaedic Research Institute of Queensland, Townsville, Australia
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21
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Lim A, Butt ML, Dix J, Elliott L, Paes B. Respiratory syncytial virus (RSV) infection in children with medical complexity. Eur J Clin Microbiol Infect Dis 2018; 38:171-176. [PMID: 30374685 DOI: 10.1007/s10096-018-3409-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
Abstract
Children with medical complexity (CMC) are vulnerable to respiratory illness hospitalization (RIH) and respiratory syncytial virus (RSV)-related hospitalization (RSVH) due to multisystem disorders and compromised airways. It is unknown whether RSV prophylaxis is effective, or if RSVH is associated with significant morbidities in CMC. The study objectives were to (1) determine the incidence of RSV-related infection in prophylaxed CMC during the first 3 years of life and (2) assess the burden of illness following RSVH. A single tertiary center, retrospective study, was conducted of CMC who received palivizumab during the 2012-2016 RSV seasons. Fifty-four subjects were enrolled; most received one (38.9%, n = 21) or two (57.4%, n = 31) seasons of prophylaxis (mean = 4.2 [SD = 1.24], palivizumab doses per season). The cohort comprised children with multiple medical conditions (n = 22, 40.8%), tracheostomy (n = 18, 33.3%), and invasive (n = 10, 18.5%) or non-invasive (n = 4, 7.4%) ventilation. Of the CMC, 24 were hospitalized 47 times for a viral-related respiratory illness. RSV incidence in the first 3 years of life was 7.4%. Viral-related RIH and RSVH rates were 44.4% (n = 24/54) and 1.9% (n = 1/54), respectively. Of the four RSV-positive children, one was ventilated for 9 days, two acquired nosocomial RSV that was managed on the ward, and one was discharged home under close complex care supervision. All four RSV-positive cases required additional oxygen during their illness. CMC experience a high viral-related RIH rate and palivizumab likely minimizes RSV-related events and associated morbidities. The efficacy of palivizumab in CMC, especially in those ≤ 3 years, should be prospectively evaluated.
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Affiliation(s)
- A Lim
- Department of Pediatrics, McMaster University, HSC-3A, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - M L Butt
- Department of Pediatrics, McMaster University, HSC-3A, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.,School of Nursing, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - J Dix
- McMaster Children's Hospital, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - L Elliott
- McMaster Children's Hospital, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - B Paes
- Department of Pediatrics, McMaster University, HSC-3A, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
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22
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Walsh G, Curley S, Costello A, Elliott L, Ryan E, Blanco A, Kolch W, Eissner G. PO-311 Characterisation of colorectal tumour endothelial cells. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.824] [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: 11/04/2022] Open
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23
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Hutchison SL, Flanagan JV, Karpov I, Elliott L, Holsinger B, Edwards J, Loveland D. Care Management Intervention to Decrease Psychiatric and Substance Use Disorder Readmissions in Medicaid-Enrolled Adults. J Behav Health Serv Res 2018; 46:533-543. [DOI: 10.1007/s11414-018-9614-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Aronson R, Galstyan G, Goldfracht M, Al Sifri S, Elliott L, Khunti K. Direct and indirect health economic impact of hypoglycaemia in a global population of patients with insulin-treated diabetes. Diabetes Res Clin Pract 2018; 138:35-43. [PMID: 29355651 DOI: 10.1016/j.diabres.2018.01.007] [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: 06/08/2017] [Revised: 12/13/2017] [Accepted: 01/09/2018] [Indexed: 01/04/2023]
Abstract
AIMS The Hypoglycaemia Assessment Tool (HAT) study investigated the health economic impact of hypoglycaemic events in 24 countries, including countries without previously published data on hypoglycaemia. METHODS Self-assessment questionnaires and patient diaries (4-week prospective period) were completed by adults with type 1 (T1D) or type 2 diabetes (T2D) treated with insulin for more than 12 months (N = 27,585). RESULTS Direct economic impacts of hypoglycaemia during the 4-week prospective period, included increased blood glucose monitoring (reported by 69.7% [T1D] and 60.9% [T2D] of patients), hospitalisation (T1D 2.1%; T2D 3.4% of patients) and medical contact (clinic or telephone; T1D 3.8%; T2D 6.8% of patients). Regional variation in medical contact and hospitalisation was found, with the highest usage in Russia (T1D 17.1%; T2D 17.3%), and Latin America (T1D 5.2%; T2D 6.8%) respectively. Indirect economic impacts following hypoglycaemia included loss of productivity due to absence from work or study; 3.9% (T1D) and 6.2% (T2D) of patients. Regional differences in work productivity were noted among patients with T2D, with a low prevalence in Northern Europe and Canada (0.9%) and high in Southeast Asia (14.6%). CONCLUSIONS This study shows that hypoglycaemia has a significant but variable impact on the economics of diabetes healthcare globally.
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Affiliation(s)
| | - Gagik Galstyan
- Endocrinology Research Center, Moscow, Russian Federation
| | | | | | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
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25
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Abstract
The Canadian First Nations population is disproportionately burdened by diabetes and diabetes complications. Body weight management is purported to be important in the prevention and management of diabetes. In this study, we sought to describe weight change in a First Nation cohort according to diabetes status and management. Study data were from two diabetes screening studies in Sandy Bay First Nation in Manitoba, Canada, collected in 2002/2003 (baseline) and 2011/2012 (follow-up). The cohort was composed of respondents to both screening studies (n=171). Fasting blood samples, anthropometric, health and demographic data were collected. At baseline, 24.8% (n=41) of the cohort members had diabetes. At follow-up, an additional 20.6% (n=34) developed diabetes. Among all participants with diabetes (long-term and incident cases), 66.6% lost weight between the two study periods. Among only participants with long-term diabetes (>8 years), 31.7% lost >10 kg. HbA1c at baseline, positive change in HbA1c over time, and use of metformin were significantly associated with weight loss ≥5%, independent of age, sex, and BMI at baseline. Further research is needed to better understand if and how diabetes-related weight loss contributes to morbidity and mortality in this First Nation population.
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Affiliation(s)
- N D Riediger
- a Department of Community Health Sciences, Rady Faculty of Health Sciences , University of Manitoba , Winnipeg , Manitoba , Canada.,b Ongomiizwin - Research, Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences , University of Manitoba , Winnipeg , Manitoba , Canada.,c Department of Human Nutritional Sciences, Faculty of Agriculture and Food Sciences , University of Manitoba , Winnipeg , Manitoba , Canada
| | - V Lukianchuk
- d Sandy Bay First Nation Health Centre , Sandy Bay Ojibway First Nation , Manitoba , Canada
| | - J Roulette
- d Sandy Bay First Nation Health Centre , Sandy Bay Ojibway First Nation , Manitoba , Canada
| | - L M Lix
- a Department of Community Health Sciences, Rady Faculty of Health Sciences , University of Manitoba , Winnipeg , Manitoba , Canada.,e Centre for Healthcare Innovation , University of Manitoba , Winnipeg , Manitoba , Canada
| | - L Elliott
- a Department of Community Health Sciences, Rady Faculty of Health Sciences , University of Manitoba , Winnipeg , Manitoba , Canada
| | - S G Bruce
- a Department of Community Health Sciences, Rady Faculty of Health Sciences , University of Manitoba , Winnipeg , Manitoba , Canada
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26
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Ahasan MS, Picard J, Elliott L, Kinobe R, Owens L, Ariel E. Evidence of antibiotic resistance in Enterobacteriales isolated from green sea turtles, Chelonia mydas on the Great Barrier Reef. Mar Pollut Bull 2017; 120:18-27. [PMID: 28476351 DOI: 10.1016/j.marpolbul.2017.04.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 05/20/2023]
Abstract
This study investigated Enterobacteriales and their antimicrobial resistance in green sea turtles captured adjacent to the central Great Barrier Reef (GBR) and proximate to urban development. Cloacal swabs were taken from 73 green turtles between 2015 and 2016. A total of 154 out of 341 Gram-negative bacterial isolates were identified as Enterobacteriales that represent 16 different species from 9 different genera. The dominant isolates were Citrobacter (30.52%), Edwardsiella (21.43%) and Escherichia (12.34%). The resistance against 12 antibiotics belonging to 6 different classes was determined. The isolates showed highest resistance to β-lactam antibiotics (78.57%) followed by quinolone (50%) and tetracycline classes (46.1%). Approximately one-third (37.7%) of the isolates identified exhibited multidrug-resistance. Isolates recovered from rehabilitated turtles were significantly multidrug resistant (p<0.009) compared to isolates from other study sites. These results provide baseline information on antimicrobial resistance while revealing gaps for further research to evaluate the level of pollution in the GBR.
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Affiliation(s)
- Md Shamim Ahasan
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Quensland, Australia.
| | - Jacqueline Picard
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Quensland, Australia
| | - Lisa Elliott
- AusPhage, 10 Heather Avenue, Rasmussen, Queensland, 4811, Australia
| | - Robert Kinobe
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Quensland, Australia
| | - Leigh Owens
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Quensland, Australia
| | - Ellen Ariel
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Quensland, Australia
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27
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Wadd S, Breslin J, McDougall G, Elliott L, Madoc-Jones I, Whittaker A, Donnelly M. DRINK WISE AGE WELL: A UK-WIDE MULTILEVEL PROGRAMME TO REDUCE ALCOHOL-RELATED HARM IN OLDER ADULTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S. Wadd
- University of Bedfordshire, Luton, Bedfordshire, United Kingdom,
| | | | - G. McDougall
- University of Bedfordshire, Luton, Bedfordshire, United Kingdom,
| | - L. Elliott
- Glasgow Caledonian University, Glasgow, United Kingdom,
| | | | - A. Whittaker
- Edinburgh Napier University, Edinburgh, United Kingdom,
| | - M. Donnelly
- Queen’s University Belfast, Belfast, United Kingdom
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28
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Clark D, King A, Sharpe K, Connelly G, Elliott L, Macpherson LMD, McMahon AD, Milligan I, Wilson P, Conway DI, Wood R. Linking routinely collected social work, education and health data to enable monitoring of the health and health care of school-aged children in state care ('looked after children') in Scotland: a national demonstration project. Public Health 2017; 150:101-111. [PMID: 28666173 DOI: 10.1016/j.puhe.2017.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/26/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Children in state care ('looked after children') have poorer health than children who are not looked after. Recent developments in Scotland and elsewhere have aimed to improve services and outcomes for looked after children. Routine monitoring of the health outcomes of looked after children compared to those of their non-looked after peers is currently lacking. Developing capacity for comparative monitoring of population-based outcomes based on linkage of routinely collected administrative data has been identified as a priority. To our knowledge there are no existing population-based data linkage studies providing data on the health of looked after and non-looked after children at national level. Smaller scale studies that are available generally provide very limited information on linkage methods and hence do not allow scrutiny of bias that may be introduced through the linkage process. STUDY DESIGN AND METHODS National demonstration project testing the feasibility of linking routinely collected looked after children, education and health data. PARTICIPANTS All children in publicly funded school in Scotland in 2011/12. RESULTS Linkage between looked after children data and the national pupil census classified 10,009 (1.5%) and 1757 (0.3%) of 670,952 children as, respectively, currently and previously looked after. Recording of the unique pupil identifier (Scottish Candidate Number, SCN) on looked after children returns is incomplete, with 66% of looked after records for 2011/12 for children of possible school age containing a valid SCN. This will have resulted in some under-ascertainment of currently and, particularly, previously looked after children within the general pupil population. Further linkage of the pupil census to the National Health Service Scotland master patient index demonstrated that a safe link to the child's unique health service (Community Health Index) number could be obtained for a very high proportion of children in each group (94%, 95% and 95% of children classified as currently, previously, and non-looked after, respectively). In general, linkage rates were higher for older children and those living in more affluent areas. Within the looked after group, linkage rates were highest for children with the fewest placements and for those in permanent fostering. CONCLUSIONS This novel data linkage demonstrates the feasibility of monitoring population-based health outcomes of school-aged looked after and non-looked after children using linked routine administrative data. Improved recording of the unique pupil identifier number on looked after data returns would be beneficial. Extending the range of personal identifiers on looked after children returns would enable linkage to health data for looked after children who are not in publicly funded schooling (i.e. those who are preschool or postschool, home schooled or in independent schooling).
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Affiliation(s)
- D Clark
- Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, UK.
| | - A King
- Education Analytical Services Division, Scottish Government, Victoria Quay, Edinburgh, EH6 6QQ, UK.
| | - K Sharpe
- School of Medicine, Dentistry, and Nursing, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.
| | - G Connelly
- CELSIS (Centre for Excellence for Looked After Children in Scotland), University of Strathclyde, Curran Building, 94 Cathedral Street, Glasgow, G4 0LT, UK.
| | - L Elliott
- Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road Glasgow, G4 OBA, UK.
| | - L M D Macpherson
- School of Medicine, Dentistry, and Nursing, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.
| | - A D McMahon
- School of Medicine, Dentistry, and Nursing, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.
| | - I Milligan
- CELSIS (Centre for Excellence for Looked After Children in Scotland), University of Strathclyde, Curran Building, 94 Cathedral Street, Glasgow, G4 0LT, UK.
| | - P Wilson
- Centre for Rural Health, University of Aberdeen, Old Perth Road, Inverness, IV2 3JH, UK.
| | - D I Conway
- Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, UK; School of Medicine, Dentistry, and Nursing, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.
| | - R Wood
- Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, UK; Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.
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Lavigne SE, Doupe MB, Iacopino AM, Mahmud S, Elliott L. The effects of power toothbrushing on periodontal inflammation in a Canadian nursing home population: A randomized controlled trial. Int J Dent Hyg 2017; 15:328-334. [PMID: 28105737 DOI: 10.1111/idh.12268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to investigate whether twice-daily use of a rotating-oscillating power toothbrush (Oral-B Professional Care 1000™ ) in nursing home (NH) residents over a 6-week period, compared to usual care (UC), would reduce periodontal inflammation. METHODS In this repeated measures single-blinded randomized controlled trial, 59 residents of one NH in Winnipeg, Canada, were randomized to receive either twice-daily tooth brushing with a rotating-oscillating power toothbrush (PB) or UC by caregivers. Consent was obtained from residents or their proxies. Participants had some natural teeth, periodontal inflammation, non-aggressive behaviour, no communicable diseases, were non-smokers and non-comatose. Outcomes were measured at baseline and 6 weeks, which included: inflammation (MGI, Lobene), bleeding (PBI, Loesche) and Plaque (Turesky). Comparisons of group changes in outcomes were analysed using an ANOVA with a repeated measure. RESULTS Of 59 original study participants, one withdrew, one died prior to study commencement and three died before study completion. All oral parameters improved significantly for the remaining 54 residents over time (P<.0001), with no differences between groups. CONCLUSIONS These results demonstrate that it is possible for caregivers to improve periodontal inflammation of residents over a 6-week period. Despite no significant group differences, periodontal inflammation of all study participants improved significantly, particularly in the reduction of bleeding, a direct measure of periodontal inflammation, which is a unique finding.
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Affiliation(s)
- S E Lavigne
- School of Dental Hygiene, University of Manitoba, Winnipeg, MB, Canada
| | - M B Doupe
- College of Medicine, University of Manitoba, Manitoba, MB, Canada
| | - A M Iacopino
- College of Dentistry, University of Manitoba, Manitoba, MB, Canada
| | - S Mahmud
- College of Medicine, University of Manitoba, Manitoba, MB, Canada
| | - L Elliott
- College of Medicine, University of Manitoba, Manitoba, MB, Canada
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Wadd S, Madoc-Jones I, Elliott L, Donnelly M, Whittaker A. Stigma and low levels of knowledge about alcohol in older adults in the United Kingdom 2015. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw172.014] [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: 11/14/2022] Open
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Dawkes S, Smith G, Raeside R, Elliott L, Donaldson J. Angina Management is Poor After Percutaneous Coronary Intervention. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Goldstein D, Chodick G, Shalev V, Thorsted BL, Elliott L, Karasik A. Use of Healthcare Services Following Severe Hypoglycemia in Patients with Diabetes: Analysis of Real-World Data. Diabetes Ther 2016; 7:295-308. [PMID: 27101312 PMCID: PMC4900979 DOI: 10.1007/s13300-016-0169-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Severe hypoglycemia is a burden for both patients and the healthcare system payer alike. This study aimed to quantify the resource use associated with a severe hypoglycemic event (SHE) in patients with diabetes. METHODS This retrospective cohort study compared resource use (e.g., physician visits, hospitalizations, and medications) 1 month pre- and post-SHE among patients with type 1 (T1D) or type 2 diabetes (T2D) from a large not-for-profit healthcare provider. RESULTS From 2005 to 2014, 284 patients with T1D (52.5% male, mean age 29.8 years, mean HbA1c 7.9%) and 3691 patients with T2D (47.6% male, mean age 67.1 years, mean HbA1c 7.3%) were eligible for inclusion in the study. In total, 95.4% of patients with T1D and 32.8% of patients with T2D were insulin treated, while 3.5% of patients with T1D and 70.4% of patients with T2D were treated with oral drugs that could cause hypoglycemia (sulfonylureas or meglitinides). Hospital admissions increased by 95% in T1D and 127% in T2D (P < 0.001) 1 month post-SHE versus 1 month pre-SHE. Of those admitted to hospital (T1D n = 59; T2D n = 1214), the mean length of stay was significantly longer during the month post- versus pre-SHE [2.08 vs. 0.88 days, P = 0.036 (T1D) and 4.17 vs. 1.45 days, P < 0.001 (T2D)]. Outpatient visits also increased by 37% for T1D and 47% for T2D between these two time periods (P < 0.001). The total monthly expense per patient increased by 46% and 87% for T1D and T2D, respectively, from $485 pre-SHE to $708 post-SHE for T1D, and from $601 pre-SHE to $1121 post-SHE for T2D (P < 0.001). The greatest expense was hospital care, with increases of 179% and 166% for T1D and T2D, respectively, to $312 and $706 per patient/month. CONCLUSION This real-world analysis from a large diabetes registry indicates an increased use of healthcare services, including more frequent and prolonged hospital admissions and outpatient visits after an SHE, which resulted in an increase in healthcare expense. FUNDING Novo Nordisk.
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Affiliation(s)
| | | | - Varda Shalev
- Maccabitech, Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Lisa Elliott
- Market Access, Novo Nordisk A/S, Søborg, Denmark
| | - Avraham Karasik
- Department of Endocrinology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel.
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Elliott L, Fidler C, Ditchfield A, Stissing T. Hypoglycemia Event Rates: A Comparison Between Real-World Data and Randomized Controlled Trial Populations in Insulin-Treated Diabetes. Diabetes Ther 2016; 7:45-60. [PMID: 26886441 PMCID: PMC4801820 DOI: 10.1007/s13300-016-0157-z] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Hypoglycemia is the most common adverse effect of diabetes therapy, particularly insulin treatment. Hypoglycemia is associated with considerable clinical and economic burden, and may be under-reported. The aim of this study was to com pare the frequency of hypoglycemic events reported in real-world settings with those reported in clinical trials. METHODS We conducted a structured literature review in PubMed to identify hypoglycemic event rates in patients with type 1 diabetes mellitus (T1DM) and insulin-treated type 2 diabetes mellitus (T2DM) from real-world data (RWD) and randomized controlled trials (RCTs). The search was restricted to English language, full-text publications from 2010 onwards, reporting on treatment of T1DM or T2DM with basal only, basal-bolus, or premix insulin. RESULTS The final dataset included 30 studies (11 RWD studies and 19 RCTs). Six studies (RWD, n = 2; RCT, n = 4) reported hypoglycemia event rates in people with T1DM. For all reported categories of hypoglycemia (severe, non-severe, and nocturnal), rates were consistently higher in RWD studies compared with RCTs. Twenty-five studies (RWD, n = 10; RCT, n = 15) reported hypoglycemia event rates in people with insulin-treated T2DM. For T2DM basal-oral therapy; the highest rates were observed in RWD studies, although there was an overlap with RCT rates. For basal-bolus therapy, there was considerable between-study variability but higher rates of severe and non-severe hypoglycemia were generally observed in RWD studies. For T2DM premix insulin, reported rates of hypoglycemia in RWD studies and RCTs were similar. CONCLUSION We found that higher rates of hypoglycemia are observed in real-world settings compared with clinical trial settings, although there is a large degree of overlap. Due to the inherent constraints of RCTs, they are likely to underestimate the burden of hypoglycemia in clinical practice. Further, high-quality RWD are needed to determine a more accurate incidence of hypoglycemia in clinical practice.
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Affiliation(s)
| | - Carrie Fidler
- DRG Abacus, 6 Talisman Business Centre, Bicester, Oxfordshire UK
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Tjaden L, Heaman M, Marzan Chang Z, Elliott L. Quantitative evaluation of Partners in Inner-city Integrated Prenatal Care in Winnipeg, Canada. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.066] [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: 11/14/2022] Open
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Tjaden L, Moffat H, Elliott L, Harlos S, Sourin L. Health for All: Promoting health equity across a regional health authority. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.143] [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: 11/15/2022] Open
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Tjaden L, Heaman M, Marzan Chang Z, Elliott L. Applying a Health Equity Promotion Lens to Prenatal Care for Inner-City Families in Winnipeg, Canada. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Caiazza F, Power R, Elliott L, Tosetto M, Nolan B, Doherty G, Ryan E. 2020 Modulation of colorectal cancer tumorigenesis by KHSRP through the tumor microenvironment. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30943-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bak-Klimek A, Karatzias T, Elliott L, Campbell J, Pugh R, Laybourn P. Nature of child sexual abuse and psychopathology in adult survivors: results from a clinical sample in Scotland. J Psychiatr Ment Health Nurs 2014; 21:550-7. [PMID: 24304425 DOI: 10.1111/jpm.12127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2013] [Indexed: 11/30/2022]
Abstract
The relationship between history of childhood sexual abuse and psychopathology in adult life is well established. However, understanding of the mechanisms by which abuse exerts its effects is limited. To our knowledge, this is the first study which investigates the relationship between a wide range of sexual abuse characteristics (i.e. age at onset, frequency of assaults, number of perpetrators and their relationship to the victim) and the severity of psychopathological disorders in a large sample of adult child sexual abuse (CSA) survivors who attended a specialist Psychotherapy Service for CSA survivors. CSA survivors in our study experienced severe sexual assault(s) in their early years and presented with severe pathology which could suggest a strong causal link. However, none of the examined trauma characteristics significantly predicted severity of psychopathology. This may suggest that for severely disordered, treatment-seeking CSA survivors post-abuse psychopathology could be caused by other factors. The study adds to the growing body of evidence suggesting that CSA effects may be dependent on factors which are not necessarily related to the nature of sexual abuse. The study findings will help improve clinicians' insight into the determinants of psychopathology.
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Affiliation(s)
- A Bak-Klimek
- Faculty of Health, Lufe & Social Science, Edinburgh Napier University, UK
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Cullen K, Dave J, Chen A, Elliott L, Walker F, Jensen H. Implementing the New School Meal Regulations: Do Elementary School Children Select and Eat 1 Fruit and 2 Vegetable Servings When Allowed? J Acad Nutr Diet 2013. [DOI: 10.1016/j.jand.2013.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Elit L, Saskin R, Raut R, Elliott L, Murphy J, Marrett L. Sociodemographic factors associated with cervical cancer screening coverage and follow-up of high grade abnormal results in a population-based cohort. Gynecol Oncol 2012; 128:95-100. [PMID: 23085459 DOI: 10.1016/j.ygyno.2012.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 10/05/2012] [Accepted: 10/08/2012] [Indexed: 11/18/2022]
Abstract
INTRODUCTION A cervical cytology based screening program is effective if there is regular screening of the 'at risk' population and close follow-up of those labeled abnormal. METHODS This is a population cohort study of women between 20-69 year old who were eligible in Ontario from 2008-2010. We used administrative data to evaluate the rates of cervical cancer screening and follow-up of high grade Pap tests. Variation in cervical cytology coverage and follow-up of high grade abnormal results are associated with age, area level income and health region. Multivariate logistic regression was used to identify independent factors associated with screening and followup. RESULTS 3.7million women were eligible for screening of which 72% had a Pap smear in the prior 3years. These rates varied by age, income and region (p<0.0001). Women residing in the lowest income neighborhoods were half as likely to be screened (p<0.0001). 83% of those with an high grade intraepithelial lesion Pap test result had follow-up with colposcopy or treatment within 6months and this varied by year, age, income and region (p<0.0001). CONCLUSIONS Despite universal health coverage, cervical cancer screening rates are suboptimal with older and low income women being at greatest risk. Follow-up among women with high grade abnormal tests is mediocre at 3months and acceptable at 6months. Novel models of cervical cancer screening program implementation are needed to address these inadequacies.
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Affiliation(s)
- L Elit
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada; Ontario Cervical Screening Program, Cancer Care Ontario, Toronto, Canada.
| | - R Saskin
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - R Raut
- Ontario Cervical Screening Program, Cancer Care Ontario, Toronto, Canada
| | - L Elliott
- Ontario Cervical Screening Program, Cancer Care Ontario, Toronto, Canada
| | - J Murphy
- Ontario Cervical Screening Program, Cancer Care Ontario, Toronto, Canada; Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Canada
| | - L Marrett
- Ontario Cervical Screening Program, Cancer Care Ontario, Toronto, Canada
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Butt M, Symington A, Janes M, Steele S, Elliott L, Chant-Gambacort C, Paes B, Mondal T. Respiratory Syncytial Virus (RSV) Prophylaxis in Cardiac Disease: A Retrospective, Single-Centre Study. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.suppl_a.26ab] [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: 11/14/2022] Open
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Marrie RA, Yu N, Leung S, Elliott L, Blanchard J. Validation of Administrative Case Definitions for Diabetes, Hypertension and Hyperlipidemia in Persons with MS and Their Application To Determine Temporal Trends in Prevalence (P06.164). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.164] [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: 11/15/2022] Open
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Lang D, Prouse J, Barry F, Catherwood A, Chaplin K, Elliott L, Greco K, McGahey W, Nilsen J, Singhal N. Evaluation of the safety and feasibility of rapid rituximab infusion. Asia Pac J Clin Oncol 2012; 8:71-5. [DOI: 10.1111/j.1743-7563.2011.01487.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Dora Lang
- The Joanna Briggs Institute, University of Adelaide, Adelaide, South Australia, Australia.
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Elliott L, Loomis D, Dement J, Hein M, Richardson D, Kuempel E, Stayner L. Lung cancer mortality in a combined cohort of North Carolina and South Carolina asbestos textile workers. Occup Environ Med 2011. [DOI: 10.1136/oemed-2011-100382.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Patel K, Jhaveri R, George J, Qiang G, Kenedi C, Brown K, Cates C, Zekry A, Tillmann HL, Elliott L, Kilaru R, Albrecht J, Conrad A, McHutchison JG. Open-label, ascending dose, prospective cohort study evaluating the antiviral efficacy of Rosuvastatin therapy in serum and lipid fractions in patients with chronic hepatitis C. J Viral Hepat 2011; 18:331-7. [PMID: 20367801 PMCID: PMC3826439 DOI: 10.1111/j.1365-2893.2010.01310.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
HMG CoA reductase inhibition suppresses in vitro HCV replication through depletion of cellular sterol proteins such as geranylgeraniol. Our aims were to prospectively evaluate the changes in serum and lipid fraction HCV RNA with Rosuvastatin in non-responder (NR) patients with CHC. A total of 11 patients with CHC genotype-1 received Rosuvastatin at 20 mg qd (weeks 0-4), 40 mg qd (weeks 5-12), with 4 week follow up. Lipid fractions were separated by a sucrose density gradient ultracentrifugation, HCV RNA determined at wks 0, 2, 4, 8, 12, 16 in serum, and in selected very low- (VLDF) to high-density (HDF) lipid fractions. A reduction in LDL and total cholesterol (TC) was not accompanied by significant decline in HCV RNA. At baseline, there was an inverse correlation between HDL and HCV RNA (ρ = -0.45, P = 0.036). At 20 mg, there was correlation between change (Δ) in TG and Δ HCV RNA (ρ = 0.75, P = 0.007), Δ ALT and Δ TC (ρ = -0.64, P = 0.03) and Δ LDL (ρ = -0.67, P = 0.02). At 40 mg, Δ TG maintained a positive correlation with Δ HCV RNA (ρ = 0.65, P = 0.03). There was a group difference for HCV RNA in relation to lipid fractions (P = 0.04) but not study time intervals (P = 0.17); mean log HCV RNA was greater in VLDF compared to HDF (5.81 ± 0.59 vs 5.06 ± 0.67, P = 0.0002) with no other differences to study time intervals (P = 0.099). Short-term Rosuvastatin monotherapy is not associated with significant changes in serum or lipid fraction HCV RNA in NR patients. HCV co-localizes with the lowest density lipid fractions in serum.
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Affiliation(s)
- K. Patel
- Duke Clinical Research Institute and Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA
,Department of Medicine, Duke University Medical Center, Durham, USA
| | - R. Jhaveri
- Division of Pediatric Infectious Diseases, Duke University Medical Center, NC, USA
| | - J. George
- Duke Clinical Research Institute and Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA
,Department of Medicine, Duke University Medical Center, Durham, USA
| | - G. Qiang
- Division of Pediatric Infectious Diseases, Duke University Medical Center, NC, USA
| | - C. Kenedi
- Department of Medicine, Duke University Medical Center, Durham, USA
| | - K. Brown
- Department of Medicine, Duke University Medical Center, Durham, USA
| | - C. Cates
- Duke Clinical Research Institute and Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA
| | - A. Zekry
- Department of Infection and Immunity, University of New South Wales, Sydney, NSW, Australia
| | - H. L. Tillmann
- Duke Clinical Research Institute and Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA
,Department of Medicine, Duke University Medical Center, Durham, USA
| | - L. Elliott
- Duke Clinical Research Institute and Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA
| | - R. Kilaru
- Duke Clinical Research Institute and Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA
| | - J. Albrecht
- National Genetics Institute, Los Angeles, CA, USA
| | - A. Conrad
- National Genetics Institute, Los Angeles, CA, USA
| | - J. G McHutchison
- Duke Clinical Research Institute and Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA
,Department of Medicine, Duke University Medical Center, Durham, USA
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Abstract
Descriptive terms associated with elevated MMPI scales were abstracted from 10 MMPI reference works. Those corresponding to the 300-word Gough Adjective Check List were retained to construct a new behavior descriptor/personality trait list.
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Affiliation(s)
- M deMendonca
- School of Professional Psychology, The University of Denver, CO 80208, USA
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Marrie RA, Yu N, Blanchard J, Leung S, Elliott L. The rising prevalence and changing age distribution of multiple sclerosis in Manitoba. Neurology 2010; 74:465-71. [DOI: 10.1212/wnl.0b013e3181cf6ec0] [Citation(s) in RCA: 212] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Reducing inequalities in health, including mental health, is of high priority in many national policies. However, it is not yet known how mental health nurses might respond to these policies. Using examples from the available evidence, we argue that the causes of mental health inequalities are complex and thought to arise from fundamental divisions in society. These divisions are formed by social relationships, which are influenced by deep social structures, such as the economy or culture. The extensive range of social determinants means that there is no single explanation of why inequalities in mental health might occur. It also suggests that these determinants may act synergistically to create pockets of inequity where health needs are most complex. This poses difficult challenges for mental health nurses who undoubtedly have a key role in addressing mental health inequalities, although their role is likely to be restricted to service redesign and delivery. Mental health nurses are unlikely to address some of the deeper structural determinants of mental health inequalities, such as poverty, which can only be tackled through government-led reforms. Furthermore, we must be mindful of the possibility that services offered by mental nurses may have an uneven uptake across social classes, which in turn could serve to maintain or worsen mental health inequalities. Therefore, a key question for mental health nursing, policy and training is whether these limitations are clearly recognized.
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Affiliation(s)
- L Elliott
- Centre for Integrated Healthcare Research, Edinburgh, UK.
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Elliott L. The Lateral Transverse Thigh Free Flap for Autologous Tissue Breast Reconstruction. Semin Plast Surg 2008. [DOI: 10.1055/s-2008-1080496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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