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Kaptoge S, Seshasai SRK, Sun L, Walker M, Bolton T, Spackman S, Ataklte F, Willeit P, Bell S, Burgess S, Pennells L, Altay S, Assmann G, Ben-Shlomo Y, Best LG, Björkelund C, Blazer DG, Brenner H, Brunner EJ, Dagenais GR, Cooper JA, Cooper C, Crespo CJ, Cushman M, D'Agostino RB, Daimon M, Daniels LB, Danker R, Davidson KW, de Jongh RT, Donfrancesco C, Ducimetiere P, Elders PJM, Engström G, Ford I, Gallacher I, Bakker SJL, Goldbourt U, de La Cámara G, Grimsgaard S, Gudnason V, Hansson PO, Imano H, Jukema JW, Kabrhel C, Kauhanen J, Kavousi M, Kiechl S, Knuiman MW, Kromhout D, Krumholz HM, Kuller LH, Laatikainen T, Lowler DA, Meyer HE, Mukamal K, Nietert PJ, Ninomiya T, Nitsch D, Nordestgaard BG, Palmieri L, Price JF, Ridker PM, Sun Q, Rosengren A, Roussel R, Sakurai M, Salomaa V, Schöttker B, Shaw JE, Strandberg TE, Sundström J, Tolonen H, Tverdal A, Verschuren WMM, Völzke H, Wagenknecht L, Wallace RB, Wannamethee SG, Wareham NJ, Wassertheil-Smoller S, Yamagishi K, Yeap BB, Harrison S, Inouye M, Griffin S, Butterworth AS, Wood AM, Thompson SG, Sattar N, Danesh J, Di Angelantonio E, Tipping RW, Russell S, Johansen M, Bancks MP, Mongraw-Chaffin M, Magliano D, Barr ELM, Zimmet PZ, Knuiman MW, Whincup PH, Willeit J, Willeit P, Leitner C, Lawlor DA, Ben-Shlomo Y, Elwood P, Sutherland SE, Hunt KJ, Cushman M, Selmer RM, Haheim LL, Ariansen I, Tybjaer-Hansen A, Frikkle-Schmidt R, Langsted A, Donfrancesco C, Lo Noce C, Balkau B, Bonnet F, Fumeron F, Pablos DL, Ferro CR, Morales TG, Mclachlan S, Guralnik J, Khaw KT, Brenner H, Holleczek B, Stocker H, Nissinen A, Palmieri L, Vartiainen E, Jousilahti P, Harald K, Massaro JM, Pencina M, Lyass A, Susa S, Oizumi T, Kayama T, Chetrit A, Roth J, Orenstein L, Welin L, Svärdsudd K, Lissner L, Hange D, Mehlig K, Salomaa V, Tilvis RS, Dennison E, Cooper C, Westbury L, Norman PE, Almeida OP, Hankey GJ, Hata J, Shibata M, Furuta Y, Bom MT, Rutters F, Muilwijk M, Kraft P, Lindstrom S, Turman C, Kiyama M, Kitamura A, Yamagishi K, Gerber Y, Laatikainen T, Salonen JT, van Schoor LN, van Zutphen EM, Verschuren WMM, Engström G, Melander O, Psaty BM, Blaha M, de Boer IH, Kronmal RA, Sattar N, Rosengren A, Nitsch D, Grandits G, Tverdal A, Shin HC, Albertorio JR, Gillum RF, Hu FB, Cooper JA, Humphries S, Hill- Briggs F, Vrany E, Butler M, Schwartz JE, Kiyama M, Kitamura A, Iso H, Amouyel P, Arveiler D, Ferrieres J, Gansevoort RT, de Boer R, Kieneker L, Crespo CJ, Assmann G, Trompet S, Kearney P, Cantin B, Després JP, Lamarche B, Laughlin G, McEvoy L, Aspelund T, Thorsson B, Sigurdsson G, Tilly M, Ikram MA, Dorr M, Schipf S, Völzke H, Fretts AM, Umans JG, Ali T, Shara N, Davey-Smith G, Can G, Yüksel H, Özkan U, Nakagawa H, Morikawa Y, Ishizaki M, Njølstad I, Wilsgaard T, Mathiesen E, Sundström J, Buring J, Cook N, Arndt V, Rothenbacher D, Manson J, Tinker L, Shipley M, Tabak AG, Kivimaki M, Packard C, Robertson M, Feskens E, Geleijnse M, Kromhout D. Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation. Lancet Diabetes Endocrinol 2023; 11:731-742. [PMID: 37708900 PMCID: PMC7615299 DOI: 10.1016/s2213-8587(23)00223-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 12/15/2022] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy. METHODS For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU. FINDINGS For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43-2·97) when diagnosed at 30-39 years, 2·26 (2·08-2·45) at 40-49 years, 1·84 (1·72-1·97) at 50-59 years, 1·57 (1·47-1·67) at 60-69 years, and 1·39 (1·29-1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes. Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier. INTERPRETATION Every decade of earlier diagnosis of diabetes was associated with about 3-4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes. FUNDING British Heart Foundation, Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.
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Sanchez R, Duncker D, Colley B, Doering M, Gummadi S, Perings C, Robertson M, Shroff G, Veltmann
C. The Heart Failure Optimization Study (HF-OPT): rationale and design. Herzschrittmacherther Elektrophysiol 2023; 34:52-58. [PMID: 36695885 PMCID: PMC9950163 DOI: 10.1007/s00399-022-00920-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND According to the current guidelines, implantable cardioverter-defibrillators (ICD) for primary prevention in patients with heart failure and reduced ejection fraction (HFrEF) should not be considered until optimal guideline-directed medical therapy (GDMT) has been achieved for a minimum of 3 months. Optimization of GDMT often needs time beyond 3 months after diagnosis. The aim of the Heart Failure Optimization Study (HF-OPT) is to evaluate the recovery of left ventricular function beyond 3 months after diagnosis of newly diagnosed HFrEF. METHODS The HF-OPT multicenter study is comprised of two non-randomized phases (registry and study). During the first 90 days a wearable cardioverter-defibrillator (WCD) is prescribed and patients are enrolled in an observational pre-study registry. Registry subjects meeting inclusion criteria for the study portion at day 90 have ongoing left ventricular ejection fraction (LVEF) reassessment at 90, 180 and 360 days after the index hospital discharge, regardless of continued WCD use. Approximately 600 subjects will be enrolled in the study portion. Of those, one-third are anticipated to start the study phase at day 90 with reduced LVEF. The primary objective of this study is to observe the rate of recovery of LVEF > 35% between 90 and 180 days, while key secondary endpoints include mortality and WCD recorded arrhythmias and shocks. DISCUSSION The HF-OPT study will provide important information on the rate of additional recovery of LVEF > 35%, between 90 and 180 days, in newly diagnosed HF with reduced LVEF patients being titrated with GDMT. The results of the study may impact indications for primary prophylactic ICD implantation.
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Affiliation(s)
- R. Sanchez
- HCA Florida Heart Institute, St. Petersburg, FL USA
| | - D. Duncker
- Hannover Heart Rhythm Center, Hannover Medical School, Hannover, Germany
| | - B. Colley
- Jackson Heart Clinic, Jackson, MS USA
| | - M. Doering
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | - C. Perings
- Katholisches Klinikum Luenen, Luenen, Germany
| | | | - G. Shroff
- Baptist Heart Specialists, Jacksonville, FL USA
| | - C. Veltmann
- Hannover Heart Rhythm Center, Hannover Medical School, Hannover, Germany
- Center for Electrophysiology Bremen, Klinikum Links der Weser, Senator-Wessling-Str. 1, 28277 Bremen, Germany
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Sanchez R, Duncker D, Colley B, Doering M, Gummadi S, Perings C, Robertson M, Shroff G, Veltmann C. Publisher Erratum: The Heart Failure Optimization Study (HF‑OPT): rationale and design. Herzschrittmacherther Elektrophysiol 2023; 34:91. [PMID: 36786850 PMCID: PMC9950152 DOI: 10.1007/s00399-023-00928-5] [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: 02/15/2023]
Affiliation(s)
- R. Sanchez
- HCA Florida Heart Institute, St. Petersburg, FL USA
| | - D. Duncker
- Hannover Heart Rhythm Center, Hannover Medical School, Hannover, Germany
| | - B. Colley
- Jackson Heart Clinic, Jackson, MS USA
| | - M. Doering
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | - C. Perings
- Katholisches Klinikum Luenen, Luenen, Germany
| | | | - G. Shroff
- Baptist Heart Specialists, Jacksonville, FL USA
| | - C. Veltmann
- Hannover Heart Rhythm Center, Hannover Medical School, Hannover, Germany ,Center for Electrophysiology Bremen, Klinikum Links der Weser, Senator-Wessling-Str. 1, 28277 Bremen, Germany
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Etling MA, Vik TA, Janota AD, Liang KL, Kryder‐Reid CL, Robertson M, Scanlon C, Carson A, Agley J, Severance TS. The continuing evolution of a cancer prevention, screening, and survivorship
ECHO
: A second year of implementation. Cancer Med 2022; 12:7398-7405. [PMID: 36504440 PMCID: PMC10067045 DOI: 10.1002/cam4.5441] [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] [Received: 09/06/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION An estimated 39,010 Indiana residents were diagnosed with cancer in 2021. To address the cancer burden, Project ECHO (Extension Community Healthcare Outcomes) was launched in 2019 in Indiana to build specialty healthcare capacity among non-specialists. Due to positive outcomes from the pilot year, the Cancer Prevention, Screening, and Survivorship ECHO was implemented for a second year. The purpose of this study was to measure the participation and regional impact of this ECHO. METHODS ECHO sessions occurred twice monthly from October 2020 to October 2021. Changes were implemented in response to feedback from the pilot year, including making the curriculum more practical for learners and adding accreditation opportunities. Participant information and feedback was extracted from electronic surveys for review. RESULTS There were 24 ECHO sessions with 213 unique participants, increased from 140 unique participants in the pilot year. An average of 23.5 individuals attended each session, increased from 15.5 individuals per session. Enrolled participants served in a diverse set of roles and represented 247 zip codes, 30 Indiana counties, and 32 states across the United States, each of which increased from the pilot year. DISCUSSION In this second year, this ECHO expanded to reach more participants with increased attendance and a more diverse distribution of roles within healthcare, which may be attributed to feedback-driven curriculum design. Cancer care is multi-disciplinary, with health educators, nurses, and administrators, each acting within the cancer care continuum. As a result, this ECHO has been adapted to serve an increasingly broad distribution of professionals. CONCLUSION The second year of the Cancer Prevention, Screening, and Survivorship ECHO displayed increased overall enrollment and participation, greater diversity among participant roles, and a wider reach across Indiana and the United States.
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Affiliation(s)
- Mary Ann Etling
- Indiana University School of Medicine Indianapolis Indiana USA
- Indiana University Richard M. Fairbanks School of Public Health Indianapolis Indiana USA
| | - Terry A. Vik
- Indiana University School of Medicine Indianapolis Indiana USA
- Riley Hospital for Children Indianapolis Indiana USA
- Riley Hospital Division of Pediatric Hematology Oncology Indianapolis Indiana USA
| | - Andrea D. Janota
- Indiana University Richard M. Fairbanks School of Public Health Indianapolis Indiana USA
| | - Kaley L. Liang
- Indiana University Richard M. Fairbanks School of Public Health Indianapolis Indiana USA
| | | | - Mary Robertson
- Indiana Cancer Consortium Indianapolis Indiana USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center Indianapolis Indiana USA
| | | | - Anyé Carson
- Indiana University Richard M. Fairbanks School of Public Health Indianapolis Indiana USA
| | - Jon Agley
- Indiana University School of Public Health Bloomington Indiana USA
- Prevention Insights Bloomington Indiana USA
| | - Tyler S. Severance
- Indiana University School of Medicine Indianapolis Indiana USA
- Riley Hospital for Children Indianapolis Indiana USA
- Riley Hospital Division of Pediatric Hematology Oncology Indianapolis Indiana USA
- Department of Child Health University of Missouri School of Medicine Columbia Missouri USA
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Melegkovits E, Blumberg J, Dixon E, Ehntholt K, Gillard J, Kayal H, Kember T, Ottisova L, Walsh E, Wood M, Gafoor R, Brewin C, Billings J, Robertson M, Bloomfield M. The effectiveness of trauma-focused psychotherapy for complex post-traumatic stress disorder: A retrospective study. Eur Psychiatry 2022; 66:e4. [PMID: 36423898 PMCID: PMC9879871 DOI: 10.1192/j.eurpsy.2022.2346] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We retrospectively evaluated the effectiveness of trauma-focused psychotherapy (TF-P) versus stabilization and waiting in a civilian cohort of patients with an 11th version of the international classification of disease (ICD-11) diagnosis of complex post-traumatic stress disorder (CPTSD). METHODS We identified patients with CPTSD treated at a specialist trauma service over a 3-year period by triangulating evidence from self-report questionnaires, file review, and expert-clinician opinion. Patients completed a phase-based treatment: stabilization consisting of symptom management and establishing safety, followed by waiting for treatment (phase 1); individual TF-P in the form of trauma-focused cognitive behavioral therapy (TF-CBT), or eye movement desensitization and reprocessing (EMDR) or TF-CBT plus EMDR (phase 2). Our primary outcome was PTSD symptoms during phase 2 versus phase 1. Secondary outcomes included depressive symptoms, functional impairment, and a proxy CPTSD measure. Exploratory analysis compared outcomes between treatments. Adverse outcomes were recorded. RESULTS Fifty-nine patients were included. Compared to receiving only phase 1, patients completing TF-P showed statistically significant reductions in PTSD [t(58) = -3.99, p < 0.001], depressive symptoms [t(58) = -4.41, p < 0.001], functional impairment [t(58) = -2.26, p = 0.028], and proxy scores for CPTSD [t(58) = 4.69, p < 0.001]. There were no significant differences in outcomes between different treatments offered during phase 2. Baseline depressive symptoms were associated with higher PTSD symptoms and functional impairment. CONCLUSIONS This study suggests that TF-P effectively improves symptoms of CPTSD. However, prospective research with validated measurements is necessary to evaluate current and new treatments and identify personal markers of treatment effectiveness for CPTSD.
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Affiliation(s)
- Eirini Melegkovits
- Traumatic Stress Clinic, Division of Psychiatry, University College London, London, United Kingdom.,Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Jocelyn Blumberg
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Emily Dixon
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Kimberley Ehntholt
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Julia Gillard
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Hamodi Kayal
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Tim Kember
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Livia Ottisova
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Eileen Walsh
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Maximillian Wood
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Rafael Gafoor
- Research Department of Primary Care and Population Health, UCL, Royal Free Hospital, London, United Kingdom
| | - Chris Brewin
- Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Jo Billings
- Traumatic Stress Clinic, Division of Psychiatry, University College London, London, United Kingdom
| | - Mary Robertson
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Michael Bloomfield
- Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, United Kingdom.,Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, University College London, London, United Kingdom.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College Hospital, London, United Kingdom.,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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6
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Clerc O, Datar Y, Cuddy SAM, Bianchi G, Taylor A, Benz D, Robertson M, Kijewski MF, Jerosh-Herold M, Kwong RY, Ruberg FL, Liao R, Di Carli MF, Falk RH, Dorbala S. Cardiomyocyte stretch mediates the relation between left ventricular amyloid burden and adverse outcomes in light chain amyloidosis: a 18F-florbetapir positron emission tomography study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.319] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with light chain (AL) amyloidosis and cardiac involvement have poor prognosis. Mayo stage accounts for severity of plasma cell dyscrasia and cardiac biomarker release, and provides powerful risk stratification. Myocardial amyloid burden can be quantified by 18F-florbetapir positron emission tomography (PET), but its prognostic value is not known.
Purpose
To test our hypothesis that (1) myocardial amyloid burden predicts adverse outcomes and (2) the relationship between amyloid burden and adverse outcomes is mediated by cardiomyocyte stretch and injury. Amyloid burden was estimated by left ventricular 18F-florbetapir retention index (RI) and cardiomyocyte stretch and injury by NT proBNP and troponin T respectively.
Methods
We performed 18F-florbetapir PET (median dose 9.05 mCi) in prospectively enrolled subjects with newly diagnosed AL amyloidosis with abnormal cardiac biomarkers or with normal cardiac biomarkers and normal left ventricular wall thickness (NCT02641145). Left ventricular RI was calculated as the activity concentration between 10 and 30 min. after injection divided by the integral of the left atrial blood time-activity curve from 0 to 20 min. RI was categorized as normal (<0.06/min, based on controls), increased (0.06–0.12/min), or high risk (>0.12/min, based on log-rank statistic maximization). Mayo stages I–IV were based on elevated serum cardiac biomarkers: NT-proBNP ≥1800 pg/ml, troponin T ≥0.025 ng/ml, and difference in free light chains ≥180 mg/l. Adverse outcomes of all-cause death or heart failure hospitalization were evaluated. Survival analysis was performed using Kaplan-Meier and Cox regression including Mayo stage and RI. Mediation analysis was used to elucidate the role of cardiomyocyte stretch (as NT-proBNP) and injury (as troponin T) in the association between amyloid burden estimated by RI and adverse outcomes.
Results
We studied 80 subjects with median age 62 years (IQR 57–67), 46 men (57%), 60 with abnormal cardiac biomarkers (75%), and median RI of 0.10/min (IQR 0.06–0.16). At follow-up (median 15 months), adverse outcomes occurred in 34 subjects (42%), with 17 deaths (21%) and 23 heart failure hospitalizations (29%). The incidence of adverse outcomes increased across Mayo stages from 9% to 44% (log-rank p<0.001), and across RI levels from 29% to 57% (log-rank p=0.037, Figure 1). In multivariable Cox regression, only Mayo stage independently predicted adverse outcomes (HR 2.0 [95% CI 1.4–3.0], p<0.001). Multivariable mediation analysis showed that 83% of the association between RI and adverse outcomes was mediated by NT-proBNP (p<0.001, Figure 2), without contribution from troponin T.
Conclusion
Myocardial amyloid burden estimated by F-18 florbetapir RI predicts adverse outcomes in AL amyloidosis, but not independently of Mayo stage. Cardiomyocyte stretch mediates the relationship between myocardial amyloid burden and adverse outcomes in AL amyloidosis.
Funding Acknowledgement
Type of funding sources: Private company.
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Affiliation(s)
- O Clerc
- Brigham and Women's Hospital , Boston , United States of America
| | - Y Datar
- Boston University School of Medicine , Boston , United States of America
| | - S A M Cuddy
- Brigham and Women's Hospital , Boston , United States of America
| | - G Bianchi
- Brigham and Women's Hospital , Boston , United States of America
| | - A Taylor
- Brigham and Women's Hospital , Boston , United States of America
| | - D Benz
- Brigham and Women's Hospital , Boston , United States of America
| | - M Robertson
- Brigham and Women's Hospital , Boston , United States of America
| | - M F Kijewski
- Brigham and Women's Hospital , Boston , United States of America
| | - M Jerosh-Herold
- Brigham and Women's Hospital , Boston , United States of America
| | - R Y Kwong
- Brigham and Women's Hospital , Boston , United States of America
| | - F L Ruberg
- Boston University School of Medicine , Boston , United States of America
| | - R Liao
- Stanford University Medical Center , Stanford , United States of America
| | - M F Di Carli
- Brigham and Women's Hospital , Boston , United States of America
| | - R H Falk
- Brigham and Women's Hospital , Boston , United States of America
| | - S Dorbala
- Brigham and Women's Hospital , Boston , United States of America
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Ottisova L, Gillard JA, Wood M, Langford S, John-Baptiste Bastien R, Madinah Haris A, Wild J, Bloomfield MAP, Robertson M. Effectiveness of psychosocial interventions in mitigating adverse mental health outcomes among disaster-exposed health care workers: A systematic review. J Trauma Stress 2022; 35:746-758. [PMID: 35182077 DOI: 10.1002/jts.22780] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 02/01/2023]
Abstract
Health care workers worldwide are at an increased risk of a range of adverse mental health outcomes, including posttraumatic stress disorder (PTSD), following the unprecedented demand placed upon them during the COVID-19 pandemic. Psychosocial interventions offered to mitigate these risks should be based on the best available evidence; however, limited information regarding the comparative effectiveness of interventions is available. We undertook a systematic review of psychosocial interventions delivered to health care workers before, during, and after disasters. Eight databases were searched, including the Cochrane Central Register of Controlled Trials, PubMed/MEDLINE, EMBASE, and PsycINFO. Our primary outcomes were changes in symptoms of PTSD, anxiety, depression, and sleep. We calculated effect sizes, where unreported, and reliable change indices to appraise intervention effectiveness. The study was registered with PROSPERO (CRD42020182774). In total, 12,198 papers were screened, 14 of which were included in the present review. Interventions based on evidence-based protocols, including individual and group-based cognitive behavioral therapy (CBT) for PTSD, anxiety, and depression were found to lead to reliable changes in PTSD and anxiety symptoms. Single-session debriefing and psychological first aid workshops showed limited efficacy. There is limited evidence on psychosocial interventions for health care workers faced with disasters, with the strongest evidence base for CBT-based approaches. Future research should include controlled evaluations of interventions and aim to target identified risk factors.
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Affiliation(s)
- Livia Ottisova
- Traumatic Stress Clinic, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Julia A Gillard
- Traumatic Stress Clinic, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Maximillian Wood
- Traumatic Stress Clinic, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Sarah Langford
- Traumatic Stress Clinic, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Rayanne John-Baptiste Bastien
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Institute of Mental Health, University College London, United Kingdom
| | - Aishah Madinah Haris
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Institute of Mental Health, University College London, United Kingdom
| | - Jennifer Wild
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Michael A P Bloomfield
- Traumatic Stress Clinic, Camden and Islington NHS Foundation Trust, London, United Kingdom.,Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Institute of Mental Health, University College London, United Kingdom.,University College London Hospitals NHS Foundation Trust, United Kingdom.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Mary Robertson
- Traumatic Stress Clinic, Camden and Islington NHS Foundation Trust, London, United Kingdom
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Greenstadt E, Walsh-Buhi ML, Robertson M, Dao B, Walsh-Buhi ER. "While You're Down There": The Unexplored Role of Estheticians in the Health of Their Clients. J Sex Res 2022; 59:321-329. [PMID: 33225767 DOI: 10.1080/00224499.2020.1840498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Young women (18-25 years) are more likely to engage in pubic hair removal and experience higher rates of negative sexual health outcomes (e.g., sexually transmitted infections [STIs]). Hair removal salons may serve as novel environments for health interventions. The Sexual Health and Esthetician (SHE) Study aimed to better understand the pubic hair removal profession, explore the esthetician-client relationship, and assess potential for esthetician offices/salons serving as health promotion/sexual health promotion intervention settings. Using an exploratory qualitative design, in-depth interviews (N = 28) were conducted with licensed estheticians who provided pubic waxing services. In a large urban area in Southern California, the catchment area of salons included five unique neighborhoods, each with high reported STI rates. Data were analyzed using a social constructivist perspective and emergent themes from interviews. Synthesis of data showed estheticians provide a variety of waxing services for young women; during appointments, sex-related discussions occur, creating "sexy spaces" where otherwise taboo conversations happen with ease; they notice clients' possible health concerns, including STIs, but have no protocols/procedures for handling these occurrences; and interactions with clients often result in the development of an intimate bond. Results indicate estheticians may be effective conveyors of sexual health promotion and risk reduction interventions.
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Affiliation(s)
- Emily Greenstadt
- Family Medicine and Public Health, University of California San Diego Health
| | | | | | - Brandon Dao
- College of Osteopathic Medicine, New York Institute of Technology
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Greene T, El-Leithy S, Billings J, Albert I, Birch J, Campbell M, Ehntholt K, Fortune L, Gilbert N, Grey N, Hana L, Kennerley H, Lee D, Lunn S, Murphy D, Robertson M, Wade D, Brewin CR, Bloomfield MAP. Anticipating PTSD in severe COVID survivors: the case for screen-and-treat. Eur J Psychotraumatol 2022; 13:1959707. [PMID: 35096282 PMCID: PMC8797726 DOI: 10.1080/20008198.2021.1959707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Based on research from previous pandemics, studies of critical care survivors, and emerging COVID-19 data, we estimate that up to 30% of survivors of severe COVID will develop PTSD. PTSD is frequently undetected across primary and secondary care settings and the psychological needs of survivors may be overshadowed by a focus on physical recovery. Delayed PTSD diagnosis is associated with poor outcomes. There is a clear case for survivors of severe COVID to be systematically screened for PTSD, and those that develop PTSD should receive timely access to evidence-based treatment for PTSD and other mental health problems by multidisciplinary teams.
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Affiliation(s)
- Talya Greene
- Department of Community Mental Health, University of Haifa, Haifa, Israel.,Division of Psychiatry, Institute of Mental Health, University College London, London, UK
| | - Sharif El-Leithy
- Traumatic Stress Service, South West London & St George's Mental Health NHS Trust, London, UK
| | - Jo Billings
- Division of Psychiatry, Institute of Mental Health, University College London, London, UK
| | - Idit Albert
- Centre for Anxiety Disorders and Trauma, South London & Maudsley NHS Trust, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jennifer Birch
- Department of Clinical Psychology and Psychology Therapies, Norwich Medical School, University of East Anglia, Norwich, UK.,Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | - Kim Ehntholt
- The Traumatic Stress Clinic, St Pancras Hospital, Camden & Islington NHS Foundation Trust, London, UK
| | - Lorna Fortune
- Barnet Enfield & Haringey MHT, London, UK.,North Middlesex University Hospital NHS Trust, London, UK
| | | | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Sussex, UK.,School of Psychology, University of Sussex, Brighton, UK
| | - Laurinne Hana
- The Traumatic Stress Clinic, St Pancras Hospital, Camden & Islington NHS Foundation Trust, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | - Helen Kennerley
- Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK.,Oxford Cognitive Therapy Centre, University of Oxford, Oxford, UK
| | - Deborah Lee
- Berkshire Traumatic Stress Service, Berkshire Foundation NHS Trust, Reading, UK
| | - Sarah Lunn
- The Traumatic Stress Clinic, St Pancras Hospital, Camden & Islington NHS Foundation Trust, London, UK.,Whittington Health NHS Trust, London, UK
| | - Dominic Murphy
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mary Robertson
- The Traumatic Stress Clinic, St Pancras Hospital, Camden & Islington NHS Foundation Trust, London, UK
| | - Dorothy Wade
- Critical Care Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Michael A P Bloomfield
- The Traumatic Stress Clinic, St Pancras Hospital, Camden & Islington NHS Foundation Trust, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK.,Translational Psychiatry Research Group, Department of Mental Health Neuroscience, Division of Psychiatry, Institute of Mental Health, University College London, London, UK.,National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK
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10
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Severance TS, Milgrom Z, Carson A, Scanlon CM, Chauhan O'Brien R, Anderson B, Robertson M, Janota A, Coven SL, Mendonca EA, Duwve J, Vik TA. Cancer prevention, screening, and survivorship ECHO: A pilot experience with an educational telehealth program. Cancer Med 2021; 11:238-244. [PMID: 34816614 PMCID: PMC8704156 DOI: 10.1002/cam4.4421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction The American Cancer Society, Inc. (ACS) estimates that 37,940 Indiana residents were diagnosed with cancer in 2020, which remains the leading cause of death in the state. Across the cancer continuum, national goals have been established targeting recommended benchmarks for states in prevention, screening, treatment, and survivorship. Indiana consistently falls below most goals for each of these targeted categories. Methods To address these disparities, we implemented Project ECHO (Extension for Community Healthcare Outcomes) as a virtual telehealth educational platform targeted at local healthcare providers. ECHO programs utilize a novel tele‐mentoring approach to the education of clinicians in a hub/spoke design. Sessions occurred twice monthly from September 2019 to September 2020 and consisted of a traditional didactic lecture and a case‐based discussion led by participating providers. Results During the pilot year there were a total of 22 ECHO sessions with 140 different participants. On average, 15.5 spokes attended each session with increasing participation at the end of the year. Post‐session surveys suggested generally favorable perception with 72% of respondents finding the quality “excellent.” Discussion Given the increasing rate of recurrent participation toward the end of the pilot year in conjunction with the favorable survey responses following each session, it was felt that the program was overall successful and warranted continued implementation. Conclusion The Project ECHO platform is a validated telehealth education platform that has the potential to impact cancer care at multiple points along the cancer continuum at the regional level.
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Affiliation(s)
- Tyler S Severance
- Riley Hospital for Children, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, Indiana, USA.,Riley Hospital Division of Pediatric Hematology Oncology, Indianapolis, Indiana, USA
| | - Zheng Milgrom
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA.,Regenstrief Institute, Indianapolis, Indiana, USA
| | - Anyé Carson
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | | | | | - Brent Anderson
- Indiana State Department of Health, Indianapolis, Indiana, USA
| | | | - Andrea Janota
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Scott L Coven
- Riley Hospital for Children, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, Indiana, USA.,Riley Hospital Division of Pediatric Hematology Oncology, Indianapolis, Indiana, USA
| | - Eneida A Mendonca
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Regenstrief Institute, Indianapolis, Indiana, USA
| | - Joan Duwve
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Terry A Vik
- Riley Hospital for Children, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, Indiana, USA.,Riley Hospital Division of Pediatric Hematology Oncology, Indianapolis, Indiana, USA.,Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
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11
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Keighley C, Garnham K, Harch SAJ, Robertson M, Chaw K, Teng JC, Chen SCA. Candida auris: Diagnostic Challenges and Emerging Opportunities for the Clinical Microbiology Laboratory. Curr Fungal Infect Rep 2021; 15:116-126. [PMID: 34178208 PMCID: PMC8220427 DOI: 10.1007/s12281-021-00420-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 12/24/2022]
Abstract
Purpose of Review This review summarises the epidemiology of Candida auris infection and describes contemporary and emerging diagnostic methods for detection and identification of C. auris. Recent Findings A fifth C. auris clade has been described. Diagnostic accuracy has improved with development of selective/differential media for C. auris. Advances in spectral databases of matrix-associated laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS) systems have reduced misidentification. Direct detection of C. auris in clinical specimens using real time PCR is increasingly used, as is whole genome sequencing (WGS) to track nosocomial spread and to study phylogenetic relationships and drug resistance. Summary C. auris is an important transmissible, nosocomial pathogen. The microbiological laboratory diagnostic capacity has extended beyond culture-based methods to include PCR and WGS. Microbiological techniques on the horizon include the use of MALDI-TOF MS for early echinocandin antifungal susceptibility testing (AST) and expansion of the versatile and information-rich WGS methods for outbreak investigation.
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Affiliation(s)
- C Keighley
- Marie Bashir Institute for Infectious Diseases and Biosecurity, Wollongong, NSW Australia.,Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead, Sydney, Australia.,Southern.IML Pathology, Sonic Healthcare, Sydney, NSW Australia.,The University of Sydney, Camperdown, NSW 2605 Australia
| | - K Garnham
- Royal North Shore Hospital, New South Wales Health Pathology, Sydney, NSW Australia
| | - S A J Harch
- Department of Microbiology and Infectious Diseases, SA Pathology, Adelaide, South Australia Australia.,Central Adelaide Local Health Network, Adelaide, South Australia Australia
| | - M Robertson
- Gosford Hospital, New South Wales Health Pathology, Gosford, NSW Australia
| | - K Chaw
- Pathology Queensland, Herston, QLD Australia
| | - J C Teng
- Melbourne Pathology, Sonic Healthcare, Melbourne, VIC Australia
| | - S C-A Chen
- Marie Bashir Institute for Infectious Diseases and Biosecurity, Wollongong, NSW Australia.,Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead, Sydney, Australia
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12
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Oliveira B, Barakat F, Robertson M, Ford I, Macdougall C, Okonko D. POS-281 Prognostic Significance of Erythropoiesis-Stimulating Agent Dose Requirements in PIVOTAL and its Implications for the Potential Mechanisms of IV Iron Benefit in Maintenance Haemodialysis Patients. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.296] [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] Open
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13
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Hamilton C, Hamilton C, Robertson M, Arbaje A, Sheikh F, Bellantoni M. "What Is a Care Plan?": A Qualitative Assessment of Nursing Home Resident's Perspectives. J Am Med Dir Assoc 2021; 22:B18-B19. [PMID: 34287162 DOI: 10.1016/j.jamda.2021.01.089] [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: 11/28/2022]
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14
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Innes N, Johnson IG, Al-Yaseen W, Harris R, Jones R, Kc S, McGregor S, Robertson M, Wade WG, Gallagher JE. A systematic review of droplet and aerosol generation in dentistry. J Dent 2020; 105:103556. [PMID: 33359043 PMCID: PMC7834118 DOI: 10.1016/j.jdent.2020.103556] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/28/2020] [Accepted: 12/08/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES This review aimed to identify which dental procedures generate droplets and aerosols with subsequent contamination, and for these, characterise their pattern, spread and settle. DATA RESOURCES Medline(OVID), Embase(OVID), Cochrane Central Register of Controlled Trials, Scopus, Web of Science and LILACS databases were searched for eligible studies from each database's inception to May 2020 (search updated 11/08/20). Studies investigating clinical dental activities that generate aerosol using duplicate independent screening. Data extraction by one reviewer and verified by another. Risk of bias assessed through contamination measurement tool sensitivity assessment. STUDY SELECTION A total eighty-three studies met the inclusion criteria and covered: ultrasonic scaling (USS, n = 44), highspeed air-rotor (HSAR, n = 31); oral surgery (n = 11), slow-speed handpiece (n = 4); air-water (triple) syringe (n = 4), air-polishing (n = 4), prophylaxis (n = 2) and hand-scaling (n = 2). Although no studies investigated respiratory viruses, those on bacteria, blood-splatter and aerosol showed activities using powered devices produced greatest contamination. Contamination was found for all activities, and at the furthest points studied. The operator's torso, operator's arm and patient's body were especially affected. Heterogeneity precluded inter-study comparisons but intra-study comparisons allowed construction of a proposed hierarchy of procedure contamination risk: higher (USS, HSAR, air-water syringe, air polishing, extractions using motorised handpieces); moderate (slow-speed handpieces, prophylaxis, extractions) and lower (air-water syringe [water only] and hand scaling). CONCLUSION Gaps in evidence, low sensitivity of measures and variable quality limit conclusions around contamination for procedures. A hierarchy of contamination from procedures is proposed for challenge/verification by future research which should consider standardised methodologies to facilitate research synthesis. CLINICAL SIGNIFICANCE This manuscript addresses uncertainty around aerosol generating procedures (AGPs) in dentistry. Findings indicate a continuum of procedure-related aerosol generation rather than the common binary AGP or non-AGP perspective. The findings inform discussion around AGPs and direct future research to support knowledge and decision making around COVID-19 and dental procedures.
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Affiliation(s)
- N Innes
- Applied Clinical Research and Public Health, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
| | - I G Johnson
- Applied Clinical Research and Public Health, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - W Al-Yaseen
- Applied Clinical Research and Public Health, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - R Harris
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - R Jones
- Education, Scholarship and Innovation, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, UK
| | - S Kc
- Faculty of Dentistry, Oral & Craniofacial Sciences King's College London, London, UK
| | - S McGregor
- Library & Learning Centre, University of Dundee, Dundee, UK
| | - M Robertson
- Child Dental and Oral Health, School of Dentistry, University of Dundee, Dundee, UK
| | - W G Wade
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - J E Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences King's College London, London, UK
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15
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Burch A, Sears S, Doring M, Gummadi S, Robertson M, Sanchez R, Shroff G, Veltmann C. Change in health-related quality of life among patients with a reduced ejection fraction initiating guideline-directed medical therapy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3431] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Management of patients with heart failure (HF) should include patient reported outcomes (PROs). The Kansas City Cardiomyopathy Questionnaire is self-administered with subscales to evaluate HF symptom burden, physical limitations, social limitations (recreational participation), and quality of life (QoL). Change in PROs among newly diagnosed patients with HF and reduced ejection fraction (HFrEF) prescribed a wearable cardioverter defibrillator (WCD) and initiating guideline-directed medical therapy (GDMT) has not been assessed.
Purpose
Examine PROs over 180 days of receiving GDMT for newly diagnosed HFrEF.
Methods
Patients (n=93, 75.3% male) were enrolled ≤10 days post-hospitalization for new onset HF; all patients had an EF ≤35% and were prescribed a WCD. Health status, as measured by PRO was assessed at baseline, day 90, and day 180. Controlling for age and EF at baseline, changes in PROs over the 180-day study period were evaluated using repeated measures modeling. Pairwise comparisons with Bonferroni adjustments were used to compare adjacent timepoints. Higher scores reflect better health status.
Results
After controlling for age (mean 56±13.4) and baseline EF (mean 22±7.7) improvements in health status were observed. From baseline to day 90, physical limitation, symptom frequency, QoL, and the summary score all increased (Δ: 17.8, 23.7, 28.4, 23.7, respectively; all p's <0.05). From day 90 to day 180, only QoL continued to improve (Δ 7.5, p=0.001). Change in social limitations over time was not significant (p=0.42).
Conclusion
Patients report improved health status in the months following a new diagnosis of HFrEF when prescribed a WCD and GDMT.
Change in Quality of Life
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Burch
- East Carolina University, Greenville, United States of America
| | - S.F Sears
- East Carolina University, Greenville, United States of America
| | - M Doring
- Leipzig Heart Institute GmbH, Leipzig, Germany
| | - S Gummadi
- Cardiovascular Institute of Central Florida, Ocala, United States of America
| | - M Robertson
- Trinity Medical, Buffalo, United States of America
| | - R Sanchez
- The Heart Institute, Saint Petersburg, United States of America
| | - G Shroff
- Baptist Heart Specialists, Jacksonville, United States of America
| | - C Veltmann
- Medizinische Hochschule Hannover, Hannover, Germany
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16
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Billings J, Greene T, Kember T, Grey N, El-Leithy S, Lee D, Kennerley H, Albert I, Robertson M, Brewin CR, Bloomfield MAP. Supporting Hospital Staff During COVID-19: Early Interventions. Occup Med (Lond) 2020; 70:327-329. [PMID: 32449752 PMCID: PMC7313813 DOI: 10.1093/occmed/kqaa098] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Jo Billings
- Division of Psychiatry, University College London, London, UK
| | - Talya Greene
- Division of Psychiatry, University College London, London, UK.,Community Mental Health Department, University of Haifa, Haifa, Israel
| | - Tim Kember
- Traumatic Stress Clinic, Camden & Islington NHS Foundation Trust, London, UK
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Worthing, UK.,University of Sussex, Sussex, UK
| | - Sharif El-Leithy
- Traumatic Stress Service, South West London and St George's Mental Health NHS Trust, London, UK
| | - Deborah Lee
- Traumatic Stress Service, Berkshire Healthcare NHS Foundation Trust, Reading, UK
| | - Helen Kennerley
- Oxford Cognitive Therapy Centre, University of Oxford, Oxford, UK
| | - Idit Albert
- Centre for Anxiety Disorders and Trauma, South London & Maudsley NHS Foundation Trust, London, UK.,Kings College London, London, UK
| | - Mary Robertson
- Traumatic Stress Clinic, Camden & Islington NHS Foundation Trust, London, UK
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Michael A P Bloomfield
- Division of Psychiatry, University College London, London, UK.,Traumatic Stress Clinic, Camden & Islington NHS Foundation Trust, London, UK.,NIHR UCL Biomedical Research Centre, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
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17
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Billings J, Greene T, Kember T, Grey N, El-Leithy S, Lee D, Kennerley H, Albert I, Robertson M, Brewin CR, Bloomfield MAP. Corrigendum to: Supporting Hospital Staff During COVID-19: Early Interventions. Occup Med (Lond) 2020; 70:453. [PMID: 32614040 PMCID: PMC7337825 DOI: 10.1093/occmed/kqaa121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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18
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Leon M, Carrubba A, Robertson M, Dinh T. 79: Avoiding oophorectomy in acute ovarian torsion. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.228] [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]
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19
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Gokal R, Mistry CD, Peers E, Brown C, Smith S, Edwards D, Junor B, Gordon A, McMillan M, Robertson M, Michael J, McKain J, Raftery M, Peters J, Clutterbuck E, Clemenger M, Walls J, Orton C, Goodship T, Grieves J, Dharmasena D, Hourhane G, Howarth D, Boyes R, Clisby L, Beran Y. A United Kingdom Multicenter Study of Icodextrin in Continuous Ambulatory Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089401402s03] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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] Open
Abstract
While glucose remains the only osmotic agent used universally for peritoneal dialysis, its various shortcomings for the long dwell equilibration continuous ambulatory peritoneal dialysis (CAPD) has led to a search for alternative agents. The large molecular weight group has been of interest, because these agents theoretically would lead to greater ultrafiltration and a better metabolic profile. Mostsubstances (dextrans, charged macromolecules) have been found unsuitable for reasons of insolubility, allergenicity, and peritoneal toxicity. Short-chain polypeptides have been studied in humans, but the experience is limited, and there is the potential for allergenicity with long-term use. The only large molecular weight agent that has been studied in some detail but hitherto in one center only and in a limited number of patients is glucose polymer (generic name, icodextrin). Because of the promise shown by these initial studies, a randomized controlled multicenter investigation of icodextrin in CAPD (MIDAS Study Group) was undertaken to evaluate the long-term safety and efficacy by comparing daily overnight (8 12 hours) use of a slightly hypo-osmolar solution (282 mOsm/ kg) with 1.36% (346 mOsm/kg) and 3.86% (484 mOsm/kg) glucose exchanges. Over a 6-month period 209 patients from 11 centers in the United Kingdom were randomized, with 106 allocated to receive icodextrin (study group) and 103 to remain on glucose (control group). One hundred and thirty-eight patients completed the 6-month study (71 control, 67 study). The mean net ultrafiltration overnight with icodextrin was 3.5 times greater than 1.36% at 8 hours and 5.5 times greater at 12 hours (p<0.0001), but no different from that of 3.86% glucose at 8 and 12 hours (although for the latter dwell the net mean ultrafiltration volume was greater by about 140 mL). Biochemical profiles were no different except for a small fall in serum sodium and chloride in the icodextrin group. The mean serum maltose rose to a steady-state level of 1.2 g/L within 2 weeks and remained stable. The mean carbohydrate absorbed for icodextrin (29±5 g) was lower than with 3.86% glucose (62±5 g). The use of icodextrin did not increase the incidence of peritonitis, nor did it alter its outcome, affect uptake of icodextrin from the peritoneum, alter serum osmolality or sodium levels. There were no adverse effects associated with the use of icodextrin, and the overall CAPD-related symptom score was significantly better for icodextrin than control subjects. This study and subsequent extensive use and clinical experience has demonstrated that the daily use of an iso-osmolar icodextrin solution is generally well tolerated, effective, and could replace the overnight use of hyperosmotic glucose solution. Its use was of equal efficacy in peritonitis and in diabetic patients. The elevated levels of maltose did not appear to have any clinical side effects.
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Affiliation(s)
- Ram Gokal
- Manchester RoyalInfirmary, Manchester
| | | | | | | | - S. Smith
- (Northern General Hospital, Sheffield)
| | | | | | | | | | | | | | - J. McKain
- (Queen Elizabeth Hospital, Birmingham)
| | | | | | | | | | - J. Walls
- (Leicester General Hospital, Leicester)
| | - C. Orton
- (Leicester General Hospital, Leicester)
| | | | - J. Grieves
- (Royal Victoria Hospital, NewcastleUpon-Tyne)
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20
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Gokal R, Mistry CD, Peers EM, Brown C, Smith S, Edwards D, Junor B, Gordon A, McMillan M, Robertson M, Michael J, McKain J, Raftery M, Peters J, Clutterbuck E, Clemenger M, Walls J, Orton C, Goodship T, Grieves J, Olubodun J, Jackson F, Dharmasena D, Hourahane G, Howarth D, Boyes R, Clisby L, Beran Y. Peritonitis Occurrence in a Multicenter Study of Icodextrin and Glucose in Capd. Perit Dial Int 2020. [DOI: 10.1177/089686089501506s07] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To compare peritonitis occurrence and outcome in a large U.K. study Multicentre Investigation of Icodextrin in Ambulatory Dialysis (MIDAS). Design Prospective, randomized, controlled 6-month comparison of icodextrin with glucose for the long dwell in continuous ambulatory peritoneal dialysis (CAPD) patients. Setting Eleven CAPD units in U.K. teaching hospitals. Patients A total of 209 patients established on CAPD for at least 3 months (103 control, 106 icodextrin). Twentythree control (C) and 22 icodextrin (I) patients experienced peritonitis during the study. Intervention Patients who had peritonitis remained on treatment (unless CAPD was withdrawn, temporarily or permanently). Main Outcome Measures The main outcome measures were the rate of peritonitis and duration of CAPD treatment prestudy; the rate of peritonitis episodes and their outcome during study; the effect of peritonitis on laboratory variables, serum icodextrin metabolites, and ultrafiltration efficacy. Results Prestudy: Nine (39%) of C but 14 (64%) of I patients had suffered previous peritonitis episode(s), with overall rates of 0.58 and 0.78 episodes per patientyear, respectively. During study There were 31 C episodes and 35 I episodes, with overall rates of 0.76 and 0.93 per patientyear, respectively. The increase in the C and I groups was 31% and 19%, respectively. Serum osmolality and sodium levels were unaffected by peritonitis, and there was no increase in serum icodextrin metabolites during peritonitis. Overnight ultrafiltration volume during peritonitis (mean±SD) declined slightly from 218±354 mL to 185±299 mL (NS) in the control group, but increased in the icodextrin group from 570±146 mL to 723±218 mL (p < 0.01). Conclusions Using icodextrin for the long dwell in CAPD does not increase the rate of peritonitis, nor does it alter the outcome of peritonitis. Peritonitis does not affect uptake of icodextrin from the peritoneum.
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Affiliation(s)
| | - Ram Gokal
- Manchester Royal Infirmary, Cardiff Royal Infirmaryl and ML Laboratories2 plc, St. Albans, U.K
| | - Chandra D. Mistry
- Manchester Royal Infirmary, Cardiff Royal Infirmaryl and ML Laboratories2 plc, St. Albans, U.K
| | - Elizabeth M. Peers
- Manchester Royal Infirmary, Cardiff Royal Infirmaryl and ML Laboratories2 plc, St. Albans, U.K
| | | | - S. Smith
- Northern General Hospital, Sheffield
| | | | | | | | | | | | | | - J. McKain
- Queen Elizabeth Hospital, Birmingham
| | | | | | | | | | - J. Walls
- Leicester General Hospital, Leicester
| | - C. Orton
- Leicester General Hospital, Leicester
| | | | - J. Grieves
- Royal Victoria Hospital, Newcastle-upon Tyne
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21
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Innes N, Clarkson J, Douglas G, Ryan V, Wilson N, Homer T, Marshman Z, McColl E, Vale L, Robertson M, Abouhajar A, Holmes R, Freeman R, Chadwick B, Deery C, Wong F, Maguire A. Child Caries Management: A Randomized Controlled Trial in Dental Practice. J Dent Res 2019; 99:36-43. [DOI: 10.1177/0022034519888882] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This multicenter 3-arm, parallel-group, patient-randomized controlled trial compared clinical effectiveness of 3 treatment strategies over 3 y for managing dental caries in primary teeth in UK primary dental care. Participants aged 3 to 7 y with at least 1 primary molar with dentinal carious lesion were randomized across 3 arms (1:1:1 via centrally administered system with variable-length random permuted blocks): C+P, conventional carious lesion management (complete carious tooth tissue removal and restoration placement) with prevention; B+P, biological management (sealing in carious tooth tissue restoratively) with prevention; and PA, prevention alone (diet, plaque removal, fluorides, and fissure sealants). Parents, children, and dentists were not blind to allocated arm. Co–primary outcomes were 1) the proportion of participants with at least 1 episode of dental pain and/or infection and 2) the number of episodes of dental pain and/or infection during follow-up (minimum, 23 mo). In sum, 1,144 participants were randomized (C+P, n = 386; B+P, n = 381; PA, n = 377) by 72 general dental practitioners, of whom 1,058 (C+P, n = 352; B+P, n = 352; PA, n = 354) attended at least 1 study visit and were included in the primary analysis. The median follow-up was 33.8 mo (interquartile range, 23.8 to 36.7). Proportions of participants with at least 1 episode of dental pain and/or infection were as follows: C+P, 42%; B+P, 40%; PA, 45%. There was no evidence of a difference in incidence of dental pain and/or infection when B+P (adjusted risk difference [97.5% CI]: −2% [−10% to 6%]) or PA (4% [−4% to 12%]) was compared with C+P. The mean (SD) number of episodes of dental pain and/or infection were as follows: C+P, 0.62 (0.95); B+P, 0.58 (0.87); and PA, 0.72 (0.98). Superiority could not be concluded for number of episodes between B+P (adjusted incident rate ratio (97.5% CI): 0.95 [0.75 to 1.21]) or PA (1.18 [0.94 to 1.48]) and C+P. In conclusion, there was no evidence of a difference among the 3 treatment approaches for incidence or number of episodes of dental pain and/or infection experienced by these participants with high caries risk and established disease (trial registration: ISRCTN77044005).
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Affiliation(s)
- N.P. Innes
- School of Dentistry, University of Dundee, Dundee, UK
| | - J.E. Clarkson
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | | | - V. Ryan
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - N. Wilson
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - T. Homer
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Z. Marshman
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - E. McColl
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - L. Vale
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - M. Robertson
- School of Dentistry, University of Dundee, Dundee, UK
| | - A. Abouhajar
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - R.D. Holmes
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - R. Freeman
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - B. Chadwick
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - C. Deery
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - F. Wong
- Institute of Dentistry, Queen Mary University of London, London, UK
| | - A. Maguire
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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Feldsine PT, Lienau AH, Leung SC, Mui LA, Aguilar G, Aharchi J, Aldridge I, Arling V, Bitner B, Bullard C, Carlson P, Cox C, Deiss K, Dillon J, Dombroski P, Ellingson J, Fitzgerald S, Forgey R, Gailbreath K, Gallagher D, Geftman V, Herbst K, Hillis P, Johnson M, Koch S, Lewis D, Luepke J, Martensen D, McDonagh S, McGovern B, Moon B, Moreland L, Murray L, Richter D, Robertson M, Rogers P, Rucker C, Sacca J, Siu MC, Smith C, Smith J, Stoltzfus E, Summers C, Taylor B, Toth J, Vess R, White S, Witt JL, Young S. Method Extension Study to Validate Applicability of AOAC Official Method 997.03 Visual Immunoprecipitate Assay (VIP®) for Listeria monocytogenes and Related Listeria spp. from Environmental Surfaces: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/85.2.470] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Test portions from 3 environmental surface types, representative of typical surfaces found in a food production facility, were analyzed by the Visual Immunoprecipitate assay (VIP®) and the U.S. Department of Agriculture/Food Safety and Inspection Service (USDA/FSIS) culture method for Listeria monocytogenes and related Listeria species. In all cases, naturally contaminated environmental test samples were collected from an actual food production facility by sponge or swab. Test samples from concrete surfaces were collected by both swab and sponge; sponge test samples were collected from rubber surfaces, and swabs were used to sample steel surfaces. Test portions from each surface type were simultaneously analyzed by both methods. A total of 27 laboratories, representing government agencies as well as private industry in both the United States and Canada, participated in the study. During this study, a total of 615 test portions and controls was analyzed and confirmed, of which 227 were positive and 378 were negative by both methods. Nine test portions were positive by culture, but negative by the VIP. Five test portions were negative by culture, but positive by the VIP. Four test portions were negative by VIP and by culture, but confirmed positive when VIP enrichment broths were subcultured to selective agars. The data reported here indicate that the VIP method and the USDA/FSIS culture method are statistically equivalent for detection of L. monocytogenes and related Listeria species from environmental surfaces taken by sponges or swabs.
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Affiliation(s)
| | - Andrew H Lienau
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | | | - Linda A Mui
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
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23
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Al Ja'bari A, Robertson M, El‐Boghdadly K, Albrecht E. A randomised controlled trial of the pectoral nerves‐2 (PECS‐2) block for radical mastectomy. Anaesthesia 2019; 74:1277-1281. [DOI: 10.1111/anae.14769] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2019] [Indexed: 01/28/2023]
Affiliation(s)
- A. Al Ja'bari
- Department of Anaesthesia Lausanne University Hospital LausanneSwitzerland
| | - M. Robertson
- Department of Anaesthesia Lausanne University Hospital LausanneSwitzerland
| | - K. El‐Boghdadly
- Department of Anaesthesia Guy's and St. Thomas’ NHS Foundation Trust LondonUK
- King's College London UK
| | - E. Albrecht
- Department of Anaesthesia Lausanne University Hospital Lausanne Switzerland
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24
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Diefenbach C, Hong F, Ambinder R, Cohen J, Robertson M, David K, Advani R, Fenske T, Barta S, Palmisano N, Svoboda J, Morgan D, Karmali R, Kahl B, Ansell S. EXTENDED FOLLOW-UP OF A PHASE I TRIAL OF IPILIMUMAB, NIVOLUMAB AND BRENTUXIMAB VEDOTIN IN RELAPSED HODGKIN LYMPHOMA: A TRIAL OF THE ECOG-ACRIN RESEARCH GROUP (E4412). Hematol Oncol 2019. [DOI: 10.1002/hon.83_2629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- C.S. Diefenbach
- Hematology-Oncology; Perlmutter Cancer Center at NYU Langone Health; New York United States
| | - F. Hong
- ECOG-ACRIN Biostatistics Center; Dana Farber Cancer Institute; Boston United States
| | - R. Ambinder
- Sidney Kimmel Cancer Center; Johns Hopkins University; Baltimore MD United States
| | - J. Cohen
- Winship Cancer Institute; Emory University; Atlanta United States
| | - M. Robertson
- Hematology-Oncology; Indiana Unversity School of Medicine; Indianapolis United States
| | - K. David
- Hematology-Oncology; Rutgers Cancer Institute of New Jersey; New Brunswick United States
| | - R. Advani
- Oncology; Stanford Cancer Institute; San Francisco United States
| | - T. Fenske
- Hematology-Oncology; Froedtert and the Medical College of Wisconsin; Milwaukee United States
| | - S. Barta
- Abramson Cancer Center; University of Pennsylvania; Philadelphia United States
| | - N. Palmisano
- Hematology-Oncology; Thomas Jefferson University Hospital; Philadelphia United States
| | - J. Svoboda
- Abramson Cancer Center; University of Pennsylvania; Philadelphia United States
| | - D. Morgan
- Hematology-Oncology; Vanderbilt Ingram Henry Cancer Center; Nashville United States
| | - R. Karmali
- Feinberg School of Medicine; Northwestern University; Chicago United States
| | - B. Kahl
- Oncology; Washington University School of Medicine; St. Louis United States
| | - S. Ansell
- Hematology-Oncology; Mayo Clinic; Rochester United States
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25
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Cossentine J, Robertson M, Xu D. Biological Activity of Bacillus thuringiensis in Drosophila suzukii (Diptera: Drosophilidae). J Econ Entomol 2019; 109:1071-1078. [PMID: 27106227 DOI: 10.1093/jee/tow062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/23/2015] [Accepted: 02/26/2016] [Indexed: 05/21/2023]
Abstract
Whole-culture extracts of Bacillus thuringiensis Berliner strains were assayed against larval and adult Drosophila suzukii (Matsumura), an important invasive pest of many thin-skinned soft fruit crops in North America. Of the 22 serovars tested versus larval D. suzukii , strains of Bacillus thuringiensis var. thuringiensis , kurstaki , thompsoni , bolivia , and pakistani caused high (75 to 100%) first-instar mortalities. Pupal mortality, measured as a failure of adults to emerge, varied with serovar. The first D. suzukii instar was the most susceptible of the three larval instars to B. thuringiensis var. kurstaki HD-1. Larval D. suzukii are shielded from crop treatments, as they develop under the skin of infested fruit, and adults would be a more vulnerable target for an efficacious strain of B. thuringiensis . Only one of the 21 B. thuringiensis serovars, var. thuringiensis , prepared as oral suspensions in sucrose for adult D. suzukii ingestion resulted in significant, albeit low mortality within 7 d. It is not a candidate for use in pest management, as it produces β -exotoxin that is toxic to vertebrates.
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Affiliation(s)
- J Cossentine
- Summerland Research and Development Centre, Agriculture and Agri-Food Canada, 4200 Hwy. 97, Summerland, BC, Canada, V0H 1Z0
| | - M Robertson
- Summerland Research and Development Centre, Agriculture and Agri-Food Canada, 4200 Hwy. 97, Summerland, BC, Canada, V0H 1Z0
| | - D Xu
- Saint-Jean-sur-Richelieu Research and Development Centre, Agriculture and Agri-Food Canada, 430 Gouin Blvd., St-Jean-sur-Richelieu, QC, Canada, J3B 3E6
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26
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Leon M, Bautista K, Robertson M, Pettit P, Destephano C. Minimally Invasive Surgical Management of Vesico-Vaginal Fistula after a Robotic Hysterectomy. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.231] [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: 11/27/2022]
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27
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Smith M, Wilson M, Robertson M, Padilla H, Zuercher H, Vandenberg R, Lorig K, DeJoy D. IMPACT OF A DISEASE SELF-MANAGEMENT PROGRAM ON EMPLOYEE HEALTH AND WORK PERFORMANCE: INTRODUCING WORKPLACE CDSMP. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1030] [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)
- M Smith
- Texas A&M School of Public Health
| | | | | | | | | | | | - K Lorig
- Self-Management Resource Center
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28
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Abstract
Clinical and patient-reported outcomes were reported for carious primary molars treated with the Hall technique (HT) as compared with conventional carious tissue removal and restorations (i.e., conventional restoration [CR]) in a 5-y randomized controlled practice-based trial in Scotland. We interrogated this data set further to investigate the cost-effectiveness of HT versus CR. A total of 132 children who had 2 matched occlusal/occlusal-proximal carious lesions in primary molars ( n = 264 teeth) were randomly allocated to HT or CR, provided by 17 general dental practitioners. Molars were followed up for a mean 5 y. A societal perspective was taken for the economic analysis. Direct dental treatment costs were estimated from a Scottish NHS perspective (an NHS England perspective was taken for a sensitivity analysis). Initial, maintenance, and retreatment costs, including rerestorations, endodontic treatments, and extractions, were estimated with fee items. Indirect/opportunity costs were estimated with time and travel costs from a UK perspective. The primary outcome was tooth survival. Secondary outcomes included 1) not having pain or needing endodontic treatments/extractions and 2) not needing rerestorations. Cost-effectiveness and acceptability were estimated from bootstrapped samples. Significantly more molars in HT survived (99%, 95% CI: 98% to 100%) than in CR (92%; 87% to 97%). Also, the proportion of molars retained without pain or requiring endodontic treatment/extraction was significantly higher in HT than CR. In the base case analysis (NHS Scotland perspective), cumulative direct dental treatment costs (Great British pound [GBP]) of HT were 24 GBP (95% CI: 23 to 25); costs for CR were 29 (17 to 46). From an NHS England perspective, the cost advantage of HT (29 GBP; 95% CI: 25 to 34) over CR (107; 86 to 127) was more pronounced. Indirect/opportunity costs were significantly lower for HT (8 GBP; 95% CI: 7 to 9) than CR (19; 16 to 23). Total cumulative costs were significantly lower for HT (32 GBP; 95% CI: 31 to 34) than CR (49; 34 to 69). Based on a long-term practice-based trial, HT was more cost-effective than CR with HT retained for longer and experiencing less complications at lower costs.
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Affiliation(s)
- F Schwendicke
- 1 Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Krois
- 1 Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - M Robertson
- 2 Child Dental Health, School of Dentistry, University of Dundee, Dundee, Scotland
| | - C Splieth
- 3 Department of Preventive and Paediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - R Santamaria
- 3 Department of Preventive and Paediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - N Innes
- 2 Child Dental Health, School of Dentistry, University of Dundee, Dundee, Scotland
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29
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Brown A, Hézode C, Zuckerman E, Foster GR, Zekry A, Roberts SK, Lahser F, Durkan C, Badshah C, Zhang B, Robertson M, Wahl J, Barr E, Haber B. Efficacy and safety of 12 weeks of elbasvir ± grazoprevir ± ribavirin in participants with hepatitis C virus genotype 2, 4, 5 or 6 infection: The C-SCAPE study. J Viral Hepat 2018; 25:457-464. [PMID: 29152828 DOI: 10.1111/jvh.12801] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 09/02/2017] [Indexed: 02/06/2023]
Abstract
People with hepatitis C virus (HCV) infection other than genotype 1 represent a heterogeneous group. The aim of the phase 2 C-SCAPE study was to evaluate elbasvir/grazoprevir (EBR/GZR), with or without ribavirin (RBV), in participants with HCV genotype 2, 4, 5 or 6 infection. This was a part randomised, open-label, parallel-group study (NCT01932762; PN047-03) of treatment-naive, noncirrhotic participants. Participants with HCV genotype 2 infection received GZR 100 mg + RBV ± EBR 50 mg for 12 weeks and those with genotype 4, 5 or 6 infection were randomized to receive EBR/GZR ± RBV for 12 weeks. The primary endpoint was sustained virological response 12 weeks after completion of treatment (SVR12; HCV RNA <25 IU/mL). Among participants with genotype 2 infection, SVR12 was achieved by 80% (24/30) of those receiving EBR/GZR + RBV and 73% (19/26) of those receiving GZR + RBV. SVR rates were high in participants with HCV genotype 4 infection receiving EBR/GZR with and without RBV (100% [10/10] and 90% [9/10]; respectively). In contrast, the addition of RBV to EBR/GZR appeared to increase SVR12 in participants with genotype 5 infection (EBR/GZR, 25%; EBR/GZR + RBV 100% [4/4]). In participants with genotype 6 infection, SVR12 was 75% (3/4) in both those receiving EBR/GZR and those receiving EBR/GZR + RBV. The safety profile was similar across treatment arms, with adverse events tending to occur more frequently among participants receiving RBV. In conclusion, these data support the inclusion of participants with genotype 4 or 6 infection in the EBR/GZR phase 3 studies. EBR/GZR ± RBV was unsatisfactory for participants with genotype 2 or 5 infection.
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Affiliation(s)
- A Brown
- Imperial College Healthcare NHS Trust, London, UK
| | - C Hézode
- Henri Mondor Hospital, University of Paris-Est, Creteil, France
| | - E Zuckerman
- Liver Unit, Carmel Medical Center Technion Faculty of Medicine, Haifa, Israel
| | - G R Foster
- Liver Unit, Queen Mary University of London, London, UK
| | - A Zekry
- St George Hospital Clinical School, Inflammation and Infection Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - S K Roberts
- The Alfred Hospital, Melbourne, VIC, Australia
| | - F Lahser
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - C Durkan
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - C Badshah
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - B Zhang
- Merck & Co., Inc., Kenilworth, NJ, USA
| | | | - J Wahl
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - E Barr
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - B Haber
- Merck & Co., Inc., Kenilworth, NJ, USA
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30
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Conway B, Dore GJ, Altice F, Litwin A, Grebely J, Dalgard O, Gane EJ, Shibolet O, Luetkemeyer A, Nahass R, Peng C, Gendrano I, Huang H, Chen E, Nguyen B, Wahl J, Barr E, Robertson M, Platt H. A172 C-EDGE CO-STAR: RISK OF REINFECTION FOLLOWING SUCCESSFUL THERAPY WITH ELBASVIR (EBR) AND GRAZOPREVIR (GZR) IN PERSONS WHO INJECT DRUGS (PWID) RECEIVING OPIOD AGONIST THERAPY (OAT). J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Conway
- Vancouver Infectious Diseases Centre, Vancouver, BC, Canada
| | - G J Dore
- Kirby Institute, Sydney, New South Wales, Australia
| | - F Altice
- Yale School of Medicine, New Haven, CT
| | - A Litwin
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - J Grebely
- Kirby Institute, Sydney, New South Wales, Australia
| | - O Dalgard
- Institute of Clinical Medicine, Oslo, Norway
| | - E J Gane
- Auckland Clinical Studies, Auckland, New Zealand
| | - O Shibolet
- Tel-Aviv Medical Center, Tel-Aviv, Israel
| | | | - R Nahass
- ID Care, Hillsborough Township, NJ
| | - C Peng
- China Medical University Hospital, Taiwan, Taiwan
| | | | - H Huang
- Merck & Co., Inc., Kenilworth, NJ
| | - E Chen
- Merck & Co., Inc., Kenilworth, NJ
| | - B Nguyen
- Merck & Co., Inc., Kenilworth, NJ
| | - J Wahl
- Merck & Co., Inc., Kenilworth, NJ
| | - E Barr
- Merck & Co., Inc., Kenilworth, NJ
| | | | - H Platt
- Merck & Co., Inc., Kenilworth, NJ
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31
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DeStephano C, Gajarawala S, Heckman M, Vargas E, Pettit P, Robertson M. 41: Factors associated with readiness for discharge from the hospital following robotic and laparoscopic hysterectomy. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.12.060] [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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32
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Killaspy H, Johnson S, Livingston G, Hassiotis A, Robertson M. Women in academic psychiatry in the United Kingdom. Psychiatr bull 2018. [DOI: 10.1192/pb.27.9.323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Although there seems to be a shared impression that the proportion of women in academic psychiatry is substantially lower than in National Health Service (NHS) posts, we are not aware of any empirical data on this. In the USA, women physicians have been shown to be more likely to pursue an academic career than men (Nonnemaker, 2000), but the number who advance to Professor appears significantly lower than expected (Reiser et al, 1993; Nonnemaker, 2000). Women in academic psychiatry in Canada also appear less likely to advance to senior positions than their male colleagues (Penfold, 1987). A recent survey of 44 academic institutions in the UK, carried out by the National Centre for Social Research (Blake & La Valle, 2000), found that women occupied lower grade academic posts than their male counterparts and therefore were less eligible to apply for project research grants. Those that were eligible were as successful in gaining funding as their male colleagues.
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33
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Gane E, Nahass R, Luketic V, Asante-Appiah E, Hwang P, Robertson M, Wahl J, Barr E, Haber B. Efficacy of 12 or 18 weeks of elbasvir plus grazoprevir with ribavirin in treatment-naïve, noncirrhotic HCV genotype 3-infected patients. J Viral Hepat 2017; 24:895-899. [PMID: 28470815 DOI: 10.1111/jvh.12719] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/03/2017] [Indexed: 12/13/2022]
Abstract
Elbasvir (EBR; HCV NS5A inhibitor) and grazoprevir (GZR; HCV NS3/4A protease inhibitor) are approved as a fixed-dose combination to treat patients chronically infected with HCV genotypes 1 and 4. During the development programme and supported by in vitro potency, the efficacy of EBR+GZR was assessed in HCV GT3-infected patients. This study's aim was to determine the efficacy and tolerability of 12 or 18 weeks of EBR+GZR with ribavirin (RBV) in treatment-naïve, noncirrhotic HCV GT3-infected patients. Randomized patients received open-label EBR (50 mg once daily) + GZR (100 mg once daily) + RBV. The primary efficacy objective was to evaluate the sustained virologic response rates 12 weeks after the end of all study therapy (SVR12). SVR12 rates (95% confidence interval) were 45.0% (23.1, 68.5) and 57.1% (34.0, 78.2) after treatment with EBR+GZR+RBV for 12 weeks or 18 weeks, respectively. On-treatment virologic failure was observed in 41% (17 of 41) of patients. At virologic failure, resistance-associated substitutions (RASs) with a >five-fold shift in potency occurred in the NS3 region in six (35%) patients and in the NS5A region in 16 (94%) patients. The most common RAS at virologic failure was Y93H in NS5A which was identified in 13 of 17 (76%) patients. The efficacy of EBR+GZR+RBV was suboptimal in HCV GT3-infected patients due to a high rate of on-treatment virologic failure and treatment-emergent RASs which demonstrates an inadequate barrier to the development of GT3 resistance. However, rapid viral clearance demonstrated the antiviral activity of EBR+GZR+RBV in GT3-infected patients.clinicaltrials.gov: NCT01717326.
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Affiliation(s)
- E Gane
- Auckland Clinical Studies, Grafton, Auckland, New Zealand
| | | | - V Luketic
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.,Hunter Holmes McGuire Department of Veterans Affairs Medical Center, Richmond, VA, USA
| | | | - P Hwang
- Merck & Co., Inc., Kenilworth, NJ, USA
| | | | - J Wahl
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - E Barr
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - B Haber
- Merck & Co., Inc., Kenilworth, NJ, USA
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34
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Cleland J, Robertson M, Ford I, Mareev Y, Borer J, Komajda M, Tavazzi L, Swedberg K, Bohm M. 246Effect of Ivabradine on Mortality in Patients with heart failure and a reduced left ventricular ejection fraction not receiving a beta-blocker: an analysis from SHIFT. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J.G. Cleland
- University of Glasgow, Robertson Centre for Biostatistics, Glasgow, United Kingdom
| | - M. Robertson
- University of Glasgow, Robertson Centre for Biostatistics, Glasgow, United Kingdom
| | - I. Ford
- University of Glasgow, Robertson Centre for Biostatistics, Glasgow, United Kingdom
| | - Y. Mareev
- University of Glasgow, Robertson Centre for Biostatistics, Glasgow, United Kingdom
| | - J. Borer
- State University of New York Downstate Medical Center, New York, United States of America
| | - M. Komajda
- University Pierre & Marie Curie Paris VI, Department of Cardiology, Paris, France
| | - L. Tavazzi
- Maria Cecilia Hospital, Cotignola, Italy
| | - K. Swedberg
- Sahlgrenska Academy - University of Gothenburg, Department of Emergency and Cardiovascular Medicine, Goteborg, Sweden
| | - M. Bohm
- Saarland University Hospital, Homburg, Germany
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Reau N, Robertson M, Feng H, Caro L, Yeh W, Nguyen B, Wahl J, Barr E, Hwang P, Klopfer S. P64 Concomitant proton pump inhibitor use does not reduce the efficacy of elbasvir/grazoprevir. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30805-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Hyatt R, Taylor JK, Robertson M, Dean J, Finch J, Bedwell R, Youds J, Wood J. 30MEASURING THE PROCESS OF CARE OF FRAIL OLDER PATIENTS IN HOSPITAL: THE FRAIL OLDER PATIENT ADMISSION QUESTIONNAIRE (FOPAQ). Age Ageing 2017. [DOI: 10.1093/ageing/afx055.30] [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: 11/12/2022] Open
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Robertson M, Watanabe M. JGH OPEN: A new open access journal for gastroenterology and hepatology. J Gastroenterol Hepatol 2017; 32:289. [PMID: 28221689 DOI: 10.1111/jgh.13715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Raeside MC, Robertson M, Nie ZN, Partington DL, Jacobs JL, Behrendt R. Dietary choice and grazing behaviour of sheep on spatially arranged pasture systems. 1. Herbage mass, nutritive characteristics and diet selection. Anim Prod Sci 2017. [DOI: 10.1071/an15539] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Offering livestock dietary choice through access to different pasture species enables livestock to regulate their own feed intake, select for nutrients and minerals, balance rumen health and display natural grazing and foraging behaviours, which could in turn result in increased livestock productivity. An experiment was conducted at Hamilton, Victoria, Australia, to test the hypothesis that offering lambs dietary choice through spatially separated combinations of pasture species would improve lamb performance, relative to lambs with no dietary choice. The experiment tested seven treatments, replicated four times in a randomised complete block design with plot sizes of 1 ± 0.1 ha. The treatments were: 100% perennial ryegrass (Lolium perenne L.) (PR), 100% plantain (Plantago lanceolata L.) (PL), 100% lucerne (Medicago sativa L.) (LU), 50 : 50 perennial ryegrass/plantain (PR + PL), 50 : 50 perennial ryegrass/lucerne (PR + LU), 50 : 50 plantain/lucerne (PL + LU) and 33 : 33 : 33 perennial ryegrass/plantain/lucerne (PR + PL + LU). In the multiple species swards, the pasture species were separated spatially (by area). Plots were grazed by weaned lambs between March and June 2011. Pre-grazing herbage mass during March and April were highest (P < 0.05) from the lucerne and lowest (P < 0.05) from the plantain, with lucerne producing 4.5–5.5 t DM/ha during this time, whereas the perennial ryegrass and plantain produced 3.5–3.9 t DM/ha and 2.3–3.0 t DM/ha, respectively. Herbage disappearance (calculated estimate of feed intake) was highest (P < 0.05) from the lucerne and lowest (P < 0.05) from the plantain during March and April. Leaf crude protein between the perennial ryegrass and plantain did not differ (P > 0.05) and were lower (P < 0.05) than the lucerne, but the perennial ryegrass and plantain had higher (P < 0.05) leaf on offer (kg DM/ha). Plantain leaf had higher (P < 0.05) Fe, Zn, Co, Ca and S than the perennial ryegrass leaf and higher (P < 0.05) Se, Cu, Mg, Na and Cl than the perennial ryegrass and lucerne leaf and a more negative (P < 0.05) dietary cation : anion difference. The agronomic data presented in this paper provides support for the hypothesis, with lambs showing dietary preferences between pasture species and morphological components, and forms to basis for why these preferences exist. The two subsequent papers show how offering lambs dietary choice affected the performance of male lambs to slaughter and female lambs to first joining.
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Raeside MC, Robertson M, Nie ZN, Partington DL, Jacobs JL, Behrendt R. Dietary choice and grazing behaviour of sheep on spatially arranged pasture systems. 2. Wether lamb growth and carcass weight at slaughter. Anim Prod Sci 2017. [DOI: 10.1071/an15540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Dry matter production and nutritive characteristics of the pasture feedbase during autumn are key drivers of profitability in Australia’s prime lamb systems. An experiment was conducted to test the hypothesis that offering lambs dietary choice through spatially separated combinations of perennial ryegrass (Lolium perenne L.), plantain (Plantago lanceolata L.) and/or lucerne (Medicago sativa L.) improves the post-weaning liveweight gain, condition score (CS), pre- and post-slaughter carcass characteristics and reduces the internal parasite burdens of wether lambs finished to a slaughter weight over autumn, relative to lambs offered no dietary choice. The experiment tested seven treatments, replicated four times in a randomised complete block design with plot sizes of 1 ± 0.1 ha. The treatments were: 100% perennial ryegrass (PR), 100% plantain (PL), 100% lucerne (LU), 50 : 50 perennial ryegrass/plantain (PR + PL), 50 : 50 perennial ryegrass/lucerne (PR + LU), 50 : 50 plantain/lucerne (PL + LU) and 33 : 33 : 33 perennial ryegrass/plantain/lucerne (PR + PL + LU). Plots were grazed by weaned lambs between March and June 2011. The lambs had been born between 3 August and 7 September 2010 and were derived from either Coopworth composite dams joined to Coopworth maternal sires or from Merino dams (Toland or Centreplus bloodlines) joined to Border Leicester sires. Backgrounding the lambs on a pasture system that contained lucerne during the lactation to weaning period increased (P < 0.05) liveweight at slaughter by 8% and hot carcass weight by 10%, relative to lambs backgrounded on perennial ryegrass. Finishing lambs on the LU treatment between weaning and slaughter increased (P < 0.05) liveweight at slaughter by 11%, CS at slaughter by 0.3 units, hot carcass weight by 16%, carcass CFAT (measured over the loin) by 2.5 mm, carcass eye muscle depth by 1.1 mm and carcass GRFAT (total tissue depth at 11/12th rib, 11 cm from mid line) by 3.8 mm, relative to lambs finished on the PR treatment. Finishing lambs on LU + PR, LU + PL or LU + PR + PL did not (P > 0.05) improve any of the measured parameters, relative to finishing lambs on the LU treatment. The PL and PR treatments did not differ (P > 0.05) in liveweight at slaughter, CS at slaughter or carcass characteristics, but the PL treatment had lower (P < 0.05) liveweight gain than the PR treatment during the first 2 weeks of the experiment (39 g/day vs 330 g/day), which was later partially compensated for. Our hypothesis has not been supported given that the use of spatially arranged mixes resulted in no improvement in liveweight gain, CS, carcass characteristics or internal parasite burdens relative to the comparable single species sward.
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Hollis C, Pennant M, Cuenca J, Glazebrook C, Kendall T, Whittington C, Stockton S, Larsson L, Bunton P, Dobson S, Groom M, Hedderly T, Heyman I, Jackson GM, Jackson S, Murphy T, Rickards H, Robertson M, Stern J. Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis. Health Technol Assess 2016; 20:1-450, vii-viii. [PMID: 26786936 DOI: 10.3310/hta20040] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Tourette syndrome (TS) is a neurodevelopmental condition characterised by chronic motor and vocal tics affecting up to 1% of school-age children and young people and is associated with significant distress and psychosocial impairment. OBJECTIVE To conduct a systematic review of the benefits and risks of pharmacological, behavioural and physical interventions for tics in children and young people with TS (part 1) and to explore the experience of treatment and services from the perspective of young people with TS and their parents (part 2). DATA SOURCES For the systematic reviews (parts 1 and 2), mainstream bibliographic databases, The Cochrane Library, education, social care and grey literature databases were searched using subject headings and text words for tic* and Tourette* from database inception to January 2013. REVIEW/RESEARCH METHODS For part 1, randomised controlled trials and controlled before-and-after studies of pharmacological, behavioural or physical interventions in children or young people (aged < 18 years) with TS or chronic tic disorder were included. Mixed studies and studies in adults were considered as supporting evidence. Risk of bias associated with each study was evaluated using the Cochrane tool. When there was sufficient data, random-effects meta-analysis was used to synthesize the evidence and the quality of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. For part 2, qualitative studies and survey literature conducted in populations of children/young people with TS or their carers or in health professionals with experience of treating TS were included in the qualitative review. Results were synthesized narratively. In addition, a national parent/carer survey was conducted via the Tourettes Action website. Participants included parents of children and young people with TS aged under 18 years. Participants (young people with TS aged 10-17 years) for the in-depth interviews were recruited via a national survey and specialist Tourettes clinics in the UK. RESULTS For part 1, 70 studies were included in the quantitative systematic review. The evidence suggested that for treating tics in children and young people with TS, antipsychotic drugs [standardised mean difference (SMD) -0.74, 95% confidence interval (CI) -1.08 to -0.41; n = 75] and noradrenergic agents [clonidine (Dixarit(®), Boehringer Ingelheim) and guanfacine: SMD -0.72, 95% CI -1.03 to -0.40; n = 164] are effective in the short term. There was little difference among antipsychotics in terms of benefits, but adverse effect profiles do differ. Habit reversal training (HRT)/comprehensive behavioural intervention for tics (CBIT) was also shown to be effective (SMD -0.64, 95% CI -0.99 to -0.29; n = 133). For part 2, 295 parents/carers of children and young people with TS contributed useable survey data. Forty young people with TS participated in in-depth interviews. Four studies were in the qualitative review. Key themes were difficulties in accessing specialist care and behavioural interventions, delay in diagnosis, importance of anxiety and emotional symptoms, lack of provision of information to schools and inadequate information regarding medication and adverse effects. LIMITATIONS The number and quality of clinical trials is low and this downgrades the strength of the evidence and conclusions. CONCLUSIONS Antipsychotics, noradrenergic agents and HRT/CBIT are effective in reducing tics in children and young people with TS. The balance of benefits and harms favours the most commonly used medications: risperidone (Risperdal(®), Janssen), clonidine and aripiprazole (Abilify(®), Otsuka). Larger and better-conducted trials addressing important clinical uncertainties are required. Further research is needed into widening access to behavioural interventions through use of technology including mobile applications ('apps') and video consultation. STUDY REGISTRATION This study is registered as PROSPERO CRD42012002059. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Chris Hollis
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, University of Nottingham, Nottingham, UK
| | - Mary Pennant
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - José Cuenca
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, University of Nottingham, Nottingham, UK
| | - Cris Glazebrook
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, University of Nottingham, Nottingham, UK
| | - Tim Kendall
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Craig Whittington
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Sarah Stockton
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Linnéa Larsson
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Penny Bunton
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Suzanne Dobson
- Tourettes Action, The Meads Business Centre, Farnborough, Hampshire, UK
| | - Madeleine Groom
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, University of Nottingham, Nottingham, UK
| | - Tammy Hedderly
- Paediatric Neurology Department, Kings College Hospital NHS Foundation Trust, London, UK
| | - Isobel Heyman
- Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children, London, UK
| | - Georgina M Jackson
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, University of Nottingham, Nottingham, UK
| | - Stephen Jackson
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Tara Murphy
- Institute of Neurology, University College London, London, UK
| | | | - Mary Robertson
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jeremy Stern
- Tourettes Action, The Meads Business Centre, Farnborough, Hampshire, UK
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Whittington C, Pennant M, Kendall T, Glazebrook C, Trayner P, Groom M, Hedderly T, Heyman I, Jackson G, Jackson S, Murphy T, Rickards H, Robertson M, Stern J, Hollis C. Practitioner Review: Treatments for Tourette syndrome in children and young people - a systematic review. J Child Psychol Psychiatry 2016; 57:988-1004. [PMID: 27132945 DOI: 10.1111/jcpp.12556] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [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] [Accepted: 01/22/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Tourette syndrome (TS) and chronic tic disorder (CTD) affect 1-2% of children and young people, but the most effective treatment is unclear. To establish the current evidence base, we conducted a systematic review of interventions for children and young people. METHODS Databases were searched from inception to 1 October 2014 for placebo-controlled trials of pharmacological, behavioural, physical or alternative interventions for tics in children and young people with TS or CTD. Certainty in the evidence was assessed with the GRADE approach. RESULTS Forty trials were included [pharmacological (32), behavioural (5), physical (2), dietary (1)]. For tics/global score there was evidence favouring the intervention from four trials of α2-adrenergic receptor agonists [clonidine and guanfacine, standardised mean difference (SMD) = -0.71; 95% CI -1.03, -0.40; N = 164] and two trials of habit reversal training (HRT)/comprehensive behavioural intervention (CBIT) (SMD = -0.64; 95% CI -0.99, -0.29; N = 133). Certainty in the effect estimates was moderate. A post hoc analysis combining oral clonidine/guanfacine trials with a clonidine patch trial continued to demonstrate benefit (SMD = -0.54; 95% CI -0.92, -0.16), but statistical heterogeneity was high. Evidence from four trials suggested that antipsychotic drugs improved tic scores (SMD = -0.74; 95% CI -1.08, -0.40; N = 76), but certainty in the effect estimate was low. The evidence for other interventions was categorised as low or very low quality, or showed no conclusive benefit. CONCLUSIONS When medication is considered appropriate for the treatment of tics, the balance of clinical benefits to harm favours α2-adrenergic receptor agonists (clonidine and guanfacine) as first-line agents. Antipsychotics are likely to be useful but carry the risk of harm and so should be reserved for when α2-adrenergic receptor agonists are either ineffective or poorly tolerated. There is evidence that HRT/CBIT is effective, but there is no evidence for HRT/CBIT alone relative to combining medication and HRT/CBIT. There is currently no evidence to suggest that the physical and dietary interventions reviewed are sufficiently effective and safe to be considered as treatments.
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Affiliation(s)
- Craig Whittington
- National Collaborating Centre for Mental Health, University College London, London, UK
| | - Mary Pennant
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Tim Kendall
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Cristine Glazebrook
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Penny Trayner
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Madeleine Groom
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tammy Hedderly
- Paediatric Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' Hospital, London, UK
| | - Isobel Heyman
- Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children, London, UK
| | - Georgina Jackson
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Stephen Jackson
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Tara Murphy
- Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children, London, UK
| | - Hugh Rickards
- National Centre for Mental Health, University of Birmingham, Birmingham, UK
| | - Mary Robertson
- Department of Neurology, St Georges Hospital, London, UK
| | - Jeremy Stern
- Department of Neurology, St Georges Hospital, London, UK
| | - Chris Hollis
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
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Zeng G, Robertson M, Murphy J, Lamey M, Wang Y. SU-D-201-02: A Systematic Planning Quality Monitoring Program for VMAT Treatment. Med Phys 2016. [DOI: 10.1118/1.4955614] [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: 11/07/2022] Open
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Lagging M, Brown A, Mantry PS, Ramji A, Weilert F, Vierling JM, Howe A, Gendrano IN, Hwang P, Zhang B, Wahl J, Robertson M, Mobashery N. Grazoprevir plus peginterferon and ribavirin in treatment-naive patients with hepatitis C virus genotype 1 infection: a randomized trial. J Viral Hepat 2016; 23:80-8. [PMID: 26353843 DOI: 10.1111/jvh.12464] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 06/29/2015] [Accepted: 08/12/2015] [Indexed: 12/30/2022]
Abstract
UNLABELLED Grazoprevir (MK-5172, Merck & Co., Inc.) is a selective inhibitor of the hepatitis C virus (HCV) NS3/4a protease. The aim of this study was to evaluate the safety and efficacy of grazoprevir at doses of 25-100 mg/day in combination with peginterferon and ribavirin (PEG-IFN/RBV). In this randomized, dose-ranging, multicentre trial, treatment-naive adults with chronic HCV genotype 1 infection received once-daily grazoprevir 25 mg, 50 mg or 100 mg plus PEG-IFN/RBV for 12 weeks. Patients with quantifiable HCV RNA (≥25 IU/mL) at week 4 received an additional 12 weeks of PEG-IFN/RBV. The primary endpoint was sustained virologic response (HCV RNA <25 IU/mL 12 weeks after completing therapy [SVR12]). Eighty-seven patients were randomly assigned and received ≥1 dose of therapy. Median time to undetectable HCV RNA was 16 days in the 100-mg arm and 22 days in the 25- and 50-mg arms. All patients except one had HCV RNA undetectable or unquantifiable at week 4 and received 12 weeks of therapy. SVR12 was achieved by 13 of 24 (54.2%), 21 of 25 (84.0%) and 23 of 26 (88.5%) patients in the 25-, 50- and 100-mg arms, respectively (per-protocol analysis). Three patients discontinued as a result of nonserious adverse events (AEs) and three patients experienced serious AEs. Transaminase elevations occurred in two patients (one each in the 25- and 100-mg arms). CONCLUSION These data support further study of the grazoprevir 100-mg dose. Phase 3 studies of grazoprevir 100 mg in combination with elbasvir are currently ongoing (NCT01710501; protocol P038).
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Affiliation(s)
- M Lagging
- Institute of Biomedicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Brown
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - P S Mantry
- The Liver Institute at Methodist Dallas Medical Center, Dallas, TX, USA
| | - A Ramji
- University of British Columbia, Vancouver, BC, Canada
| | - F Weilert
- Waikato District Health Board, Hamilton, New Zealand
| | | | - A Howe
- Merck & Co. Inc., Kenilworth, NJ, USA
| | | | - P Hwang
- Merck & Co. Inc., Kenilworth, NJ, USA
| | - B Zhang
- Merck & Co. Inc., Kenilworth, NJ, USA
| | - J Wahl
- Merck & Co. Inc., Kenilworth, NJ, USA
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Gulisano M, Calì P, Palermo F, Robertson M, Rizzo R. Premonitory Urges in Patients with Gilles de la Tourette Syndrome: An Italian Translation and a 7-Year Follow-up. J Child Adolesc Psychopharmacol 2015; 25:810-6. [PMID: 26288345 DOI: 10.1089/cap.2014.0154] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Premonitory sensations or urges (PUs) are described as characteristic sensory phenomena preceding tics, which are often described as unpleasant. They occur in 90% of patients affected by Gilles de la Tourette Syndrome (GTS). They may be localized (around the area of tic) or generalized (covering a wide area of the body). The PUs can be measured by the Premonitory Urge for Tics Scale (PUTS). In this study we translated the PUTS scale into Italian and then assessed children and adolescents/young people (CYP) with GTS using the scale. METHODS GTS patients were assessed at the initial interview and after 7 years to evaluate the PUs, and the correlations of the PUTS scores with tic severity, severity of comorbid disorders (obsessive-compulsive disorder [OCD], attention-deficit/hyperactivity disorder [ADHD]), and a variety of coexisting psychopathologies. RESULTS A total of 95 patients were studied. We successfully translated the PUTS into Italian, and our results indicated that our translated version had good psychometric properties. Results demonstrated that the CYP had PUs at both interviews, but that older CYP were more consistent in reporting PUs than younger CYP (i.e., PUTS scores increased with age). We found no correlations between PUTS score and tic severity at either interview. We found a statistical significant correlation between PUTS score and obsessive-compulsive symptoms (OCS) at both interviews; Moreover both the PUTS and Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) scores increased significantly, whereas the Yale Global Tic Severity Rating Scale (YGTSS) score decreased significantly. We found no relationships between PUTS scores and anxiety, depression, ADHD, and externalizing/internalizing behavioral scores. CONCLUSIONS Our results suggest the the Italian translation of the PUTS has good psychometric properties. Although both younger (<10 years of age) and older CYP (≤ 10 years of age) reported PUs, the scores at the initial interview were statistically significantly lower than at follow-up. Moreover, in CYP >10 years of age, the PUs correlated with obsessions and compulsions (CY-BOCS scores).
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Affiliation(s)
- Mariangela Gulisano
- 1 Departmento of Clinical and Experimental Medicine, Section of Child and Adolescent Neuropsychiatry, University of Catania , Catania, Italy
| | - Paola Calì
- 1 Departmento of Clinical and Experimental Medicine, Section of Child and Adolescent Neuropsychiatry, University of Catania , Catania, Italy
| | - Filippo Palermo
- 2 Department of Internal and Specialist Medicine, Section of Infectious Disease, University of Catania , Catania, Italy
| | - Mary Robertson
- 3 University College, London, England; University of Cape Town, Cape Town, South Africa; St George's Hospital & Medical School, London, England; University of Catania , Catania, Italy
| | - Renata Rizzo
- 1 Departmento of Clinical and Experimental Medicine, Section of Child and Adolescent Neuropsychiatry, University of Catania , Catania, Italy
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Omar AY, Stern JS, Simmons H, Robertson M. MOTOR VERSUS VOCAL TICS. J Neurol Psychiatry 2015. [DOI: 10.1136/jnnp-2015-311750.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Poordad F, Lawitz E, Gutierrez J, Evans B, Howe A, Feng HP, Li J, Hwang P, Robertson M, Wahl J, Barr E, Haber B. O006 : C-swift: grazoprevir/elbasvir + sofosbuvir in cirrhotic and noncirrhotic, treatment-naive patients with hepatitis C virus genotype 1 infection, for durations of 4, 6 or 8 weeks and genotype 3 infection for durations of 8 or 12 weeks. J Hepatol 2015. [DOI: 10.1016/s0168-8278(15)30013-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Cuenca J, Glazebrook C, Kendall T, Hedderly T, Heyman I, Jackson G, Murphy T, Rickards H, Robertson M, Stern J, Trayner P, Hollis C. Perceptions of treatment for tics among young people with Tourette syndrome and their parents: a mixed methods study. BMC Psychiatry 2015; 15:46. [PMID: 25879205 PMCID: PMC4359496 DOI: 10.1186/s12888-015-0430-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 02/24/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Tourette syndrome (TS) among young people is associated with psychosocial difficulties and parents play an important role in the management of the condition. Clinical guidelines have been developed for the treatment of TS and tics, but little is known about how young people and their parents perceive their treatment options or their desired outcomes of treatment. The aim of this study is to explore perceptions of treatments for tics among young people with TS and their parents. METHODS In-depth interviews with 42 young people with TS and a mixed-methods, online survey of 295 parents of young people with TS. Participant recruitment was conducted through Tourettes Action (TA): a non-profit UK organisation for the support of people with TS. Interview transcripts were analysed using thematic analysis and responses to survey open-ended questions were analysed using content analysis. Triangulation of qualitative and quantitative data from the parents' survey and qualitative data from the interviews with young people was used to increase the validity and depth of the findings. RESULTS A strong theme was the perception that health professionals have limited knowledge of TS and its treatment. Medication was a common treatment for tics and both young people and parents described benefits of medication. However, adverse effects were frequently described and these were a common reason for stopping medication among young people. Aripiprazole was viewed most positively. Access to behavioural interventions for tics was limited and 76% of parents wanted this treatment to be available for their child. Some young people had reservations about the effectiveness or practicality of behavioural interventions. Reduction and abolition of tics were desired outcomes of treatment, but both parents and young people also identified the importance of increasing control over tics and reducing anxiety-related symptoms. For young people, managing the urge to tic was an important outcome of treatment. CONCLUSIONS The results suggest a need for more training in the identification and management of TS and wider availability of behavioural treatments. Clinical trials could explore the effectiveness of Aripiprazole used in combination with psycho-educational interventions to reduce anxiety and promote a sense of control.
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Affiliation(s)
- José Cuenca
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, Jubilee Campus, Nottingham, UK.
| | - Cris Glazebrook
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, Jubilee Campus, Nottingham, UK.
| | - Tim Kendall
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
| | - Tammy Hedderly
- Department of Paediatric Neurology, King's College Hospital NHS Foundation Trust, London, UK.
| | - Isobel Heyman
- Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children, London, UK.
| | - Georgina Jackson
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, Jubilee Campus, Nottingham, UK.
| | - Tara Murphy
- Department of Clinical Neuropsychology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Hugh Rickards
- Department of Neuropsychiatry, University of Birmingham and Barberry National Centre for Mental Health, Birmingham, UK.
| | - Mary Robertson
- Department of Neurology, St George's Hospital and Medical School, London, UK.
| | - Jeremy Stern
- Department of Neurology, St George's Hospital and Medical School, London, UK.
| | - Penny Trayner
- Division of Clinical Psychology, University of Manchester, Manchester, UK.
| | - Chris Hollis
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, Jubilee Campus, Nottingham, UK.
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48
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Abstract
Public health and therapeutic measures to reduce cardiac and stroke risk may already be reducing risks of dementia in populations. In routine clinical care, dementia risk could be further reduced by optimized management of delirium, depressive disorders, traumatic brain injury and stroke. These are opportunities to minimize risk of progression to dementia during acute care and subsequent rehabilitation. Although interventions to protect against progress to dementia may be of small effect in each clinical situation, awareness of dementia risk and appropriate steps to reduce that risk should contribute to an overall reduction in the incidence of dementia.
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Affiliation(s)
- M Robertson
- From the Perth College, University of the Highlands & Islands, Crieff Road, Perth PH1 2NX and Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZH, UK
| | - A Seaton
- From the Perth College, University of the Highlands & Islands, Crieff Road, Perth PH1 2NX and Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZH, UK
| | - L J Whalley
- From the Perth College, University of the Highlands & Islands, Crieff Road, Perth PH1 2NX and Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZH, UK
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49
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Taylor K, Stern J, Williams D, Simmons H, Robertson M. DO PRENATAL AND PERINATAL COMPLICATIONS INFLUENCE TIC SEVERITY IN PATIENTS WITH GILLES DE LA TOURETTE SYNDROME? Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-308883.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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50
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Gharatya A, Stern J, Man C, Williams D, Simmons H, Robertson M. SUICIDALITY IN PATIENTS WITH TOURETTE'S SYNDROME. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-308883.27] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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