1
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Angwin C, Zschocke J, Kammin T, Björck E, Bowen J, Brady AF, Burns H, Cummings C, Gardner R, Ghali N, Gröbner R, Harris J, Higgins M, Johnson D, Lepperdinger U, Milnes D, Pope FM, Sehra R, Kapferer-Seebacher I, Sobey G, Van Dijk FS. Non-oral manifestations in adults with a clinical and molecularly confirmed diagnosis of periodontal Ehlers-Danlos syndrome. Front Genet 2023; 14:1136339. [PMID: 37323685 PMCID: PMC10264792 DOI: 10.3389/fgene.2023.1136339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/03/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction: Periodontal Ehlers-Danlos Syndrome (pEDS) is a rare autosomal dominant type of EDS characterised by severe early-onset periodontitis, lack of attached gingiva, pretibial plaques, joint hypermobility and skin hyperextensibility as per the 2017 International EDS Classification. In 2016, deleterious pathogenic heterozygous variants were identified in C1R and C1S, which encode components of the complement system. Materials and Methods: Individuals with a clinical suspicion of pEDS were clinically and molecularly assessed through the National EDS Service in London and Sheffield and in genetic services in Austria, Sweden and Australia. Transmission electron microscopy and fibroblast studies were performed in a small subset of patients. Results: A total of 21 adults from 12 families were clinically and molecularly diagnosed with pEDS, with C1R variants in all families. The age at molecular diagnosis ranged from 21-73 years (mean 45 years), male: female ratio 5:16. Features of easy bruising (90%), pretibial plaques (81%), skin fragility (71%), joint hypermobility (24%) and vocal changes (38%) were identified as well as leukodystrophy in 89% of those imaged. Discussion: This cohort highlights the clinical features of pEDS in adults and contributes several important additional clinical features as well as novel deleterious variants to current knowledge. Hypothetical pathogenic mechanisms which may help to progress understanding and management of pEDS are also discussed.
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Affiliation(s)
- C. Angwin
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Section of Genetics and Genomics, Imperial College London, London, United Kingdom
| | - J. Zschocke
- Institute of Human Genetics, Medical University Innsbruck, Innsbruck, Austria
| | - T. Kammin
- National EDS Diagnostic Service, Sheffield Children’s NHS Foundation Trust, Sheffield, United Kingdom
| | - E. Björck
- Clinical Genetics, Karolinska University Hospital, Solna, Sweden
| | - J. Bowen
- National EDS Diagnostic Service, Sheffield Children’s NHS Foundation Trust, Sheffield, United Kingdom
| | - A. F. Brady
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Section of Genetics and Genomics, Imperial College London, London, United Kingdom
| | - H. Burns
- Department Otolaryngology Head and Neck Surgery, Children’s Health QLD, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - C. Cummings
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
| | - R. Gardner
- Clinical Genetics, Genetic Health Queensland, Brisbane, QLD, Australia
| | - N. Ghali
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Section of Genetics and Genomics, Imperial College London, London, United Kingdom
| | - R. Gröbner
- Institute of Human Genetics, Medical University Innsbruck, Innsbruck, Austria
| | - J. Harris
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
| | - M. Higgins
- Clinical Genetics, Genetic Health Queensland, Brisbane, QLD, Australia
| | - D. Johnson
- National EDS Diagnostic Service, Sheffield Children’s NHS Foundation Trust, Sheffield, United Kingdom
| | - U. Lepperdinger
- Department of Operative and Restorative Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - D. Milnes
- Clinical Genetics, Genetic Health Queensland, Brisbane, QLD, Australia
| | - F. M. Pope
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - R. Sehra
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
| | - I. Kapferer-Seebacher
- Department of Operative and Restorative Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - G. Sobey
- National EDS Diagnostic Service, Sheffield Children’s NHS Foundation Trust, Sheffield, United Kingdom
| | - F. S. Van Dijk
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Section of Genetics and Genomics, Imperial College London, London, United Kingdom
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2
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Kovacs-Balint ZA, Raper J, Richardson R, Gopakumar A, Kettimuthu KP, Higgins M, Feczko E, Earl E, Ethun KF, Li L, Styner M, Fair D, Bachevalier J, Sanchez MM. The role of puberty on physical and brain development: A longitudinal study in male Rhesus Macaques. Dev Cogn Neurosci 2023; 60:101237. [PMID: 37031512 PMCID: PMC10114189 DOI: 10.1016/j.dcn.2023.101237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 02/20/2023] [Accepted: 03/21/2023] [Indexed: 04/07/2023] Open
Abstract
This study examined the role of male pubertal maturation on physical growth and development of neurocircuits that regulate stress, emotional and cognitive control using a translational nonhuman primate model. We collected longitudinal data from male macaques between pre- and peri-puberty, including measures of physical growth, pubertal maturation (testicular volume, blood testosterone -T- concentrations) and brain structural and resting-state functional MRI scans to examine developmental changes in amygdala (AMY), hippocampus (HIPPO), prefrontal cortex (PFC), as well as functional connectivity (FC) between those regions. Physical growth and pubertal measures increased from pre- to peri-puberty. The indexes of pubertal maturation -testicular size and T- were correlated at peri-puberty, but not at pre-puberty (23 months). Our findings also showed ICV, AMY, HIPPO and total PFC volumetric growth, but with region-specific changes in PFC. Surprisingly, FC in these neural circuits only showed developmental changes from pre- to peri-puberty for HIPPO-orbitofrontal FC. Finally, testicular size was a better predictor of brain structural maturation than T levels -suggesting gonadal hormones-independent mechanisms-, whereas T was a strong predictor of functional connectivity development. We expect that these neural circuits will show more drastic pubertal-dependent maturation, including stronger associations with pubertal measures later, during and after male puberty.
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Affiliation(s)
- Z A Kovacs-Balint
- Emory National Primate Research Center, Emory University, Atlanta, GA 30329, USA.
| | - J Raper
- Emory National Primate Research Center, Emory University, Atlanta, GA 30329, USA; Dept. of Pediatrics, Emory University, Atlanta, GA 30322, USA
| | - R Richardson
- Emory National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - A Gopakumar
- Emory National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - K P Kettimuthu
- Emory National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - M Higgins
- Office of Nursing Research, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
| | - E Feczko
- Dept. of Pediatrics, University of Minnesota, Minneapolis, MN 55414, USA; Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, USA
| | - E Earl
- Dept. of Behavioral Neuroscience, Oregon Health & Sciences University, Portland, OR 97239, USA
| | - K F Ethun
- Emory National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - L Li
- Dept. of Pediatrics, Emory University, Atlanta, GA 30322, USA; Marcus Autism Center; Children's Healthcare of Atlanta, GA, USA
| | - M Styner
- Dept. of Psychiatry, University of North Carolina, Chapel Hill, NC 27514, USA
| | - D Fair
- Dept. of Pediatrics, University of Minnesota, Minneapolis, MN 55414, USA; Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, USA
| | - J Bachevalier
- Emory National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - M M Sanchez
- Emory National Primate Research Center, Emory University, Atlanta, GA 30329, USA; Dept. of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA 30322, USA
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3
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McCormack KM, Howell BR, Higgins M, Bramlett S, Guzman D, Morin EL, Villongco C, Liu Y, Meyer J, Sanchez MM. The developmental consequences of early adverse care on infant macaques: A cross-fostering study. Psychoneuroendocrinology 2022; 146:105947. [PMID: 36242820 DOI: 10.1016/j.psyneuen.2022.105947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022]
Abstract
Early life adversity/stress (ELA/ELS), particularly adverse caregiving experiences such as child maltreatment (MALT), is a main risk factor for psychopathology, including psychiatric disorders such as anxiety, depression, ADHD, and substance abuse. Yet how these alterations unfold during development and the underlying mechanisms remain poorly understood, as it is difficult to prospectively and longitudinally study early developmental phases in humans, and nearly impossible to disentangle postnatal caregiving effects from heritable traits. This study examined the specific effects of "nurture" (maternal care) versus "nature" (heritable, biological maternal factors) on nonhuman primate infant socioemotional, stress neuroendocrine, and physical development. For this we used a translational and naturalistic macaque model of infant maltreatment by the mother with randomized assignment at birth to either mothers with a history of maltreating their infants (MALT group, n = 22) or to competent mothers (Control group, n = 20). Over the first 6 months of life (roughly equivalent to 2 years in humans), we examined the development of the mother-infant relationship, as well as infants' social behavior and emotional reactivity. In parallel, we assessed hypothalamic-pituitary-adrenal (HPA) axis function longitudinally, using measures of hair cortisol accumulation, and basal morning plasma cortisol. We identified broad impairments in maternal care exhibited by MALT foster mothers, beyond maltreatment (physical abuse, rejection) events, suggesting that MALT foster mothers provide an overall lower quality of care to their infants compared to Controls. MALT infants exhibited alterations in their initiations and breaks of proximity towards their mothers, as well as heightened emotional reactivity in comparison to Controls. Most striking are the HPA axis findings, with MALT infants showing higher levels of plasma cortisol across the first 6 postnatal months as well as higher hair cortisol accumulation from birth through month 6 (a signature of chronic stress) than Controls. No caregiving effects were detected on physical growth, which ruled out confounding effects of maternal nutrition, metabolism, etc. Taken together, these results suggest that the developmental trajectory of MALT and Control infants is different, marked by heightened levels of emotional reactivity, increased HPA activity and alterations in mother-infant interactions in MALT animals. These findings appear to be due to specific effects of postnatal maternal care, and not to biological/ behavioral traits inherited from the mother, or due to prenatal programming caused by prenatal stress, as the cross-fostering design controlled for these potential factors. However, we also detected a couple of interesting biological effects suggesting heritable transmission of some phenotypes. The prolonged HPA axis activation during the first 6 postnatal months of life is expected to have long-term consequences for brain, physiological, and behavioral development in MALT offspring.
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Affiliation(s)
- K M McCormack
- Department of Psychology, Spelman College, Atlanta, GA, USA; Emory National Primate Research Center, Emory University, Atlanta, GA, USA.
| | - B R Howell
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA; Department of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA, USA; Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Department of Human Development and Family Science, Virginia Tech, Blacksburg, VA, USA
| | - M Higgins
- School of Nursing, Emory University, Atlanta, GA, USA
| | - S Bramlett
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - D Guzman
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA; Department of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - E L Morin
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA; Department of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - C Villongco
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Y Liu
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - J Meyer
- Department of Psychological & Brain Sciences, University of Massachusetts, Amherst, MA, USA
| | - M M Sanchez
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA; Department of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA, USA
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4
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Higgins M, Healy A, Eakins S, Brennan A, Cregg K. 161 CLEAR DISCHARGE PRESCRIBING IN STROKE PATIENTS: A RETROSPECTIVE AUDIT OF DUAL ANTIPLATELET DURATION AT FIRST FOLLOW-UP APPOINTMENT. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The risk of further ischaemic events post stroke and TIA is high in the following weeks. Short term treatment with Dual Anti-Platelet Therapy (DAPT) in appropriate patients has been shown to decrease the incidence of recurrent ischaemic events. However continuing DAPT longer than six weeks increases the risk of haemorrhagic complications.
Methods
Retrospective analysis of patients admitted to the Acute Stroke Unit over 4 months in a tertiary referral centre, reviewing discharge summaries and follow-up Outpatient Department (OPD) clinic letters on the online hospital computer system.
Results
We analysed data from 205 patients. 57 patients were discharged on DAPT. Of those, 18(31.6%) did not have a recommended duration of DAPT documented in their discharge summary. 40 patients returned to OPD for review, 16 patients had no documented follow-up, 11 were repatriated to a referring hospital for follow-up locally. The average time of OPD review was 4 months post discharge. Of those 40 patients who attended OPD follow up appointment, 33(82.5%) had documented evidence of a medication review in clinic. 9 of those patients (27.3%) were still inappropriately on DAPT, 5 of whom (55.6%) had no DAPT duration instructions documented in the discharge summary.
Conclusion
Treatment with DAPT puts patients at risk of haemorrhagic complications with longer term use. Clear documentation of treatment duration and communication with the patient and the patient’s GP is vital to ensure medication errors and unnecessary complications for the patient are avoided. Intervention: Following these results, we organised an education session for the Stroke Department staff and re-designed the stroke discharge summary template to highlight instructions on DAPT duration. We also emphasised the importance of communication with the patient’s GP and medication counselling with patients.
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Affiliation(s)
| | - A Healy
- Beaumont Hospital , Dublin, Ireland
| | - S Eakins
- Beaumont Hospital , Dublin, Ireland
| | | | - K Cregg
- Beaumont Hospital , Dublin, Ireland
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5
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Higgins M, McGuirk C, Devitt L, Ludgate S, Doyle R, O'Donoghue C, O'Dwyer C, O'Hanlon S. 313 STREAMLINING A ZOLEDRONIC ACID SERVICE TO A LEVEL TWO HOSPITAL. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Approximately, 350-400 patients are admitted to a level 4 hospital for hip-fractures yearly (2019). According to the Irish Hip Fracture Database (2020) the average age for a hip-fracture is 81 years old. Patients post-hip fractures are commenced on Zoledronic acid; a bisphosphonate which is given intravenously 10 days post-surgery and then annually in year two and three. Zoledronic acid is a first line choice of bisphosphonate for the ≥65 population with a fragility fracture.
Methods
274 patients were transferred from the level 4 Hospital waiting list to a level 2 hospital waiting list to streamline the service. Meetings occurred to establish a pathway for the transition of services. A rapid improvement of the level 2 Day Hospital (DH) was commenced. Essential resources, training and information leaflets were developed in order to begin the service. A policy review, procedure guidelines and referral pathway were implemented. An excel database of patient information was transferred between organisations. The 274 patients were triaged by the DH. Pre-assessment phone calls were conducted determining if patients were still eligible for Zoledronic acid.
Results
Of the 274 referrals; 24 had died; 30 refused; 37 were on other bone treatments and another 7 patients haven’t made creatinine clearance, leaving 176. All 176 patients were allocated an appointment for 2022. Of the 176 patients; currently 57 patients have received their Zoledronic acid infusion in the DH. 69 of these referrals had an indicative date for their next Zoledronic acid infusion for dates after April 2022. There are 50 patients yet to receive their treatment which is overdue.
Conclusion
With the prospect of service demands increasing due to Irelands aging population inevitably placing extra pressures on infusion suites in a level 4 hospital. The level 2 hospital has effectively managed to focus on tackling the backlog, streamlining referrals to the bone health service and thus reducing the risk of subsequent hip fractures.
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Affiliation(s)
- M Higgins
- St. Columcille's Hospital , Dublin, Ireland
| | - C McGuirk
- St. Columcille's Hospital , Dublin, Ireland
| | - L Devitt
- St. Columcille's Hospital , Dublin, Ireland
| | - S Ludgate
- St. Vincent's University Hospital , Dublin, Ireland
| | - R Doyle
- St. Columcille's Hospital , Dublin, Ireland
| | | | - C O'Dwyer
- St. Vincent's University Hospital , Dublin, Ireland
| | - S O'Hanlon
- St. Columcille's Hospital , Dublin, Ireland
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6
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Higgins M, Brewer L. 354 PROMOTING THE BENEFITS OF COGNITIVE STIMULATION AMONGST OLDER PATIENTS: A BRIEF SURVEY AND QUALITY IMPROVEMENT PROJECT. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cognitive Stimulation (CS) enhances cognitive function in patients with Cognitive Impairment (CI), including those with mild/moderate dementia. It has positive effects on various cognitive and non-cognitive symptoms. Engaging in CS can reduce the risk developing dementia and allows proactive improvement in wellbeing. Physical exercise and promotion of independence are also beneficial. Patients and staff are often poorly informed regarding such benefits.
Methods
We developed a 9-question survey, administered to a sample of representative doctors involved in the care of patients with CI to gauge their understanding of CS and its benefits. We envisaged this data may support the development of a patient-friendly information leaflet to educate about CS.
Results
Of 45 respondents, 68.89% could readily provide three examples of CS. 55.56% reported that CS “definitely” benefits patients with CI, 44.44% reported it “probably” does. All reported it was the joint responsibility of the doctor, memory nurse and occupational therapist to provide advice on CS. 44.44% regularly or sometimes discuss CS with patients/families, compared with 55.55% who rarely or never do. 55.56% were “not confident” giving advice on CS, only 8.89% were “quite confident”. 80% reported that exercise reduces the risk of CI. 37.78% could give an appropriate example of a compensatory strategy. All reported an information leaflet available for patients and their families, would be beneficial. We designed a patient information leaflet explaining cognitive domains, examples of impairments and measures patients can embrace to promote and maintain cognitive function. We highlighted physical and cognitive activities, social engagement and compensatory techniques to promote independence. We provided everyday examples of each including local clubs/classes to ensure accessibility and relatability.
Conclusion
Gaps in knowledge and confidence were identified amongst doctors rotating through the Geriatric Medicine Service. Recognising this, we designed an information leaflet ensuring we can readily impart accurate education and lifestyle advice to patients.
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Affiliation(s)
| | - L Brewer
- Beaumont Hospital , Dublin, Ireland
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7
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Brennan F, Higgins M, Russell S, Sands H, Keogh C, Curran C. 259 AN AUDIT OF DNACPR FORM USAGE IN A LEVEL 4 HOSPITAL FOLLOWING RE-DESIGN AND IMPLICATIONS FOR ITS FUTURE USE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In 2020 during the Covid-19 pandemic our hospital introduced a new green DNACPR form with 2 significant changes. It now specifies if the patient is or is not for resuscitation (as a yes/no choice) and a Treatment Escalation Plan (TEP) has moved to the front of the page from the back. A subsequent audit found that 19% of inpatients had forms completed, of which 68% stated DNACPR and 29% for CPR. 76% of forms had a TEP (versus 56% on the old forms). We repeated the hospital wide audit in 2022 to assess if the improvement in TEP documentation was sustained, and if it was used on all patients or primarily to document DNACPR decisions.
Methods
The hospital-wide audit was performed on the 25.05.2022. Charts were reviewed on medical and surgical wards. ICU patients were excluded. The following data were recorded: Resuscitation status, form completion, presence of a TEP, if the date of admission and form completion were recorded, if the name of doctor and nature of discussion with patient and family were documented, and if the TEP was consistent with the most recent clinical notes. The data was compared to the 2020 audit and against the Hospital’s DNAR & TEP policy.
Results
634 inpatients were identified. 15.7% (100) had a form completed of which 92% stated DNAR. One of these did not have a TEP. The doctor’s name and grade were clearly documented on all forms.
Conclusion
99% of patients who were not for CPR had a TEP indicating sustained improvement since the introduction of the new form. Given 83.3% of patients did not have any documented resuscitation status the approach of documenting yes or no for resuscitation is not being utilised. A return to a dedicated form that indicates someone should not undergo attempts at resuscitation may offer more clarity.
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Affiliation(s)
| | | | | | - H Sands
- Beaumont Hospital , Dublin, Ireland
| | - C Keogh
- Beaumont Hospital , Dublin, Ireland
| | - C Curran
- Beaumont Hospital , Dublin, Ireland
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8
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Nugent K, O'Neill B, Brennan V, Lynch J, Higgins M, Dunne M, Skourou C. Quantification of organ motion in male and female patients undergoing long course radiotherapy for rectal cancer in the supine position. Adv Radiat Oncol 2022; 8:101109. [DOI: 10.1016/j.adro.2022.101109] [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] [Received: 03/12/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022] Open
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9
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Higgins M, Farietta T, Volkova N, Liu M, Ostrenga J, Elbert A. WS08.04 Real-world data demonstrate clinical response in people with cystic fibrosis (pwCF) who have select residual function (RF) mutations and are treated with ivacaftor (IVA). J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00198-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Friefeld A, Higgins M, Branch-Elliman W, Sturgeon D, Bart N, Hederstedt K, Foster M, Seren A, Lamkin R, Sullivan B, Mull H. Abstract No. 605 An algorithm to flag totally implantable venous access port infections for the administration of chemotherapy using unstructured and structured data in the Veterans Health Administration’s electronic medical record. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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11
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Killeen E, Doherty R, Higgins M, O'Reilly A, Brewer L. 254 OPTIMISING COMMUNICATION WITH FAMILIES OF PATIENTS ON ACUTE STROKE AND GERIATRIC MEDICINE WARDS IN A LARGE TERTIARY HOSPITAL. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Good communication with patients and families is important for older adults admitted to acute stroke or geriatric medicine wards, particularly with COVID19-related restricted visiting. These patients often have communication difficulties including aphasia, delirium, cognitive or hearing impairment, limiting their own communication with relatives. Using the Plan, Do, Study, Act (PDSA) approach we undertook a quality improvement project to optimise communication with families of patients on above wards in a large tertiary hospital.
Methods
PDSA cycle 1: Staff were surveyed to identify satisfaction level with communication and ways to optimise communication. Inpatients on study wards were identified, we recorded demographic and clinical details and prevalence of communication difficulties. We created a designated folder with individual ‘communication sheets’ in conjunction with ward doctors and the nurse manager. PDSA cycle 2: We performed a rapid interval audit of the communication folder use. ‘Outlier’ patients were excluded as their teams did not receive education about folder use.
Results
PDSA cycle 1: A total of 90 inpatients on three wards were included, mean age 78y (SD ±14.4y), 47% were male. Three-quarters (73%) had a communication difficulty noted, reported by nursing staff. Two patients were intubated and six had stroke-related aphasia. Half of surveyed staff reported communication with families was suboptimal. Most (86%) suggested a centrally-located communication logbook would be helpful. PDSA cycle 2: Over two weeks, communication sheets were reviewed for all included patients. Median frequency of calls to families was 4 days (range 0–14). Most (79%) had the name of the primary contact clearly documented. Many (52%) included no contact number. Only 9% had secondary contact information documented.
Conclusion
Communication with families of patients on acute stroke and geriatric medicine wards was suboptimal. Over a short interval this improved with regular phone calls using specific centrally-located communication folders. Further optimisation of their use is needed.
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Affiliation(s)
| | | | | | | | - L Brewer
- Beaumont Hospital , Dublin, Ireland
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12
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Killeen E, Higgins M, Keogh C, Russell S, Curran C. 154 SAFEGUARDING ADULTS AT RISK OF ABUSE—IDENTIFYING KNOWLEDGE GAPS AMONGST HOSPITAL STAFF TO GUIDE POLICY IMPLEMENTATION AND TRAINING. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Safeguarding is the protection of health, wellbeing and life free from abuse. Abuse is a a violation of a person’s human and civil rights; forms include psychological, financial, physical, sexual, neglect and self-neglect. Health Service Executive (HSE) drafted the 2019 ‘Adult Safeguarding Policy’ for adults at risk of abuse to replace the 2014 version. In preparation for implementation a tertiary hospital founded a Safeguarding Committee in 2021. A core objective was establishing staff understanding, experience of safeguarding and education needs to guide future training.
Methods
10-question survey of 223 staff; included doctors, nurses, allied health professionals, medical social workers, healthcare assistants, porters, psychologists.
Results
91% response rate.
184 (91%) staff were familiar with the term ‘safeguarding’; only 44% were aware of the HSE 2019 policy. 129 (64%) had experience with a case of suspected abuse. Most common forms were financial, psychological and self-neglect (n = 60, 47, 39 respectively). Sexual abuse was least common (n = 10).
47% felt ‘somewhat’ confident recognising possible abuse compared to 42% who felt ‘extremely’ or ‘very’ confident.
61% were ‘somewhat’ or ‘not so’ confident about the next steps for suspected abuse; only 11% were ‘extremely’ confident.
49% felt ‘extremely’ or ‘very’ confident in reporting a suspected abuse case; 50% felt ‘somewhat’ or ‘not so’ confident.
Most common reasons for lack of confidence were lack of training, unclear reporting process and lack of experience with cases of abuse. Medical social workers were most confident; doctors were the least.
170 (84%) wanted more safeguarding training—the most popular options were online or in-person training.
Conclusion
Gaps in knowledge and confidence were identified amongst staff for cases of suspected abuse. This will guide future training in the hospital in line with the HSE Adult Safeguarding policy.
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Affiliation(s)
| | | | - C Keogh
- Beaumont Hospital , Dublin, Ireland
| | | | - C Curran
- Beaumont Hospital , Dublin, Ireland
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13
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Higgins M, O’Keeffe S, Quinn M, Harper D, Thirion P, Armstrong J. PO-1620 Quantification of Incidental Clinical Target Volume Coverage in Linear Accelerator Based Lung SABR. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08071-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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14
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McCormick PA, Higgins M, McCormick CA, Nolan N, Docherty JR. Hepatic infarction, hematoma, and rupture in HELLP syndrome: support for a vasospastic hypothesis. J Matern Fetal Neonatal Med 2021; 35:7942-7947. [PMID: 34130599 DOI: 10.1080/14767058.2021.1939299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose: HELLP syndrome is a relatively uncommon pregnancy-related condition characterized by hemolysis, elevated liver function tests, and low platelets. It can be accompanied by life-threatening hepatic complications including hepatic infarction, hematoma formation, and hepatic rupture. HELLP syndrome occurs in approximately 0.2% of pregnancies. Major hepatic complications occur in less than 1% of HELLP patients suggesting an incidence of 1/50,000. The pathogenesis is incompletely understood and in particular, it is difficult to understand a disorder with both major thrombotic and bleeding manifestations.Methods: Literature review.Results: On the basis of reports in the published literature, and our own clinical experience, we suggest that vasospasm is one of the principal drivers with hepatic ischemia, infarction, and hemorrhage as secondary events. It is known that vasoactive substances are released by the failing placenta. We suggest these cause severe vasospasm, most likely affecting the small post-sinusoidal hepatic venules. This leads to patchy or confluent hepatic ischemia and/or necrosis with a resultant increase in circulating liver enzymes. Reperfusion is associated with a fall in platelet count and microvascular hemorrhage if the microvasculature is infarcted. Blood tracks to the subcapsular space causing hematoma formation. If the hematoma ruptures the patient presents with severe abdominal pain, intra-abdominal hemorrhage, and shock.Conclusions: We suggest that hepatic and other complications associated with HELLP syndrome including placental abruption, acute renal failure, and posterior reversible encephalopathy syndrome (PRES) may also be due to regional vasospasm.
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Affiliation(s)
- P A McCormick
- Liver Unit, St Vincent's University Hospital, Dublin, Ireland
| | - M Higgins
- University College Dublin Perinatal Research Centre, National Maternity Hospital, Dublin, Ireland
| | - C A McCormick
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Australia
| | - N Nolan
- Histopathology Department, St Vincent's University Hospital, Dublin, Ireland
| | - J R Docherty
- Physiology Department, Royal College of Surgeons in Ireland, Dublin, Ireland
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Abstract
INTRODUCTION The weekend effect has been defined as a real or perceived decline in patient care provided on weekends and that provided on weekdays. The primary aim of this study was to investigate the association between day of surgery and length of stay for patients receiving elective lower limb joint arthroplasty in a large NHS teaching hospital. MATERIALS AND METHODS Data were obtained from a prospectively collected database of consecutive patients undergoing elective primary total knee and hip arthroplasty. Patient and clinical variables were collected alongside length of hospital stay. Data were anonymised and analysed using a multiple linear regression model. RESULTS A total of 3,544 knee and 3,277 hip replacements were included. No association was found between length of stay and day of surgery for either procedure. A significant association was noted between longer length of stay and increasing age, higher American Society of Anesthesiologists grade and male compared with female gender. DISCUSSION No evidence of a weekend effect was identified. Certain patient factors predicted longer hospital stay and focussing additional resources on these patient groups may prove a useful strategy in reducing overall length of stay. CONCLUSIONS Length of stay reduced across the time period included in this review while maintaining equality between the days of the week, which represents the successful management of weekend services.
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Affiliation(s)
- M Higgins
- Trauma and Orthopaedics, Nottingham City Hospitals NHS Trust, Nottingham, UK
| | - J Nightingale
- Trauma and Orthopaedics, Nottingham City Hospitals NHS Trust, Nottingham, UK
| | - K Sehat
- Trauma and Orthopaedics, Nottingham City Hospitals NHS Trust, Nottingham, UK
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Alsendi M, Lucas M, Darwish W, Higgins M, Kelly C. 94P Integration of clinicopathological and genomic data and adjuvant treatment decisions in premenopausal women with recurrence scores between 16 and 25. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.034] [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: 10/24/2022] Open
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18
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Campbell L, Kohli M, Heaton A, Higgins M, Lee E, Kaufmann C, Heaton R, Moore D, Moore R. B-24 Objective and Subjective Sleep Measures are Associated with Neurocognition in Middle-Aged and Older Adults With and Without HIV. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
Poorer sleep quality is related to worse cognitive functioning in the general population and people living with HIV; however, many studies use self-report sleep questionnaires that rely on retrospective recall. This study aimed to examine the relationship between objective (wrist actigraphy) and subjective sleep quality with neurocognitive functioning.
Method
Eighty-five adults aged 50-74 years with and without HIV (HIV+ n = 53, HIV- n = 32) were recruited from the community and ongoing studies at UC San Diego. Participants completed comprehensive neuropsychological testing assessing global and domain-specific cognition. Participants wore actigraphy watches for 14 nights after neuropsychological testing to objectively assess sleep quality (i.e., total sleep time (TST), efficiency, wake after sleep onset, and sleep fragmentation). The Pittsburgh Sleep Quality Index assessed subjective sleep quality.
Results
After adjusting for demographic variables and use of sleep medications, there were no differences in any sleep quality measures by HIV status (p’s>0.05). In separate adjusted linear regression models, lower sleep efficiency (p = 0.02; 95% CI: -9.5, -1.1) and greater sleep fragmentation (p = 0.02; 95% CI: -0.82, -0.09) were associated with worse learning. Less TST was associated with worse working memory (p = 0.02; 95% CI: -9.2, -0.8). In contrast, worse subjective sleep quality was associated with worse executive function (p < 0.01; 95% CI: -1.18, -0.23) and working memory (p = 0.03; 95% CI: -1.22, -0.07).
Conclusion
Both objective and subjective sleep quality were associated with cognition in both persons with and without HIV; however, subjective and objective sleep quality were associated with different cognitive domains. Therefore, both objective and subjective sleep quality are important health behaviors to assess.
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Higgins M, Kenny D, Fitzsimons C, Blackshields G, Coyle S, McKenna C, McGee M, Morris D, Waters S. PSIV-18 Identification of genes expressed in the liver transcriptome of Holstein-Friesian and Charolais steers divergent in residual feed intake across three dietary phases. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - C Fitzsimons
- Department of Agriculture,Ireland, Dublin, Ireland
| | | | | | | | - M McGee
- Teagasc, Animal and Grassland Research and Innovation Centre, Grange, Dunsany, Co. Meath, Ireland, Meath, Ireland
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20
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Higgins M, Fitzsimons C, McClure M, McKenna C, Conroy S, Kenny D, McGee M, Waters S, Morris D. 289 Genome-wide association study and expression quantitative trait loci analysis identifies a single nucleotide polymorphism associated with both residual feed intake and GFRA2. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - C Fitzsimons
- Department of Agriculture,Ireland, Celbridge, Ireland
| | - M McClure
- Genus PLC,Basingstoke, United Kingdom
| | | | - S Conroy
- Irish Cattle Breeding Federation,Cork, Ireland
| | | | - M McGee
- Teagasc, Animal and Grassland Research and Innovation Centre,Dunsany, Ireland
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21
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Brewster G, Parker MW, Epps F, Dye C, Higgins M, Bliwise DL, Hepburn K. DOES A PSYCHOEDUCATIONAL INTERVENTION WITH & WITHOUT EXERCISE AFFECT SLEEP QUALITY IN AFRICAN AMERICAN CAREGIVERS? Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- G Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States
| | - M W Parker
- Emory Alzheimer’s Disease Research Center, Atlanta, GA
| | - F Epps
- Byrdine F. Lewis College of Nursing and Health Professions, Atlanta, GA
| | | | - M Higgins
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - D L Bliwise
- Emory University School of Medicine, Atlanta, GA; Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - K Hepburn
- Nell Hodgson Woodruff School of Nursing, Atlanta, GA; Alzheimer’s Disease Research Center, Atlanta, GA
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22
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Brokaw EB, Fine MS, Kindschi KE, Santago Ii AC, Lum PS, Higgins M. Cross-sectional evaluation of visuomotor tracking performance following subconcussive head impacts. Technol Health Care 2018; 26:109-118. [PMID: 29125529 DOI: 10.3233/thc-171079] [Citation(s) in RCA: 4] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Repeated mild traumatic brain injury (mTBI) has been associated with increased risk of degenerative neurological disorders. While the effects of mTBI and repeated injury are known, studies have only recently started examining repeated subconcussive impacts, impacts that do not result in a clinically diagnosed mTBI. In these studies, repeated subconcussive impacts have been connected to cognitive performance and brain imaging changes. OBJECTIVE Recent research suggests that performance on a visuomotor tracking (VMT) task may help improve the identification of mTBI. The goal of this study was to investigate if VMT performance is sensitive to the cumulative effect of repeated subconcussive head impacts in collegiate men's lacrosse players. METHODS A cross-sectional, prospective study was completed with eleven collegiate men's lacrosse players. Participants wore helmet-mounted sensors and completed VMT and reaction time assessments. The relationship between cumulative impact metrics and VMT metrics were investigated. RESULTS In this study, VMT performance correlated with repeated subconcussive head impacts; individuals approached clinically diagnosed mTBI-like performance as the cumulative rotational velocity they experienced increased. CONCLUSION This suggests that repeated subconcussive impacts can result in measurable impairments and indicates that visuomotor tracking performance may be a useful tool for monitoring the effects of repeated subconcussive impacts.
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Affiliation(s)
- E B Brokaw
- Emerging Technologies Department, The MITRE Corporation, McLean, VA, USA
| | - M S Fine
- Emerging Technologies Department, The MITRE Corporation, McLean, VA, USA
| | - K E Kindschi
- Department of Sports Medicine, The MedStar Health Union Memorial Hospital, Baltimore, MD, USA
| | - A C Santago Ii
- Emerging Technologies Department, The MITRE Corporation, McLean, VA, USA
| | - P S Lum
- Center for Applied Biomechanics and Rehabilitation Research, The MedStar Health National Rehabilitation Hospital, Washington, DC, USA.,Department of Biomedical Engineering, The Catholic University of America, Washington, DC, USA
| | - M Higgins
- Kinesiology Department, Towson University, Towson, MD, USA
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23
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Volkova N, Evans J, Higgins M, Campbell D, Tian S, Simard C, Sewall A, Nyangoma S, Elbert A, Marshall B, Bilton D. IPD2.02 Real-world outcomes in patients with CF treated with ivacaftor: 2016 US and UK CF Registry analyses. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30286-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Rosenfeld M, Wainwright C, Mckee C, Higgins M, Wang L, Campbell D, Tian S, Schneider J, Cunningham S, Davies J. WS01.1 A phase 3, 2-part, single-arm study of ivacaftor treatment in patients <2 years with a CFTR gating mutation: results from the ARRIVAL study in patients 1 to 2 years. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30119-x] [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: 10/14/2022]
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25
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Volkova N, Evans J, Higgins M, Campbell D, Tian S, Simard C, Sewall A, Nyangoma S, Elbert A, Marshall B, Bilton D. IPD2.01 Disease progression in patients with CF treated with ivacaftor: analyses of real-world data from the US and UK CF Registries. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30285-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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26
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Mulligan K, Higgins M. Could undertaking qualitative research serve to develop clinical empathy at undergraduate level? Ir Med J 2018; 111:743. [PMID: 30468369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- K Mulligan
- UCD School of Medicine and Medical science, Health Sciences Centre, Belfield, Dublin 4
| | - M Higgins
- UCD School of Medicine and Medical science, Health Sciences Centre, Belfield, Dublin 4
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27
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Nugent K, O'Neill B, Lynch J, Higgins M, Brennan V, Dunne M, Skourou C. EP-1503: Rectal motion in patients receiving neoadjuvant radiotherapy for rectal cancer in supine position. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31812-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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28
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Higgins M, Burke O, Nugent K, Dunne M, Skourou C, Fitzpatrick D, Faul C. EP-1193: SRS to cavity post resection of intracranial metastases. A single centre experience 2013-2016. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31503-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Prior L, Teo M, Greally M, Ward C, O'Leary C, Aslam R, Darwish W, Ahmed N, Watson G, Kelly D, Kiely L, Hassan A, Gleeson J, Featherstone H, Lim M, Murray H, Gallagher D, Westrup J, Hennessy B, Leonard G, Grogan L, Breathnach O, Horgan A, Coate L, O'Mahony D, Coate L, O'Reilly S, Gupta R, Keane M, Duffy K, O'Connor M, Kennedy J, McCaffrey J, Higgins M, Kelly C, Carney D, Gullo G, Crown J, Walshe J. Abstract P6-08-17: Pregnancy associated breast cancer: Evaluating maternal outcomes. A multicentre study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-08-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Pregnancy associated breast cancer (PABC) is defined as breast cancer (BC) diagnosed during the gestational period (GP) or in the first year postpartum (PP). Despite its infrequent occurrence, the incidence of PABC appears to be rising due to the increasing propensity for women to delay childbirth. We have established the first combined prospective and retrospective registry study of PABC in Ireland to examine specific clinicopathological characteristics, treatments and maternal outcomes. We present the retrospective findings to date.
Methods
We performed a retrospective multicentre observational study of patients (pts) with PABC treated in the eight Irish cancer centres from August 2001 to March 2017. Data extracted included information on pt demographics, tumour biology, staging, treatment administered and maternal outcomes. Standard biostatistical methods were used for analysis.
Results
111 PABC patients were identified. Sixty pts (54%) were diagnosed during the GP and 51 (46%) within 1 year PP. Median age at diagnosis was 36 years (yrs). Table 1 illustrates baseline characteristics. Two thirds of pts were node positive and a similar proportion had grade 3 pathology. Seventy pts (63%) were estrogen receptor (ER) positive, 36 (32%) HER2 positive, 25 (22%) triple negative. Twenty-two pts (20%) were metastatic at presentation. Seven pts (6%) had a known BRCA 1/2 mutation. The median OS (overall survival) and DFS (disease free survival) for the entire cohort was 107.4 and 94.2 months respectively (resp). There was no survival difference between those diagnosed during the GP versus PP. 5 yr DFS and OS was 68.6% and 69.2% resp. This compares unfavourably to results reported by the National Cancer Registry of Ireland in a similar age-matched BC population between 2000-2012 where the 5 yr OS was 86.5%. Variables in our study associated with poorer outcomes included younger age, tumour size, node positivity and lack of estrogen expression.
Baseline characteristics PABC patients (n=11) %(n)Diagnosed in GP (n=60) %(n)Diagnosed 1yr PP (n=51) %(n)p valueDemographic Age at diagnosis3636(25-49)36(21-44)0.31Stage I-II54(60)55(33)53(27)0.85III23(26)23(14)23(12)1IV20(22)18(11)22(11)0.81Unknown3(3)3(2)2(1)1Pathology Grade 366(74)70(42)63(32)0.43Node positive66(73)68(41)63(32)0.55ER+/HER2-41(45)38(23)43(22)0.69ER+/HER2+23(25)28(17)16(8)0.17ER-/HER2+14(16)17(10)12(6)0.59Triple negative22(25)17(10)29(15)0.11Surgery Breast conservation23(26)25(15)21(11)0.82Mastectomy56(63)57(34)59(30)0.84Adjuavnt/Neoadjuvant treatment Chemotherapy73(81)77(46)69(35)0.39Anthracycline68(55)78(36)54(19)0.03Taxane89(72)93(43)83(29)0.16Anti HER2 agent21(23)18(11)24(12)0.63Endocrine therapy64(52)63(29)66(23)0.84Radiotherapy79(64)74(34)86(30)0.85Relapse in Stage I-III Local relapse15(13)12(6)18(7)0.55Distant relapse24(21)22(11)25(10)0.80
Conclusions
PABC patients may have a poorer outcome. Our study reported higher rates of triple negative and HER2 positive breast cancer which are associated with more aggressive biology. Prospective evaluation of clinicopathological features, pharmacokinetics of treatments selected and maternal and fetal outcomes is imperative in this distinct pt group.
Citation Format: Prior L, Teo M, Greally M, Ward C, O'Leary C, Aslam R, Darwish W, Ahmed N, Watson G, Kelly D, Kiely L, Hassan A, Gleeson J, Featherstone H, Lim M, Murray H, Gallagher D, Westrup J, Hennessy B, Leonard G, Grogan L, Breathnach O, Horgan A, Coate L, O'Mahony D, Coate L, O'Reilly S, Gupta R, Keane M, Duffy K, O'Connor M, Kennedy J, McCaffrey J, Higgins M, Kelly C, Carney D, Gullo G, Crown J, Walshe J. Pregnancy associated breast cancer: Evaluating maternal outcomes. A multicentre study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-17.
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Affiliation(s)
- L Prior
- Cancer Trials Ireland, Dublin, Ireland
| | - M Teo
- Cancer Trials Ireland, Dublin, Ireland
| | - M Greally
- Cancer Trials Ireland, Dublin, Ireland
| | - C Ward
- Cancer Trials Ireland, Dublin, Ireland
| | - C O'Leary
- Cancer Trials Ireland, Dublin, Ireland
| | - R Aslam
- Cancer Trials Ireland, Dublin, Ireland
| | - W Darwish
- Cancer Trials Ireland, Dublin, Ireland
| | - N Ahmed
- Cancer Trials Ireland, Dublin, Ireland
| | - G Watson
- Cancer Trials Ireland, Dublin, Ireland
| | - D Kelly
- Cancer Trials Ireland, Dublin, Ireland
| | - L Kiely
- Cancer Trials Ireland, Dublin, Ireland
| | - A Hassan
- Cancer Trials Ireland, Dublin, Ireland
| | - J Gleeson
- Cancer Trials Ireland, Dublin, Ireland
| | | | - M Lim
- Cancer Trials Ireland, Dublin, Ireland
| | - H Murray
- Cancer Trials Ireland, Dublin, Ireland
| | | | - J Westrup
- Cancer Trials Ireland, Dublin, Ireland
| | | | - G Leonard
- Cancer Trials Ireland, Dublin, Ireland
| | - L Grogan
- Cancer Trials Ireland, Dublin, Ireland
| | | | - A Horgan
- Cancer Trials Ireland, Dublin, Ireland
| | - L Coate
- Cancer Trials Ireland, Dublin, Ireland
| | | | - L Coate
- Cancer Trials Ireland, Dublin, Ireland
| | | | - R Gupta
- Cancer Trials Ireland, Dublin, Ireland
| | - M Keane
- Cancer Trials Ireland, Dublin, Ireland
| | - K Duffy
- Cancer Trials Ireland, Dublin, Ireland
| | | | - J Kennedy
- Cancer Trials Ireland, Dublin, Ireland
| | | | - M Higgins
- Cancer Trials Ireland, Dublin, Ireland
| | - C Kelly
- Cancer Trials Ireland, Dublin, Ireland
| | - D Carney
- Cancer Trials Ireland, Dublin, Ireland
| | - G Gullo
- Cancer Trials Ireland, Dublin, Ireland
| | - J Crown
- Cancer Trials Ireland, Dublin, Ireland
| | - J Walshe
- Cancer Trials Ireland, Dublin, Ireland
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Auerbach AJ, Higgins M, Brickman P, Andrews TC. Teacher Knowledge for Active-Learning Instruction: Expert-Novice Comparison Reveals Differences. CBE Life Sci Educ 2018; 17:17/1/ar12. [PMID: 29420184 PMCID: PMC6007764 DOI: 10.1187/cbe.17-07-0149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/13/2017] [Accepted: 12/08/2017] [Indexed: 05/13/2023]
Abstract
Active-learning strategies can improve science, technology, engineering, and mathematics (STEM) undergraduates' abilities to learn fundamental concepts and skills. However, the results instructors achieve vary substantially. One explanation for this is that instructors commonly implement active learning differently than intended. An important factor affecting how instructors implement active learning is knowledge of teaching and learning. We aimed to discover knowledge that is important to effective active learning in large undergraduate courses. We developed a lesson-analysis instrument to elicit teacher knowledge, drawing on the theoretical construct of teacher noticing. We compared the knowledge used by expert (n = 14) and novice (n = 29) active-learning instructors as they analyzed lessons. Experts and novices differed in what they noticed, with experts more commonly considering how instructors hold students accountable, topic-specific student difficulties, whether the instructor elicited and responded to student thinking, and opportunities students had to generate their own ideas and work. Experts were also better able to support their lesson analyses with reasoning. This work provides foundational knowledge for the future design of preparation and support for instructors adopting active learning. Improving teacher knowledge will improve the implementation of active learning, which will be necessary to widely realize the potential benefits of active learning in undergraduate STEM.
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Affiliation(s)
- A J Auerbach
- Department of Genetics, University of Georgia, Athens, GA 30602
| | - M Higgins
- Department of Genetics, University of Georgia, Athens, GA 30602
| | - P Brickman
- Department of Plant Biology, University of Georgia, Athens, GA 30602
| | - T C Andrews
- Department of Genetics, University of Georgia, Athens, GA 30602
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31
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Windrim CM, Crosby DA, Mitchell K, Brophy C, Mahony R, Higgins M. Vitamin D supplementation in pregnancy-a survey of compliance with recommendations. Ir J Med Sci 2017; 187:709-712. [PMID: 29159790 DOI: 10.1007/s11845-017-1707-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/23/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Vitamin D deficiency in pregnancy has important maternal and fetal implications, with increased risk of developing gestational diabetes, preeclampsia, preterm birth and small for gestational age birthweight. It is recommended that every pregnant woman should take 5 μg (200 IU) of vitamin D per day during pregnancy and lactation. AIMS This study aimed to determine the prevalence of women taking vitamin D supplementation and to identify the reasons for patients not taking supplementation within women attending an antenatal clinic in Dublin. METHODS Survey of women attending the antenatal clinic of the National Maternity Hospital Dublin during 2 weeks in January 2017. Women were asked to record demographics, medical comorbidities and use of vitamin D supplementation or any other supplements in pregnancy, as well as reasons for non-use if appropriate. RESULTS Three hundred women were invited to participate and 175 completed the questionnaire (58%). Overall, 38.9% (n = 68) reported to be taking vitamin D supplementation. Of the women that reported not to be taking vitamin D supplementation, 57.9% (n = 62) were taking a pregnancy multivitamin that contained vitamin D, and 28.0% (n = 30) did not know that it was recommended in pregnancy. Therefore, a total of 45 women (25.7%) in our cohort were taking no vitamin D supplementation during pregnancy. There was no difference in non-use based on maternal age, BMI, parity, or country of origin. CONCLUSIONS Of the women surveyed, 74.3% reported supplementation with vitamin D, either knowingly or unknowingly. Public health initiatives need to utilize this relatively safe, low-cost intervention to maximize maternal and fetal health. This could reduce the rates of antenatal conditions with associated high morbidity and healthcare burden such as gestational diabetes and preeclampsia.
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Affiliation(s)
- C M Windrim
- Obstetrics and Gynaecology, National Maternity Hospital, University College Dublin, Holles St, Dublin 2, Ireland
| | - D A Crosby
- Obstetrics and Gynaecology, National Maternity Hospital, University College Dublin, Holles St, Dublin 2, Ireland
| | - K Mitchell
- National Maternity Hospital, Dublin, Ireland
| | - C Brophy
- Midwifery, National Maternity Hospital, Dublin, Ireland
| | - R Mahony
- Obstetrics and Gynaecology, National Maternity Hospital, University College Dublin, Holles St, Dublin 2, Ireland
| | - M Higgins
- Obstetrics and Gynaecology, National Maternity Hospital, University College Dublin, Holles St, Dublin 2, Ireland.
- UCD Perinatal Research Center, National Maternity Hospital, University College Dublin, Dublin, Ireland.
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32
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Kelly C, Feighery R, McCaffrey J, Higgins M, Smith M, O'Reilly S, Murphy C, Horgan A, Walshe J, McDermott R, O'Donnell D, Morris P, Keane M, Martin M, Duffy K, Mihai A, Armstrong J, Mulroe E, Murphy V, Kelly C. Do oncology patients understand clinical trials? A nationwide study by Cancer Trials Ireland. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.068] [Citation(s) in RCA: 3] [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: 11/12/2022] Open
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33
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Kelly C, Feighery R, McCaffrey J, Higgins M, Smith M, O'Reilly S, Horgan A, Walshe J, McDermott R, O'Donnell D, Morris P, Keane M, Martin M, Murphy C, Duffy K, Mihai A, Armstrong J, Mulroe E, Murphy V, Kelly C. Decisions and supports around clinical trial participation: A national study by Cancer Trials Ireland. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx385.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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34
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Bessonova L, Volkova N, Higgins M, Bengtsson L, Tian S, Simard C, Sewall A, Nyangoma S, Elbert A, Bilton D. EPS5.10 Real-world outcomes in patients (pts) with cystic fibrosis (CF) treated with ivacaftor (IVA): analysis of 2015 US and UK CF registry data. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30321-1] [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: 10/19/2022]
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35
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Campbell S, Clohessy A, O’Brien C, Higgins S, Higgins M, McAuliffe F. Fetal anhydramnios following maternal non-steroidal anti-inflammatory drug use in pregnancy. Obstet Med 2017; 10:93-95. [PMID: 28680471 PMCID: PMC5480648 DOI: 10.1177/1753495x16686466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/15/2016] [Indexed: 10/31/2023] Open
Abstract
We present a case report of transient fetal anhydramnios following maternal non-steroidal anti-inflammatory drug use in pregnancy. This reduction in liquor volume resolved following cessation of the medication with no obvious ill-effect on neonatal outcome. The case report is followed by a comprehensive summary of the relevant literature.
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Affiliation(s)
- S Campbell
- Obstetrics & Gynaecology, National Maternity Hospital, Dublin, Ireland
| | - A Clohessy
- Pharmacy Department, National Maternity Hospital, Dublin, Ireland
| | - C O’Brien
- Ultrasound Department, National Maternity Hospital, Dublin, Ireland
| | - S Higgins
- University College Dublin/National Maternity Hospital, Dublin, Ireland
| | - M Higgins
- University College Dublin/National Maternity Hospital, Dublin, Ireland
| | - F McAuliffe
- University College Dublin/National Maternity Hospital, Dublin, Ireland
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36
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Bessonova L, Volkova N, Higgins M, Bengtsson L, Tian S, Simard C, Nyangoma S, Bilton D. 411 Disease progression in patients (pts) with cystic fibrosis (CF) treated with ivacaftor (IVA): analysis of real-world data from the UK CF Registry. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30741-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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37
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Higgins M. Susan Bewley (Ed.): My life as a woman and a doctor—Beulah Bewley. Ir J Med Sci 2017. [DOI: 10.1007/s11845-016-1533-4] [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: 11/29/2022]
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38
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Nugent K, McDermott R, Higgins M, O'Neill B. EP-1257: A look at pre-operative MRI accuracy at predicting rectal cancer staging post chemoradiotherapy. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31692-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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39
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Higgins M, Murphy J, Nugent K, O'Regan K, Kelly P. EP-1313: 18 F NaF PET use in prostate cancer staging in a single centre 2013-2016: retrospective review. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31748-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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40
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Chavarri-Guerra Y, St. Louis J, Bukowski A, Soto-Perez-de-Celis E, Liedke P, Symecko H, Moy B, Higgins M, Finkelstein D, Goss P. Real world patterns of care in HER2-overexpressing breast cancer: Results of a survey of TEACH clinical trial investigators in 2011. Breast 2017; 31:197-201. [DOI: 10.1016/j.breast.2016.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/05/2016] [Accepted: 11/18/2016] [Indexed: 01/13/2023] Open
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41
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Davies JC, Robertson S, Cooke J, Higgins M, Rosenfeld M. S112 Long-term safety and efficacy of ivacaftor in paediatric patients aged 2–5 years with cystic fibrosis and a CFTR gating mutation. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.118] [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]
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42
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Roseingrave R, Tuthill E, Higgins M. ’This One Things…’: facilitating communication in antenatal clinics at the National Maternity Hospital. Eur J Obstet Gynecol Reprod Biol 2016. [DOI: 10.1016/j.ejogrb.2016.07.258] [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]
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43
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Higgins M, Mcmorrow T. The development of a high-throughput assay to screen potential carcinogens by assessing cilia loss in renal epithelial cells. Toxicol Lett 2016. [DOI: 10.1016/j.toxlet.2016.06.1424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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44
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Kelly C, Smith M, Flynn S, Reyes A, Higgins M, McCaffrey J, Kelly C. Accrual to Cancer Clinical Trial. Ir Med J 2016; 109:436. [PMID: 27834087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Accrual to cancer clinical trials (CCT) is imperative to safeguard continued improvement in cancer outcomes. A retrospective chart review was performed of patients (n=140) starting a new anti-cancer agent in a north Dublin cancer centre. This review was performed over a four-month period, beginning in November 2015. Only 29% (n=41) had a CCT option. The overall accrual rate to CCT was 5% (n=7), which is comparable to internationally reported figures. The main reasons for failure to recruit to CCT included the lack of a CCT option for cancer type (n=30, 23%), stage (n=25, 19%), and line of treatment (n=23, 17%). Over the last decade, the rate of accrual to CCTs has in fact doubled and the number of trials open to recruitment has tripled. Ongoing governmental and philanthropic support is necessary to continue this trend to further expand CCT patient options with a target accrual rate of 10%.
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Affiliation(s)
- C Kelly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - M Smith
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - S Flynn
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - A Reyes
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - M Higgins
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - J McCaffrey
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - C Kelly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
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Brantley A, Collins-Brown S, Kirkland J, Knapp M, Pressley J, Higgins M, McMurtry JP. Clinical Trial of an Educational Program to Decrease Monitor Alarms in a Medical Intensive Care Unit. AACN Adv Crit Care 2016; 27:283-289. [DOI: 10.4037/aacnacc2016110] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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46
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Stalvey M, Niknian M, Higgins M, Tarn V, Heltshe S, Rowe S. 197 Ivacaftor improves linear growth in children with cystic fibrosis (CF) and a G551D-CTFR mutation: data from the ENVISION study. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30436-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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47
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Bai Y, Higgins M, Volkova N, Bengtsson L, Tian S, Sewall A, Nyangoma S, Elbert A, Bilton D. ePS03.2 Real-world outcomes in patients (pts) with cystic fibrosis (CF) treated with ivacaftor (IVA): analysis of 2014 US and UK CF registries. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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48
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Bai Y, Higgins M, Volkova N, Bengtsson L, Tian S, Sewall A, Nyangoma S, Elbert A, Bilton D. 25 Real-world outcomes in young (6- to 12-year-old) patients (pts) with cystic fibrosis (CF) treated with ivacaftor (IVA): analysis of 2014 US and UK CF registries data. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30265-x] [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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49
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Volkova N, Bai Y, Higgins M, Bengtsson L, Tian S, Nyangoma S, Bilton D. ePS03.1 Disease progression in patients (pts) with cystic fibrosis (CF) treated with ivacaftor (IVA): analysis of real-world data from the UK CF Registry. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30205-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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50
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O'Leary B, Khalid A, Higgins M. Early Pregnancy Ultrasound and Management: Effect of a Multifaceted Training on Physician Knowledge. Ir Med J 2016; 109:394. [PMID: 27685488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Vaginal bleeding is a common event in early pregnancy, with 20-40% of pregnancies affected. Prompt diagnosis and management of bleeding is important, both to reduce morbidity and to avoid excessive emotional distress. This was a prospective study of an educational programme aimed at Obstetrics and Gynaecology BST trainees in the National Maternity Hospital, Dublin. The educational programme consisted of didactic lectures, and simulation and practical sessions. A questionnaire reviewing early pregnancy complications was used to assess participant knowledge. Six trainees participated in the programme, with five (83%) answering the questionnaire. The pre-education questionnaire showed a generally poor level of knowledge of early pregnancy complications with 8/50 (16%) questions answered correctly. Following the educational intervention there was a statistically significant increase in participant knowledge with 45/50 (90%) questions answered correctly. A significant increase in participant knowledge of early pregnancy complications followed our multifaceted educational programme. Study limitations exist, however we have shown the potential value of our educational programme.
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Affiliation(s)
- B O'Leary
- UCD Obstetrics Gynaecology, National Maternity Hospital, Holles St, Dublin 2
| | - A Khalid
- UCD Obstetrics Gynaecology, National Maternity Hospital, Holles St, Dublin 2
| | - M Higgins
- UCD Obstetrics Gynaecology, National Maternity Hospital, Holles St, Dublin 2
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