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Fennelly O, Moroney D, Doyle M, Eustace-Cook J, Hughes M. Key interoperability Factors for patient portals and Electronic health Records: A scoping review. Int J Med Inform 2024; 183:105335. [PMID: 38266425 DOI: 10.1016/j.ijmedinf.2023.105335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024]
Abstract
AIM To identify the key requirements and challenges to interoperability between patient portals and electronic health records (EHRs). INTRODUCTION Patient portals provide patients with access to their health information directly from EHRs within hospitals, primary care centres and general practices (GPs). Patient portals offer many benefits to patients including improved communication with healthcare providers and care coordination. However, many challenges exist with the integration and automatic and secure sharing of information between EHRs and patient portals. It is critical that countries learn from international experiences to successfully develop interoperable national patient portals. METHODS A scoping review methodology was undertaken. A search strategy using index terms and keywords was applied across four key databases, an additional grey literature search was also run. The identified studies were screened by two reviewers to determine eligibility against defined inclusion criteria. Data were abstracted from the eligible studies and reviewed to identify the key requirements and challenges to interoperability of patient portals with EHRs. RESULTS After screening 3,462 studies, 34 were included across 11 countries. Of the 29 unique patient portals studied, few offered patients access to their entire healthcare record across multiple sites and a number of different functionalities were available. Key interoperability requirements and challenges identified were: Data Sharing Incentives & Supports; Heterogenous Organisations & Information Systems; Data Storage & Management; Available Information & Functionalities; Data Formats & Standards; Identification of Individuals; User Access, Control & Consent; and Security & Privacy. CONCLUSION Seamless exchange of health information across patient portals and EHRs required organisational and individual factors, as well as technical considerations. Interorganisational collaboration and engagement of key stakeholders to determine standards and guidelines for consent and sharing of information, as well as technical standards and security measures were recommended.
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Affiliation(s)
| | | | - Michelle Doyle
- Children's Health Ireland at Temple Street, Dublin, Ireland
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Murray GL, Plummer EL, Bodiyabadu K, Vodstrcil LA, Huaman JL, Danielewski JA, Chua TP, Machalek DA, Garland S, Doyle M, Sweeney EL, Whiley DM, Bradshaw CS. gyrA Mutations in Mycoplasma genitalium and Their Contribution to Moxifloxacin Failure: Time for the Next Generation of Resistance-Guided Therapy. Clin Infect Dis 2023; 76:2187-2195. [PMID: 36722416 PMCID: PMC10273371 DOI: 10.1093/cid/ciad057] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/22/2023] [Accepted: 01/27/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although single nucleotide polymorphisms (SNPs) in Mycoplasma genitalium parC contribute to fluoroquinolone treatment failure, data are limited for the homologous gene, gyrA. This study investigated the prevalence of gyrA SNPs and their contribution to fluoroquinolone failure. METHODS Samples from 411 patients (male and female) undergoing treatment for M. genitalium infection (Melbourne Sexual Health Centre, March 2019-February 2020) were analyzed by Sanger sequencing (gyrA and parC). For patients treated with moxifloxacin (n = 194), the association between SNPs and microbiologic treatment outcome was analyzed. RESULTS The most common parC SNP was G248T/S83I (21.1% of samples), followed by D87N (2.3%). The most common gyrA SNP was G285A/M95I (7.1%). Dual parC/gyrA SNPs were found in 8.6% of cases. One third of infections harboring parC G248T/S83I SNP had a concurrent SNP in gyrA conferring M95I. SNPs in gyrA cooccurred with parC S83I variations. Treatment failure was higher in patients with parC S83I/gyrA dual SNPs when compared with infections with single S83I SNP alone from analysis of (1) 194 cases in this study (81.2% vs 45.8%, P = .047), and (2) pooled analysis of a larger population of 535 cases (80.6% vs 43.2%; P = .0027), indicating a strong additive effect. CONCLUSIONS Compared with parC S83I SNP alone, M. genitalium infections with dual mutations affecting parC/gyrA had twice the likelihood of failing moxifloxacin. Although antimicrobial resistance varies by region globally, these data indicate that gyrA should be considered as a target for future resistance assays in Australasia. We propose a strategy for the next generation of resistance-guided therapy incorporating parC and gyrA testing.
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Affiliation(s)
- Gerald L Murray
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Erica L Plummer
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Kaveesha Bodiyabadu
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jose L Huaman
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jennifer A Danielewski
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Teck Phui Chua
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Dorothy A Machalek
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanne Garland
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Michelle Doyle
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Emma L Sweeney
- The University of Queensland Centre for Clinical Research (UQ-CCR), Queensland, Australia
- SpeeDx Pty Ltd, Sydney, New South Wales, Australia
| | - David M Whiley
- The University of Queensland Centre for Clinical Research (UQ-CCR), Queensland, Australia
- Pathology Queensland Central Laboratory, Queensland, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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O'Donnell D, O'Mahony A, Doyle M, O'Gorman M, O'Donoghue A, O'Halloran A, Mulcahy R, Pope G, Cooke J. Point Prevalence of Frailty and Cognitive Impairment Exceeds the Capacity of a Single Ward - Specialist Geriatric Wards to lead Best Practice. Ir Med J 2022; 115:690. [PMID: 36920487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Dolphin H, Dyer A, Domsa M, McNally D, Doyle M, Keating J, Noonan C, McGuinn C, Ahern L, Murphy A, Malone N, Kennelly SP. 356 OLDER PERSONS LIVING ALONE IN INTEGRATED CARE: DEPRESSION, LOW EDUCATION AND FUEL POVERTY. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
An important consequence of population ageing has been the increasing number of older adults who live alone. According to TILDA data, older adults with the lowest levels of education tend to experience most social isolation and there is a strong association between living alone and loneliness. We sought to compare the cohort of patients open to the Integrated Care for Older Persons (ICPOP) team in a University Teaching Hospital serving a community area of approx. 300,000 population, to this national dataset.
Methods
A convenience sample of 174 patients who underwent comprehensive geriatric assessment via domiciliary visit between July 2021-May 2022 by was analysed. Data was anonymised and analysis was performed using SPSS v.27.
Results
The average age was 81.5 (±8.1) with 63% women in the sample. Eighty-five older adults i.e. 49% of the sample either lived alone or spent more than 21 hours alone per 24-hour period. Compared to those who live with someone, those who lived alone had higher rates of likely depression as determined by Geriatric Depression Score (6.6 vs 4.8 p=0.007). They were also likely to have less educational attainment, as determined by years spent in full time education (11.81 vs 10.42 42 p= 0.0016) and those living alone had overall less central heating in their homes than those not living alone (64/85 vs 81/89 p=0.0109). There were no significant differences in the rates of polypharmacy, falls, dementia and home ownership between groups. There were higher levels of frailty in the group living with someone than those living alone as determined by Clinical Frailty Scale (6.14 vs 5.23 p<0.001).
Conclusion
A high proportion of patients seen by our ICPOP team live alone and have complex care needs that require an innovative, multidisciplinary approach. Financial vulnerability in this group is likely to compound isolation and loneliness.
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Affiliation(s)
- H Dolphin
- Tallaght University Hospital , Dublin, Ireland
| | - A Dyer
- Tallaght University Hospital , Dublin, Ireland
| | - M Domsa
- Tallaght University Hospital , Dublin, Ireland
| | - D McNally
- Tallaght University Hospital , Dublin, Ireland
| | - M Doyle
- Tallaght University Hospital , Dublin, Ireland
| | - J Keating
- Tallaght University Hospital , Dublin, Ireland
| | - C Noonan
- Tallaght University Hospital , Dublin, Ireland
| | - C McGuinn
- Tallaght University Hospital , Dublin, Ireland
| | - L Ahern
- Tallaght University Hospital , Dublin, Ireland
| | - A Murphy
- Tallaght University Hospital , Dublin, Ireland
| | - N Malone
- Tallaght University Hospital , Dublin, Ireland
| | - SP Kennelly
- Tallaght University Hospital , Dublin, Ireland
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Doyle M, Louw J, Corry M. 107 LESSONS LEARNED FOLLOWING COVID-19: PLANNING FOR FUTURE INFECTIOUS OUTBREAKS IN A RESIDENTIAL CARE SETTING. Age Ageing 2022. [PMCID: PMC9620289 DOI: 10.1093/ageing/afac218.087] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background During the COVID-19 pandemic, maintaining resident and staff safety was a key priority. This study explored the experiences of the nursing team in a residential care facility for older adults and we report on the lessons learned for future infection control outbreaks. Methods Following ethical approval, all members of the nursing team were invited to take part in a one-to-one virtual interview using Microsoft teams. Eleven interviews were conducted. The data were imported into NVIVO data management software and analysed using thematic analysis. Results The findings highlight the importance of preparedness in terms of ‘keeping the house in order’ by having policy, guidelines and staff training up-to-date, so that they are easily amended to meet unexpected challenges. Having advanced care planning as part of routine care will ensure that the wishes of the residents are always respected. Keeping the channels of communication open by embracing technology and being technology ready emerged as key to relationship centred care. This was important for maintaining relationships between staff, residents, and family/caregivers, and was essential for resident and family well-being, particularly for residents with cognitive impairment. Conclusion Scientific predictions indicate that the next pandemic may come sooner and be deadlier than COVID-19. Health care managers and staff need to be ready to ensure that quality care is maintained. In residential settings, disruption to routine care can be minimised by embedding aspects of care embraced during COVID-19, into routine practice. Advanced care planning, embracing technology, and ensuring staff training, policy and procedures are up-to-date will make sure they can be easily amended to address infection specific requirements and this, will enable health care workers respond to outbreaks efficiently.
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Affiliation(s)
- M Doyle
- Peamount Healthcare , Dublin, Ireland
| | - J Louw
- Trinity College , Dublin, Ireland
| | - M Corry
- Trinity College , Dublin, Ireland
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Cowled BD, Hillman A, Ward MP, Clutterbuck H, Doyle M, Webb Ware J, Thomas M, Plain K, Barwell R, Laurence M, Pfeiffer C. The black summer bushfires: impacts and risk factors for livestock bushfire injury in south-eastern Australia. Aust Vet J 2022; 100:306-317. [PMID: 35514115 PMCID: PMC9546107 DOI: 10.1111/avj.13165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 03/21/2022] [Accepted: 04/16/2022] [Indexed: 11/26/2022]
Abstract
Background The 2019/2020 Australian bushfires were the largest bushfire event in modern Australian history. While actions to mitigate risk to homes from bushfires are well reported, there is very little research reported on the impacts of bushfires on livestock. With an increasing incidence of bushfires predicted, there is an urgent need to identify how farmers can best protect their livestock. Objectives Compare bushfire affected farms with and without injured livestock to identify associations between risk factors and bushfire injury. Infer management approaches that can be used to reduce bushfire injury in livestock. Method A case‐control study using a structured interview questionnaire, delivered in late 2020 to cattle and sheep farmers in south‐eastern Australia (New South Wales and Victoria) whose farmland was burnt in the 2019/2020 Australian bushfires. Case farms were farms with bushfires injured or killed livestock. Control farms were farms that had no bushfire injured livestock but that still had fire present on the farm. Interview responses were summarised and information theoretical approaches were used to identify potential risk factors for livestock bushfire injury and protective actions that could inform future fire‐preparation recommendations. Results and discussion Of 46 farms in the case‐control study, 21 (46%) reported bushfire injured or killed livestock. Apparent protective factors identified included: preparation (having a bushfire plan and more than two farm bushfire fighting units), backburning and receiving assistance from fire authorities. Combined beef and sheep grazing enterprises appeared to have an increased risk of bushfire injury to livestock.
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Affiliation(s)
- B D Cowled
- Ausvet Pty Ltd, 34 Thynne St, Bruce, Australian Capital Territory, Australia.,Sydney School of Veterinary Science, Faculty of Science, University of Sydney, 425 Werombi Road, Camden, New South Wales, Australia
| | - A Hillman
- Ausvet Pty Ltd, 34 Thynne St, Bruce, Australian Capital Territory, Australia
| | - M P Ward
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, 425 Werombi Road, Camden, New South Wales, Australia
| | - H Clutterbuck
- South East Local Land Services, 159 Auburn St, Goulburn, New South Wales, Australia
| | - M Doyle
- South East Local Land Services, 159 Auburn St, Goulburn, New South Wales, Australia
| | - J Webb Ware
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Science, University of Melbourne, Grattan St, Parkville, Victoria, Australia
| | - M Thomas
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Science, University of Melbourne, Grattan St, Parkville, Victoria, Australia
| | - K Plain
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, 425 Werombi Road, Camden, New South Wales, Australia
| | - R Barwell
- Animal Health Australia, Level 2, 95 Northbourne Ave, Turner, Australian Capital Territory, Australia
| | - M Laurence
- Meat and Livestock Australia, Level 1, 40 Mount Street, North Sydney, New South Wales, 2060, Australia
| | - C Pfeiffer
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Science, University of Melbourne, Grattan St, Parkville, Victoria, Australia
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7
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Vodstrcil LA, Plummer EL, Doyle M, Murray GL, Bodiyabadu K, Jensen JS, Whiley D, Sweeney E, Williamson DA, Chow EPF, Fairley CK, Bradshaw CS. Combination therapy for Mycoplasma genitalium, and new insights into the utility of parC mutant detection to improve cure. Clin Infect Dis 2022; 75:813-823. [PMID: 34984438 DOI: 10.1093/cid/ciab1058] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mycoplasma genitalium (MG) infection is challenging to cure due to rising antimicrobial resistance and limited treatment options. METHODS This was a prospective evaluation of the efficacy and tolerability of resistance-guided combination antimicrobial therapy for MG-treatment at Melbourne Sexual Health Centre (August 2019-December 2020). All patients received 7-days doxycycline prior to combination therapy based on the macrolide-resistant profile. Macrolide-susceptible infections received combination doxycycline+azithromycin (1g day-1, 500mg days-2-4) and macrolide-resistant infections combination doxycycline+moxifloxacin (400mg daily 7-days). Adherence and adverse effects were recorded at test-of-cure, recommended 14-28-days after antimicrobial completion. Sequencing was performed to determine the prevalence of single nucleotide polymorphisms (SNPs) in the parC gene and their association with moxifloxacin-treatment outcomes in macrolide-resistant infections. RESULTS Of 100 patients with macrolide-susceptible MG treated with doxycycline+azithromycin, 93 were cured (93.0%; 95%CI:86.1%-97.1%). Of 247 patients with macrolide-resistant MG receiving doxycycline+moxifloxacin, 210 were cured (85.0%; 95%CI:80.0%-89.2%). parC sequencing was available for 164 (66%) macrolide-resistant infections; 29% had SNPs at parC S83 or D87 (23% S83I). The absence of SNPs at parC S83/D87 was associated with 98.3% cure (95%CI:93.9-99.8%) following doxycycline+moxifloxacin. The presence of the parC S83I-SNP was associated with failure in 62.5% (95%CI:45.8-77.3%). Side-effects were common (40-46%) and predominantly mild and gastrointestinal. CONCLUSION Combination doxycycline+azithromycin achieved high cure for macrolide-susceptible infections. However, in the context of a high prevalence of the parC S83I mutation (23%) in macrolide-resistant infections, doxycycline+moxifloxacin cured only 85%Infections that were wildtype for S83/D87 experienced high cure following doxycycline+moxifloxacin, supporting the use of a parC-resistance/susceptibility testing strategy in clinical care.
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Affiliation(s)
- Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Erica L Plummer
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michelle Doyle
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Gerald L Murray
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Kaveesha Bodiyabadu
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Jorgen S Jensen
- Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark
| | - David Whiley
- The University of Queensland Centre for Clinical Research (UQ-CCR), Queensland, Australia.,Pathology Queensland Central Laboratory, Queensland, Australia
| | - Emma Sweeney
- The University of Queensland Centre for Clinical Research (UQ-CCR), Queensland, Australia
| | - Deborah A Williamson
- Department of Microbiology, Royal Melbourne Hospital, Melbourne, Australia.,Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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8
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Flood E, Browne L, Kurian S, Lynch C, Doyle M, Jordan A, Varghese R, Mello S. 132 GERIATRIC REHABILITATION IN THE COVID-19 ERA: SERVICE INNOVATION AND PATIENT OUTCOMES. Age Ageing 2021. [PMCID: PMC8689995 DOI: 10.1093/ageing/afab219.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- E Flood
- Peamount Healthcare, Dublin, Ireland
| | - L Browne
- Peamount Healthcare, Dublin, Ireland
| | - S Kurian
- Peamount Healthcare, Dublin, Ireland
| | - C Lynch
- Peamount Healthcare, Dublin, Ireland
| | - M Doyle
- Peamount Healthcare, Dublin, Ireland
| | - A Jordan
- Peamount Healthcare, Dublin, Ireland
| | | | - S Mello
- Peamount Healthcare, Dublin, Ireland,Tallaght University Hospital, Dublin, Ireland
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Duff E, Moran J, Doyle M, O'Gorman M, Ryan MD, Finucane P, Cooke J, Pope G, Mulcahy R, O’Regan N. 108 COMBATTING CONFUSION: SIMULATION-BASED MEDICAL EDUCATION FOR DEALING WITH DELIRIUM. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Delirium is a complex, costly, and common clinical syndrome. Simulation-based medical education has been shown to be effective in enhancing the confidence, knowledge and skills of healthcare professionals in the management of delirium. We piloted an inter-professional education simulation on delirium in an acute hospital setting. The session’s design was informed by participating in ‘Sim Stars’, a regional simulation development competition.
Methods
We iteratively developed a low-fidelity simulation scenario on the recognition, prevention and management of delirium. The resulting simulation was piloted during an hour-long multidisciplinary departmental teaching session in a lecture hall setting. A candidate was asked to review an acutely confused patient (played by a ‘confederate’) on call. The candidate was expected to screen for delirium using the 4AT tool; assess for possible causes of delirium; and implement an appropriate management plan. After the session, qualitative feedback from the participants and audience was sought.
Results
This pilot simulation included one candidate (medical Senior House Officer); two confederates (Consultant Geriatrician, Advanced Nurse Practitioner); two facilitators (Consultant Geriatrician, Advanced Nurse Practitioner); and an audience of 17 members. Feedback indicated that learners and trainers found this a helpful and enjoyable pedagogical method. Areas for improvement were highlighted, including providing advance notice for learners of the topic to be simulated; a more structured introduction defining the learning outcomes and declaring a ‘blame free’ environment; improved script for the patient confederate; and that having a team of learners (rather than specialists) to play ‘confederates’ may help improve team-building and reduce learner anxiety.
Conclusion
This pilot simulation received positive appraisals from the team, and plans are underway to incorporate simulation more regularly into departmental teaching. Suggestions to improve future simulations were welcomed. Given its low-fidelity, this scenario can easily be used at any site for simulation-based training.
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Affiliation(s)
- E Duff
- University Hospital Waterford , Waterford, Ireland
| | - J Moran
- University Hospital Waterford , Waterford, Ireland
| | - M Doyle
- University Hospital Waterford , Waterford, Ireland
| | - M O'Gorman
- University Hospital Waterford , Waterford, Ireland
| | - M D Ryan
- University Hospital Waterford , Waterford, Ireland
| | - P Finucane
- University Hospital Waterford , Waterford, Ireland
| | - J Cooke
- University Hospital Waterford , Waterford, Ireland
| | - G Pope
- University Hospital Waterford , Waterford, Ireland
| | - R Mulcahy
- University Hospital Waterford , Waterford, Ireland
| | - N O’Regan
- University Hospital Waterford , Waterford, Ireland
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10
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Doyle M, Ryan D, Mello S. 56 EFFICACY OF AN ELECTIVE PERIOD OF IN-PATIENT REHABILITATION FOR PATIENTS LIVING WITH PARKINSON’S DISEASE AND FRAILTY: A PILOT STUDY. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Frailty and Parkinson’s disease (PD) are more common with increasing age and are associated with syndromes such as falls, immobility, cognitive dysfunction and incontinence. PD may directly cause or co-exist with and compound frailty. A coordinated, multidisciplinary approach to care has been shown to optimize outcomes in both of these conditions. This pilot study aims to examine the short-term effects of an elective two-week in-patient rehabilitation program on frail PD patients’ function, mobility, and self-reported quality of life (QOL).
Methods
This prospective cohort study included all frail PD patients admitted for elective rehabilitation since the program’s conception. Patients included must be able to mobilize independently with or without an aid, or with assistance of one person. They also must be cognitively able to participate in rehabilitation. Patients received consultant-led Comprehensive Geriatric Assessment and attended daily physiotherapy and occupational therapy sessions. Functional outcome and health related QOL measurements were collected on admission and discharge and compared using a paired t-test. Frailty was quantified by the Clinical Frailty Index.
Results
Twelve patients completed the program (58% male). The average age was 79 (range 70–86) and average clinical frailty score was 5.6 indicating mild to moderate frailty. Performance in activities of daily living (Barthel Index: 64 vs 73, p = 0.005), overall mobility (Elderly Mobility Scale: 10.6 vs 12.9, p = 0.004), gait speed (Timed Up and Go: 35 vs 29 seconds, p = 0.05), and balance (Berg Balance Scale: 25 vs 32, p = 0.002) significantly improved from admission to discharge from the program. Health-related QOL also improved (EQ-5D: 44 vs 66, p = 0.004).
Conclusion
Early data suggests that a short elective in-patient rehabilitation program has highly significant benefits for frail PD patients on mobility, performance of activities of daily living, and QOL. Longer term follow-up is required to assess sustainability of these improvements and cost-effectiveness of this intervention.
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Affiliation(s)
- M Doyle
- Peamount Healthcare , Dublin, Ireland
| | - D Ryan
- Peamount Healthcare , Dublin, Ireland
- Tallaght University Hospital , Dublin, Ireland
| | - S Mello
- Peamount Healthcare , Dublin, Ireland
- Tallaght University Hospital , Dublin, Ireland
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11
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Kashyap K, Tobaa A, Khalif A, Doyle M, Shah M. Invasive Coronary Angiography Yield When Applying A Computed Tomography-derived Fractional Flow Reserve (ct-ffrct) Strategy: A Real-world Experience. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.174] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Latimer RL, Vodstrcil LA, Plummer EL, Doyle M, Murray GL, Fairley CK, Bodiyabadu K, Read TRH, Kaiser M, Mokany E, Guy R, Chow EPF, Bradshaw C. The clinical indications for testing women for Mycoplasma genitalium. Sex Transm Infect 2021; 98:277-285. [PMID: 34210839 DOI: 10.1136/sextrans-2020-054818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 05/29/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND While the contribution of Mycoplasma genitalium (MG) to symptoms in men is well described, less is known about its association with common genital symptoms in women. We aimed to determine the prevalence of MG and macrolide resistance, and its association with common genital symptoms in women attending a sexual health service, to inform indications for testing and clinical practice. METHODS We undertook a cross-sectional study of symptomatic and asymptomatic women attending Melbourne Sexual Health Centre (MSHC), between April 2017 and April 2019. Women were tested for MG and macrolide resistance, Chlamydia trachomatis (CT), Neisseria gonorrhoeae, Trichomonas vaginalis, bacterial vaginosis and vulvovaginal candidiasis. Women completed a questionnaire on symptoms, and symptomatic women underwent examination. The prevalence of MG (and macrolide resistance) and other genital infections was calculated with 95% CIs, and associations between these outcomes and specific genital symptoms were examined using logistic regression. RESULTS Of 1318 women, 83 (6%, 95% CI: 5% to 8%) had MG, of which 39 (48%, 95% CI: 36% to 59%) had macrolide-resistant MG; 103 (8%, 95% CI: 6% to 9%) women had CT. MG prevalence was similar in asymptomatic (10 of 195; 5%) and symptomatic (73 of 1108; 7%) women, p=0.506. MG was associated with mucopurulent cervicitis on examination (adjusted OR=4.38, 95% CI: 1.69 to 11.33, p=0.002), but was not associated with other specific genital symptoms or signs. CONCLUSIONS MG was as common as CT among women attending MSHC. MG was not associated with genital symptoms, but like CT, was significantly associated with cervicitis. These data provide evidence that routine testing for MG in women with common genital symptoms is not indicated. The presence of macrolide resistance in 48% of women supports use of resistance-guided therapy.
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Affiliation(s)
- Rosie L Latimer
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia .,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Erica L Plummer
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michelle Doyle
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Gerald L Murray
- Molecular Microbiology Research Group, Murdoch Children's Research institute, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Kaveesha Bodiyabadu
- Molecular Microbiology Research Group, Murdoch Children's Research institute, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia.,SpeeDx Pty Ltd, Sydney, New South Wales, Australia
| | - Tim R H Read
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Marti Kaiser
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Elisa Mokany
- SpeeDx Pty Ltd, Sydney, New South Wales, Australia
| | - Rebecca Guy
- Sexual Health Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Catriona Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Carlier J, Doyle M, Finn JA, Ó hUallacháin D, Moran J. A landscape classification map of Ireland and its potential use in national land use monitoring. J Environ Manage 2021; 289:112498. [PMID: 33878703 DOI: 10.1016/j.jenvman.2021.112498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/04/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
This study presents a novel landscape classification map of the Republic of Ireland and is the first to identify broad landscape classes by incorporating physiographic and land cover data. The landscape classification responds to commitments to identify and classify the Irish landscape as a signatory to the European Landscape Convention. The methodology applied a series of clustering iterations to determine an objective multivariate classification of physiographic landscape units and land cover datasets. The classification results determined nine statistically significant landscape classes and the development of a landscape classification map at a national scale. A statistical breakdown of land cover area and diversity of each class was interpreted, and a comparison was extended using independent descriptive variables including farmland use intensity, elevation, and dominant soil type. Each class depicts unique spatial and composition characteristics, from coastal, lowland and elevated, to distinct and dominating land cover types, further explained by the descriptive variables. The significance of individual classes and success of the classification is discussed with particular reference to the wider applicability of the map. The transferability of the methodology to other existing physiographic maps and environmental datasets to generate new landscape classifications is also considered. This novel work facilitates the development of a strategic framework to efficiently monitor, compare and analyse ecological and other land use data that is spatially representative of the distribution and extent of land cover in the Irish countryside.
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Affiliation(s)
- J Carlier
- Agroecology and Rural Development Group, Marine and Freshwater Research Centre, Galway-Mayo Institute of Technology, Galway Campus, Dublin Road, Galway, Ireland.
| | - M Doyle
- Agriculture & Food Science Centre, University College Dublin, Belfield, Dublin, 4, Ireland
| | - J A Finn
- Teagasc Environment Research Centre, Johnstown Castle, Co. Wexford, Ireland
| | - D Ó hUallacháin
- Teagasc Environment Research Centre, Johnstown Castle, Co. Wexford, Ireland
| | - J Moran
- Agroecology and Rural Development Group, Marine and Freshwater Research Centre, Galway-Mayo Institute of Technology, Galway Campus, Dublin Road, Galway, Ireland
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14
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Durukan D, Doyle M, Murray G, Bodiyabadu K, Vodstrcil L, Chow EPF, Jensen JS, Fairley CK, Aguirre I, Bradshaw CS. Doxycycline and Sitafloxacin Combination Therapy for Treating Highly Resistant Mycoplasma genitalium. Emerg Infect Dis 2021; 26:1870-1874. [PMID: 32687029 PMCID: PMC7392426 DOI: 10.3201/eid2608.191806] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Antimicrobial-resistant Mycoplasma genitalium is becoming increasingly common and creating major treatment challenges. We present early data on combination therapy with doxycycline and sitafloxacin to treat highly resistant M. genitalium. We found the regimen was well tolerated and cured 11/12 infections that had failed prior regimens with moxifloxacin and pristinamycin.
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15
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S C, Doyle M, Mahon OM, G K. Urinary tract imaging in infants with spina bifida: a selective approach to a baseline DMSA. J Pediatr Urol 2021; 17:396.e1-396.e6. [PMID: 33637457 DOI: 10.1016/j.jpurol.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION There is no general agreement among paediatric urologists on how infants with spina bifida (SB) should be investigated after birth. Recently the EUA/ESPU guidelines have been published recommending a baseline DMSA scan in the first year of life and a Voiding Cystourethrogram (VCUG) or Videourodynamic (VUD) between the second and third month of life. OBJECTIVE The aim of this study was to evaluate the outcome of renal investigations in the first year of life in infants with SB to verify if an early DMSA scan is indicated in the management of this group of patients. METHODS All renal imaging, Renal and Bladder Ultrasound (RBUS), VCUGs, VUDs and DMSA were reviewed by two independent assessors to evaluate outcome. RESULTS Seventy patients with spina bifida (40 girls) were enrolled between June 2015 and February 2020. An early VUD detected vesico-ureteral reflux (VUR) in 8/49 (16%) of patients. An early VUD also gave additional information on detrusor under or over activity, bladder trabeculation, end filling detrusor pressure (EFDP) and sphincteric incompetence. DMSA scan detected renal scarring in 4/68 (6%) patients. Three of these 4 patients had significant history of febrile UTIs while the fourth patient had grade 2 left sided VUR. CONCLUSIONS The initial assessment of a newborn with myelodysplasia includes a Renal and Bladder Ultrasound during birth hospitalization. This study confirms the recently published EUA/ESPU guidelines on the management of neurogenic bladder in children and adolescents, which recommend a VUD or VCUG & Cystomanometry with Electromyogram (CMG) (if VUD not available) in the first 6-12 weeks of life. A selective approach to DMSA scan only in infants with SB who either had a febrile UTI or vesico-ureteric reflux would not have missed any scarring or dysplasia and would have saved 58 unnecessary nuclear scans.
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Affiliation(s)
- Cascio S
- Department of Paediatric Urology, Children's Health Ireland at Temple Street, Dublin, Ireland; University College Dublin, Ireland.
| | - M Doyle
- Department of Paediatric Urology, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - O Mc Mahon
- Department of Paediatric Urology, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Kelly G
- School of Mathematics and Statistics, Ireland; University College Dublin, Ireland
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Doyle M, Bhattacharya A, Rice K, Collins G. MDPV High‐responder Phenotype as a Tool to Evaluate Candidate Medications for Stimulant Use Disorder. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.01637] [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: 11/11/2022]
Affiliation(s)
- Michelle Doyle
- University of Texas Health Science Center At San AntonioSan AntonioTX
| | - Ayon Bhattacharya
- University of Texas Health Science Center At San AntonioSan AntonioTX
| | - Kenner Rice
- Molecular Targets and Medications Discovery Branch, Drug Design and Synthesis SectionNational Institute on Drug Abuse, Intramural Research Program, National Institutes of HealthBethesdaMD
| | - Gregory Collins
- University of Texas Health Science Center At San AntonioSan AntonioTX
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17
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Durukan D, Read TRH, Murray G, Doyle M, Chow EPF, Vodstrcil LA, Fairley CK, Aguirre I, Mokany E, Tan LY, Chen MY, Bradshaw CS. Resistance-Guided Antimicrobial Therapy Using Doxycycline-Moxifloxacin and Doxycycline-2.5 g Azithromycin for the Treatment of Mycoplasma genitalium Infection: Efficacy and Tolerability. Clin Infect Dis 2021; 71:1461-1468. [PMID: 31629365 DOI: 10.1093/cid/ciz1031] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 10/15/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Macrolide resistance in Mycoplasma genitalium (MG) exceeds 50% in many regions, and quinolone resistance is increasing. We recently reported that resistance-guided therapy (RGT) using doxycycline followed by sitafloxacin or 2.5 g azithromycin cured 92% and 95% of macrolide-resistant and macrolide-susceptible infections, respectively. We present data on RGT using doxycycline-moxifloxacin, the regimen recommended in international guidelines, and extend data on the efficacy of doxycycline-2.5 g azithromycin and de novo macrolide resistance. METHODS Patients attending Melbourne Sexual Health Centre between 2017 and 2018 with sexually transmitted infection syndromes were treated with doxycycline for 7 days and recalled if MG-positive. Macrolide-susceptible cases received 2.5 g azithromycin (1 g, then 500 mg daily for 3 days), and resistant cases moxifloxacin (400 mg daily, 7 days). Test of cure was recommended 14-28 days post-antimicrobials. RESULTS There were 383 patients (81 females/106 heterosexual males/196 men who have sex with men) included. Microbial cure following doxycycline-azithromycin was 95.4% (95% confidence interval [CI], 89.7-98.0) and doxycycline-moxifloxacin was 92.0% (95% CI, 88.1-94.6). De novo macrolide resistance was detected in 4.6% of cases. Combining doxycycline-azithromycin data with our prior RGT study (n = 186) yielded a pooled cure of 95.7% (95% CI, 91.6-97.8). ParC mutations were present in 22% of macrolide-resistant cases. CONCLUSIONS These findings support the inclusion of moxifloxacin in resistance-guided strategies and extend the evidence for 2.5 g azithromycin and presumptive use of doxycycline. These data provide an evidence base for current UK, Australian, and European guidelines for the treatment of MG.
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Affiliation(s)
- Duygu Durukan
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Tim R H Read
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Gerald Murray
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Michelle Doyle
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Eric P F Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Lenka A Vodstrcil
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Christopher K Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Ivette Aguirre
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Elisa Mokany
- SpeeDx Pty Ltd, National Innovation Centre, Eveleigh, New South Wales, Australia
| | - Lit Y Tan
- SpeeDx Pty Ltd, National Innovation Centre, Eveleigh, New South Wales, Australia
| | - Marcus Y Chen
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Catriona S Bradshaw
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
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18
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Plummer EL, Vodstrcil LA, Bodiyabadu K, Murray GL, Doyle M, Latimer RL, Fairley CK, Payne M, Chow EPF, Garland SM, Bradshaw CS. Are Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum associated with specific genital symptoms and clinical signs in non-pregnant women? Clin Infect Dis 2021; 73:659-668. [PMID: 33502501 DOI: 10.1093/cid/ciab061] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is limited evidence supporting an association between Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum and symptoms or disease in non-pregnant women. However, testing and reporting of these organisms frequently occurs, in-part due to their inclusion in multiplex-PCR assays for sexually transmitted infection (STI) detection. We investigated if M. hominis, U. urealyticum and U. parvum were associated with symptoms and/or signs in non-pregnant women attending a sexual health service. METHODS Eligible women attending Melbourne Sexual Health Centre completed a questionnaire regarding sexual practices and symptoms. Symptomatic women underwent examination. Women were assessed for bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC), and tested for M. hominis, U. urealyticum and U. parvum, and four non-viral STIs using a commercial multiplex-PCR. RESULTS 1,272 women were analysed. After adjusting for STIs and VVC, M. hominis was associated with abnormal vaginal discharge (aOR=2.70, 95%CI:1.92-3.79), vaginal malodour (aOR=4.27, 95%CI:3.08-5.91), vaginal pH>4.5 (aOR=4.27, 95%CI:3.22-5.66) and presence of clue cells (aOR=8.08, 95%CI:5.68-11.48). Ureaplasma spp. were not associated with symptoms/signs. BV was strongly associated with M. hominis (aOR=8.01, 95%CI:5.99-10.71), but was not associated with either Ureaplasma spp. In stratified analyses, M. hominis was associated with self-reported vaginal malodour and clinician-recorded vaginal discharge in women with BV, but not with symptoms/signs in women without BV. CONCLUSION Only M. hominis was associated with symptoms/signs, and these were manifestations of BV. Importantly, M. hominis was not associated with symptoms/signs in women without BV. These findings do not support routine testing for M. hominis, U. urealyticum and U. parvum in non-pregnant women.
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Affiliation(s)
- Erica L Plummer
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Lenka A Vodstrcil
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Kaveesha Bodiyabadu
- Murdoch Children's Research Institute, Parkville, Australia
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Australia
- SpeeDx Pty Ltd, Sydney, Australia
| | - Gerald L Murray
- Murdoch Children's Research Institute, Parkville, Australia
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Australia
| | - Michelle Doyle
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Rosie L Latimer
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Matthew Payne
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Australia
| | - Eric P F Chow
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Suzanne M Garland
- Murdoch Children's Research Institute, Parkville, Australia
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Australia
| | - Catriona S Bradshaw
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Doyle M, Watson D, Nguyen M, Wu J, Elder D, Ng M, Morton R, Keech A, Shah K, Harris J, Woldendorp K, Seco M. M19 Case Volume, Demographics and Surgical Risk Trends of Patients Undergoing Surgical and Transcatheter Aortic Valve Replacement. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Woldendorp K, Doyle M, Bannon P, Yan T. R21 Aortic Valve Replacement Using Stented or Sutureless Prosthesis via Either Full-Sternotomy or a Minimally Invasive Approach: A Metwork Meta-analysis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Shah K, Woldendorp K, Harris J, Keech A, Morton R, Ng M, Elder D, Seco M, Nguyen M, Turner L, Wu J, Watson D, Doyle M. R29 Hospital Resource Use and Costs of Isolated Aortic Valve Replacement Procedures in Patients with aortic stenosis, by STS risk scores in New South Wales, Australia. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Murray GL, Doyle M, Bodiyabadu K, Vodstrcil LA, Garland SM, Danielewski J, Machalek DA, McGuinness C, Plummer EL, De Petra V, Williamson DA, Bradshaw CS. Evaluation of ResistancePlus MG FleXible, a 'near-patient' test for the detection of Mycoplasma genitalium and macrolide resistance mutations, using freshly collected clinical samples. J Med Microbiol 2021; 70. [PMID: 33226320 DOI: 10.1099/jmm.0.001271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Introduction. Mycoplasma genitalium is a sexually transmitted pathogen with increasing resistance to first- and second-line antimicrobials. The 'near-patient test' ResistancePlus MG FleXible (SpeeDx) detects M. genitalium plus four macrolide resistance mutations (MRMs), facilitating same-day patient follow up.Hypothesis/Gap Statement. This assay has not been assessed on freshly collected samples.Aim. Our goal was to evaluate the performance of the ResistancePlus MG FleXible test against the standard of care open platform test.Methods. ResistancePlus MG FleXible (analysed on the Cepheid GeneXpert platform) was evaluated on freshly collected samples and compared to the standard of care open platform test ResistancePlus MG (SpeeDx) analysed on the LightCycler 480 II (Roche).Results. For 270 valid tests, ResistancePlus MG FleXible yielded a high positive per cent agreement (PPA) of 94.1% [96/102; 95 % confidence interval (CI): 87.6-97.8 %] and negative per cent agreement (NPA) of 95.2% (160/168; 95 % CI: 90.8-97.9%) for M. genitalium detection compared to the reference assay (kappa for test concordance of 0.89; 95 % CI: 0.83-0.95). Performance was similar across different sample types. For the detection of MRMs, ResistancePlus MG FleXible had a PPA of 97.1% (66/68; 95% CI: 89.8-99.6) and NPA of 78.6% (22/28; 95 % CI: 59.0-91.7), with test comparison kappa of 0.79 (95 % CI: 0.65-0.93). Notably, of six discordant results (i.e. determined to be wild type by the reference assay), five were positive for MRMs by Sanger sequencing, indicating that the ResistancePlus MG FleXible assay has an improved performance for mutation detection.Conclusion. ResistancePlus MG FleXible had comparable test performance for M. genitalium detection as the open platform assay, with improved detection of MRMs. The ResistancePlus MG FleXible 'near-patient' assay can deliver a rapid result to expedite appropriate treatment.
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Affiliation(s)
- Gerald L Murray
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia
- Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- The Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia
- Infection and Immunity Program, Department of Microbiology, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Michelle Doyle
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia
| | - Kaveesha Bodiyabadu
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia
- Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Suzanne M Garland
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia
- Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- The Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia
| | - Jennifer Danielewski
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia
- Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Dorothy A Machalek
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia
- Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Erica L Plummer
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia
- Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Vesna De Petra
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
- Department of Microbiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
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23
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Vodstrcil LA, Plummer EL, Doyle M, Fairley CK, McGuiness C, Bateson D, Hocking JS, Law MG, Petoumenos K, Donovan B, Chow EPF, Bradshaw CS. Treating male partners of women with bacterial vaginosis (StepUp): a protocol for a randomised controlled trial to assess the clinical effectiveness of male partner treatment for reducing the risk of BV recurrence. BMC Infect Dis 2020; 20:834. [PMID: 33176727 PMCID: PMC7661182 DOI: 10.1186/s12879-020-05563-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 10/30/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Bacterial vaginosis (BV) is estimated to affect 1 in 3 women globally and is associated with obstetric and gynaecological sequelae. Current recommended therapies have good short-term efficacy but 1 in 2 women experience BV recurrence within 6 months of treatment. Evidence of male carriage of BV-organisms suggests that male partners may be reinfecting women with BV-associated bacteria (henceforth referred to as BV-organisms) and impacting on the efficacy of treatment approaches solely directed to women. This trial aims to determine the effect of concurrent male partner treatment for preventing BV recurrence compared to current standard of care. METHODS StepUp is an open-label, multicentre, parallel group randomised controlled trial for women diagnosed with BV and their male partner. Women with clinical-BV defined using current gold standard diagnosis methods (≥3 Amsel criteria and Nugent score (NS) = 4-10) and with a regular male partner will be assessed for eligibility, and couples will then be consented. All women will be prescribed oral metronidazole 400 mg twice daily (BID) for 7 days, or if contraindicated, a 7-day regimen of topical vaginal 2% clindamycin. Couples will be randomised 1:1 to either current standard of care (female treatment only), or female treatment and concurrent male partner treatment (7 days of combined antibiotics - oral metronidazole tablets 400 mg BID and 2% clindamycin cream applied topically to the glans penis and upper shaft [under the foreskin if uncircumcised] BID). Couples will be followed for up to 12 weeks to assess BV status in women, and assess the adherence, tolerability and acceptability of male partner treatment. The primary outcome is BV recurrence defined as ≥3 Amsel criteria and NS = 4-10 within 12 weeks of enrolment. The estimated sample size is 342 couples, to detect a 40% reduction in BV recurrence rates from 40% in the control group to 24% in the intervention group within 12 weeks. DISCUSSION Current treatments directed solely to women result in unacceptably high rates of BV recurrence. If proven to be effective the findings from this trial will directly inform the development of new treatment strategies to impact on BV recurrence. TRIAL REGISTRATION The trial was prospectively registered on 12 February 2019 on the Australian and New Zealand Clinical Trial Registry (ACTRN12619000196145, Universal Trial Number: U1111-1228-0106, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376883&isReview=true ).
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Affiliation(s)
- Lenka A Vodstrcil
- Central Clinical School, Monash University, Carlton, VIC, 3053, Australia.
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, 3053, Australia.
| | - Erica L Plummer
- Central Clinical School, Monash University, Carlton, VIC, 3053, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, 3053, Australia
| | - Michelle Doyle
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, 3053, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Carlton, VIC, 3053, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, 3053, Australia
| | - Colette McGuiness
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, 3053, Australia
| | - Deborah Bateson
- Family Planning New South Wales, Ashfield, 2131, Australia
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Camperdown, 2006, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, University of Melbourne, Parkville, 3010, Australia
| | - Matthew G Law
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
| | - Kathy Petoumenos
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
| | - Eric P F Chow
- Central Clinical School, Monash University, Carlton, VIC, 3053, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, 3053, Australia
| | - Catriona S Bradshaw
- Central Clinical School, Monash University, Carlton, VIC, 3053, Australia.
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, 3053, Australia.
- Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, University of Melbourne, Parkville, 3010, Australia.
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Doyle M, Vodstrcil LA, Plummer EL, Aguirre I, Fairley CK, Bradshaw CS. Nonquinolone Options for the Treatment of Mycoplasma genitalium in the Era of Increased Resistance. Open Forum Infect Dis 2020; 7:ofaa291. [PMID: 32782911 PMCID: PMC7408185 DOI: 10.1093/ofid/ofaa291] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/08/2020] [Indexed: 11/13/2022] Open
Abstract
In the era of increasing macrolide- and quinolone-resistant Mycoplasma genitalium (MG), we report the efficacy of 2 nonquinolone antimicrobials in patients with limited treatment options. Pristinamycin + doxycycline cured 75% (95% CI, 64%–85%), and minocycline cured 71% (95% CI, 54%–85%) of cases. These data provide useful estimates to inform clinical practice.
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Affiliation(s)
- Michelle Doyle
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Erica L Plummer
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ivette Aguirre
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Wigan R, Vaughn C, Vodstrcil L, Doyle M, Kaiser M, McGuiness C, Bradshaw CS, Bilardi JE. "It's just an issue and you deal with it… you just deal with it, you move on and you do it together.": Men's experiences of bacterial vaginosis and the acceptability of male partner treatment. PLoS One 2020; 15:e0235286. [PMID: 32598394 PMCID: PMC7323956 DOI: 10.1371/journal.pone.0235286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/11/2020] [Indexed: 01/28/2023] Open
Abstract
Bacterial vaginosis (BV) is a common vaginal infection among women of reproductive age. Increasing evidence suggests BV may be sexually transmitted indicating a potential role for the treatment of sexual partners. If partner treatment reduces BV recurrence in women, real-world success will depend on sexual partners’ willingness to accept it. However, a lack of data exists on the acceptability of partner treatment among sexual partners, and no data exists on male partners’ experience of BV specifically. The aim of this study was to explore male partners’ views and experience of BV and their attitudes toward associated partner treatment. A social constructionist approach informed the framework of this study. Semi structured interviews were conducted with eleven men who participated in a BV partner treatment trial. Interviews were transcribed verbatim and analysed thematically. In the absence of symptoms in themselves, BV had little impact on men beyond their concerns for their partner’s health and self-esteem. Acceptance of treatment was largely a demonstration of care and support. While all participants had accepted treatment, men surmised the primary reasons other men may reject treatment as being: if they felt BV had “nothing to do with them”, which was related to not wanting to be viewed as having a ‘problem’ and exacerbated by norms of masculinity and STI-related stigma; lack of a diagnostic test to indicate if a male “had BV”; and a casual or less established relationship. Men’s attitudes to BV and partner treatment were primarily influenced by the nature of their relationships. The ambiguous aetiology of BV appears to attenuate STI related stigma and questions of infidelity.
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Affiliation(s)
- Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- * E-mail:
| | - Cathy Vaughn
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lenka Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michelle Doyle
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Marti Kaiser
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Collette McGuiness
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Catriona S. Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jade E. Bilardi
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
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26
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Read TRH, Fairley CK, Murray GL, Jensen JS, Danielewski J, Worthington K, Doyle M, Mokany E, Tan L, Chow EPF, Garland SM, Bradshaw CS. Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections: A Prospective Evaluation. Clin Infect Dis 2020; 68:554-560. [PMID: 29873691 PMCID: PMC6355821 DOI: 10.1093/cid/ciy477] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/04/2018] [Indexed: 11/14/2022] Open
Abstract
Background Rising macrolide and quinolone resistance in Mycoplasma genitalium necessitate new treatment approaches. We evaluated outcomes of sequential antimicrobial therapy for M. genitalium guided by a macrolide-resistance assay. Methods In mid-2016, Melbourne Sexual Health Centre switched from azithromycin to doxycycline (100 mg twice daily for 7 days) for nongonococcal urethritis, cervicitis, and proctitis. Cases were tested for M. genitalium and macrolide-resistance mutations (MRMs) by polymerase chain reaction. Directly after doxycycline, MRM-negative infections received 2.5 g azithromycin (1 g, then 500 mg daily for 3 days), and MRM-positive infections received sitafloxacin (100 mg twice daily for 7 days). Assessment of test of cure and reinfection risk occurred 14-90 days after the second antibiotic. Results Of 244 evaluable M. genitalium infections (52 women, 68 heterosexual men, 124 men who have sex with men) diagnosed from 20 June 2016 to 15 May 2017, MRMs were detected in 167 (68.4% [95% confidence interval {CI}, 62.2%-74.2%]). Treatment with doxycycline decreased bacterial load by a mean 2.60 log10 (n = 56; P < .0001). Microbiologic cure occurred in 73 of 77 MRM-negative infections (94.8% [95% CI, 87.2%-98.6%]) and in 154 of 167 MRM-positive infections (92.2% [95% CI, 87.1%-95.8%]). Selection of macrolide resistance occurred in only 2 of 76 (2.6% [95% CI, .3%-9.2%]) macrolide-susceptible infections. Conclusions In the context of high levels of antimicrobial resistance, switching from azithromycin to doxycycline for presumptive treatment of M. genitalium, followed by resistance-guided therapy, cured ≥92% of infections, with infrequent selection of macrolide resistance.
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Affiliation(s)
- Tim R H Read
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne
- Melbourne Sexual Health Centre, Alfred Health, Carlton
- Correspondence: T. R. H. Read, Melbourne Sexual Health Centre, 580 Swanston St, Carlton, Victoria 3053, Australia ()
| | - Christopher K Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne
- Melbourne Sexual Health Centre, Alfred Health, Carlton
| | - Gerald L Murray
- Murdoch Children’s Research Institute, Parkville
- Department of Microbiology and Infectious Diseases, Royal Women’s Hospital, Melbourne
- Infection and Immunity Program, Monash Biomedicine Discovery Institute
- Royal Children’s Hospital, Melbourne, Victoria, Australia
| | | | - Jennifer Danielewski
- Murdoch Children’s Research Institute, Parkville
- Department of Microbiology and Infectious Diseases, Royal Women’s Hospital, Melbourne
| | | | | | | | - Litty Tan
- SpeeDx Pty Ltd, Eveleigh, New South Wales
| | - Eric P F Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne
- Melbourne Sexual Health Centre, Alfred Health, Carlton
| | - Suzanne M Garland
- Murdoch Children’s Research Institute, Parkville
- Department of Microbiology and Infectious Diseases, Royal Women’s Hospital, Melbourne
- Royal Children’s Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne
- Melbourne Sexual Health Centre, Alfred Health, Carlton
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Robinson AJ, Hopkins GL, Rastogi N, Hodges M, Doyle M, Davies S, Hole PS, Omidvar N, Darley RL, Tonks A. Reactive Oxygen Species Drive Proliferation in Acute Myeloid Leukemia via the Glycolytic Regulator PFKFB3. Cancer Res 2020; 80:937-949. [PMID: 31862780 PMCID: PMC7611211 DOI: 10.1158/0008-5472.can-19-1920] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/15/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023]
Abstract
Acute myeloid leukemia (AML) is a heterogeneous clonal disorder with a poor clinical outcome. Previously, we showed that overproduction of reactive oxygen species (ROS), arising from constitutive activation of NOX2 oxidase, occurs in >60% of patients with AML and that ROS production promotes proliferation of AML cells. We show here that the process most significantly affected by ROS overproduction is glycolysis. Whole metabolome analysis of 20 human primary AML showed that blasts generating high levels of ROS have increased glucose uptake and correspondingly increased glucose metabolism. In support of this, exogenous ROS increased glucose consumption while inhibition of NOX2 oxidase decreased glucose consumption. Mechanistically, ROS promoted uncoupling protein 2 (UCP2) protein expression and phosphorylation of AMPK, upregulating the expression of a key regulatory glycolytic enzyme, 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase (PFKFB3). Overexpression of PFKFB3 promoted glucose uptake and cell proliferation, whereas downregulation of PFKFB3 strongly suppressed leukemia growth both in vitro and in vivo in the NSG model. These experiments provide direct evidence that oxidase-derived ROS promotes the growth of leukemia cells via the glycolytic regulator PFKFB3. Targeting PFKFB3 may therefore present a new mode of therapy for this disease with a poor outcome. SIGNIFICANCE: These findings show that ROS generated by NOX2 in AML cells promotes glycolysis by activating PFKFB3 and suggest PFKFB3 as a novel therapeutic target in AML.
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Affiliation(s)
- Andrew J Robinson
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Goitseone L Hopkins
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Namrata Rastogi
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Marie Hodges
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Wales, United Kingdom
- Cardiff Experimental and Cancer Medicine Centre (ECMC), School of Medicine, Cardiff University, Wales, United Kingdom
| | - Michelle Doyle
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Wales, United Kingdom
- Cardiff Experimental and Cancer Medicine Centre (ECMC), School of Medicine, Cardiff University, Wales, United Kingdom
| | - Sara Davies
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Paul S Hole
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Nader Omidvar
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Richard L Darley
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Alex Tonks
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Wales, United Kingdom.
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28
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Alanazi B, Munje CR, Rastogi N, Williamson AJK, Taylor S, Hole PS, Hodges M, Doyle M, Baker S, Gilkes AF, Knapper S, Pierce A, Whetton AD, Darley RL, Tonks A. Integrated nuclear proteomics and transcriptomics identifies S100A4 as a therapeutic target in acute myeloid leukemia. Leukemia 2020; 34:427-440. [PMID: 31611628 PMCID: PMC6995695 DOI: 10.1038/s41375-019-0596-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/18/2019] [Accepted: 09/30/2019] [Indexed: 12/20/2022]
Abstract
Inappropriate localization of proteins can interfere with normal cellular function and drive tumor development. To understand how this contributes to the development of acute myeloid leukemia (AML), we compared the nuclear proteome and transcriptome of AML blasts with normal human CD34+ cells. Analysis of the proteome identified networks and processes that significantly affected transcription regulation including misexpression of 11 transcription factors with seven proteins not previously implicated in AML. Transcriptome analysis identified changes in 40 transcription factors but none of these were predictive of changes at the protein level. The highest differentially expressed protein in AML nuclei compared with normal CD34+ nuclei (not previously implicated in AML) was S100A4. In an extended cohort, we found that over-expression of nuclear S100A4 was highly prevalent in AML (83%; 20/24 AML patients). Knock down of S100A4 in AML cell lines strongly impacted their survival whilst normal hemopoietic stem progenitor cells were unaffected. These data are the first analysis of the nuclear proteome in AML and have identified changes in transcription factor expression or regulation of transcription that would not have been seen at the mRNA level. These data also suggest that S100A4 is essential for AML survival and could be a therapeutic target in AML.
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Affiliation(s)
- Bader Alanazi
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Chinmay R Munje
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
- Paul O'Gorman Leukaemia Research Centre, University of Glasgow, Glasgow, G12 0ZD, UK
| | - Namrata Rastogi
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Andrew J K Williamson
- Stoller Biomarker Discovery Centre, The University of Manchester, Manchester, M20 3LJ, UK
| | - Samuel Taylor
- Stoller Biomarker Discovery Centre, The University of Manchester, Manchester, M20 3LJ, UK
| | - Paul S Hole
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Marie Hodges
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
- Cardiff Experimental and Cancer Medicine Centre (ECMC), School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Michelle Doyle
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
- Cardiff Experimental and Cancer Medicine Centre (ECMC), School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Sarah Baker
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
- Cardiff Experimental and Cancer Medicine Centre (ECMC), School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Amanda F Gilkes
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
- Cardiff Experimental and Cancer Medicine Centre (ECMC), School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Steven Knapper
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Andrew Pierce
- Stoller Biomarker Discovery Centre, The University of Manchester, Manchester, M20 3LJ, UK
| | - Anthony D Whetton
- Stoller Biomarker Discovery Centre, The University of Manchester, Manchester, M20 3LJ, UK
| | - Richard L Darley
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK
| | - Alex Tonks
- Department of Haematology, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK.
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Shah K, Elder D, Nguyen M, Turner L, Doyle M, Woldendorp K, Seco M, Law C, Wilson M, Keech A, Ng M, Morton R. 628 Transcatheter Aortic Valve Implantation (TAVI) Versus Surgical Aortic Valve Replacement (SAVR) for Aortic Stenosis: A Cost-Comparison Study. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.635] [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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30
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Read TRH, Murray GL, Danielewski JA, Fairley CK, Doyle M, Worthington K, Su J, Mokany E, Tan LT, Lee D, Vodstrcil LA, Chow EPF, Garland SM, Chen MY, Bradshaw CS. Symptoms, Sites, and Significance of Mycoplasma genitalium in Men Who Have Sex with Men. Emerg Infect Dis 2019; 25:719-727. [PMID: 30882306 PMCID: PMC6433010 DOI: 10.3201/eid2504.181258] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During 2016-2017, we tested asymptomatic men who have sex with men (MSM) in Melbourne, Australia, for Mycoplasma genitalium and macrolide resistance mutations in urine and anorectal swab specimens by using PCR. We compared M. genitalium detection rates for those asymptomatic men to those for MSM with proctitis and nongonococcal urethritis (NGU) over the same period. Of 1,001 asymptomatic MSM, 95 had M. genitalium; 84.2% were macrolide resistant, and 17% were co-infected with Neisseria gonorrhoeae or Chlamydia trachomatis. Rectal positivity for M. genitalium was 7.0% and urine positivity was 2.7%. M. genitalium was not more commonly detected in the rectums of MSM (n = 355, 5.6%) with symptoms of proctitis over the same period but was more commonly detected in MSM (n = 1,019, 8.1%) with NGU. M. genitalium is common and predominantly macrolide-resistant in asymptomatic MSM. M. genitalium is not associated with proctitis in this population.
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McMahon G, Rogers A, Woulfe Z, Tuthill E, Doyle M, Burke G, Imcha M. Women's Opinions on Cardiotocograph Monitoring and Staff Communication During Labour. Ir Med J 2019; 112:1022. [PMID: 32311252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- G McMahon
- Dept. of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Ireland
| | - A Rogers
- Labour Ward, University Maternity Hospital Limerick, Ireland
| | - Z Woulfe
- Labour Ward, University Maternity Hospital Limerick, Ireland
| | - E Tuthill
- Dept. of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Ireland
| | - M Doyle
- Labour Ward, University Maternity Hospital Limerick, Ireland
| | - G Burke
- Dept. of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Ireland
| | - M Imcha
- Dept. of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Ireland
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Fry J, Alarcon R, Baeßler S, Balascuta S, Palos LB, Bailey T, Bass K, Birge N, Blose A, Borissenko D, Bowman J, Broussard L, Bryant A, Byrne J, Calarco J, Caylor J, Chang K, Chupp T, Cianciolo T, Crawford C, Ding X, Doyle M, Fan W, Farrar W, Fomin N, Frlež E, Gericke M, Gervais M, Glück F, Greene G, Grzywacz R, Gudkov V, Hamblen J, Hayes C, Hendrus C, Ito T, Jezghani A, Li H, Makela M, Macsai N, Mammei J, Mammei R, Martinez M, Matthews D, McCrea M, McGaughey P, McLaughlin C, Mueller P, Petten DV, Penttilä S, Perryman D, Picker R, Pierce J, Počanić D, Qian Y, Ramsey J, Randall G, Riley G, Rykaczewski K, Salas-Bacci A, Samiei S, Scott E, Shelton T, Sjue S, Smith A, Smith E, Stevens E, Wexler J, Whitehead R, Wilburn W, Young A, Zeck B. The Nab experiment: A precision measurement of unpolarized neutron beta decay. EPJ Web Conf 2019. [DOI: 10.1051/epjconf/201921904002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Neutron beta decay is one of the most fundamental processes in nuclear physics and provides sensitive means to uncover the details of the weak interaction. Neutron beta decay can evaluate the ratio of axial-vector to vector coupling constants in the standard model, λ = gA/gV, through multiple decay correlations. The Nab experiment will carry out measurements of the electron-neutrino correlation parameter a with a precision of δa/a = 10−3 and the Fierz interference term b to δb = 3 × 10−3 in unpolarized free neutron beta decay. These results, along with a more precise measurement of the neutron lifetime, aim to deliver an independent determination of the ratio λ with a precision of δλ/λ = 0.03% that will allow an evaluation of Vud and sensitively test CKM unitarity, independent of nuclear models. Nab utilizes a novel, long asymmetric spectrometer that guides the decay electron and proton to two large area silicon detectors in order to precisely determine the electron energy and an estimation of the proton momentum from the proton time of flight. The Nab spectrometer is being commissioned at the Fundamental Neutron Physics Beamline at the Spallation Neutron Source at Oak Ridge National Lab. We present an overview of the Nab experiment and recent updates on the spectrometer, analysis, and systematic effects.
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Latimer RL, Vodstrcil L, De Petra V, Fairley CK, Read TR, Williamson D, Doyle M, Chow EP, Bradshaw C. Extragenital Mycoplasma genitalium infections among men who have sex with men. Sex Transm Infect 2019; 96:10-18. [PMID: 31217322 DOI: 10.1136/sextrans-2019-054058] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/24/2019] [Accepted: 06/02/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES There are limited data on the prevalence of Mycoplasma genitalium (Mgen) coinfection with rectal chlamydia (Chlamydia trachomatis (CT)) and rectal gonorrhoea (Neisseria gonorrhoeae (NG)) infections and few studies examining the prevalence of pharyngeal Mgen in men who have sex with men (MSM). Using transcription-mediated amplification assay, this study aimed to determine the proportion of rectal CT and rectal NG infections in MSM who are coinfected with rectal Mgen, and the proportion of MSM with Mgen detected in the pharynx in order to inform clinical practice. METHODS This was a cross-sectional study conducted at Melbourne Sexual Health Centre in Australia. Consecutively collected rectal swabs from MSM that tested positive for CT (n=212) or NG (n=212), and consecutively collected pharyngeal samples (n=480) from MSM were tested for Mgen using the Aptima Mycoplasma genitalium Assay (Hologic, San Diego). Samples were linked to demographic data and symptom status. RESULTS Rectal Mgen was codetected in 27 of 212 rectal CT (13%, 95% CI 9 to 18) and in 29 of 212 rectal NG (14%, 95% CI 9 to 19) samples, with no difference in the proportion positive for Mgen. MSM with rectal CT/Mgen coinfection had more sexual partners than those with rectal CT monoinfection (mean 6 vs 11, p=0.06). MSM with rectal NG/Mgen coinfection were more likely to be HIV-positive than those with rectal NG monoinfection (OR=2.96, 95% CI 1.21 to 7.26, p=0.023). MSM with rectal CT/Mgen coinfection were more likely to be using pre-exposure prophylaxis than MSM with rectal NG/Mgen coinfection (OR 0.25, 95% CI 0.10 to 0.65, p=0.002). Pharyngeal Mgen was uncommon and detected in 8 of 464 samples (2%, 95% CI 1% to 3%). Pharyngeal Mgen was associated with having a rectal STI (OR=10.61, 95% CI 2.30 to 48.87, p=0.002), and there was a borderline association with being HIV-positive (p=0.079). CONCLUSION These data indicate one in seven MSM treated for rectal CT or rectal NG will have undiagnosed Mgen that is potentially exposed to azithromycin during treatment of these STIs. Rectal Mgen coinfection was associated with specific risk factors which may inform testing practices. Pharyngeal Mgen was uncommon.
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Affiliation(s)
- Rosie Louise Latimer
- Central Clinical School, Monash University, Clayton, Victoria, Australia .,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Lenka Vodstrcil
- Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Vesna De Petra
- Doherty Institute, Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Tim Rh Read
- Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Deborah Williamson
- Doherty Institute, Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle Doyle
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Eric Pf Chow
- Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Catriona Bradshaw
- Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
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Hannon DM, Harkin E, Donnachie K, Sibartie S, Doyle M, Chan G. A case of Capnocytophaga canimorsus meningitis and bacteraemia. Ir J Med Sci 2019; 189:251-252. [PMID: 31203505 DOI: 10.1007/s11845-019-02045-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
Capnocytophaga canimorsus is a commonly detectable commensal in the oral flora of dogs and cats, found in 25.5% and 15%, respectively, by culture and 70% and 55%, respectively, by molecular methods [1]. Formerly known as dysgonic fermenter 2 (DF-2), it was first reported in 1976 as a Gram-negative bacillus causing septicaemia and meningitis following dog bites [2]. It causes a spectrum of clinical syndromes from wound infections to bacteraemia and meningitis, especially in those with hyposplenism and alcoholism. We report a case of C. canimorsus meningitis and bacteraemia, and give a review of the relevant literature.
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Affiliation(s)
- D M Hannon
- Mayo University Hospital, Westport Rd, Curragh, Castlebar, Co. Mayo, Ireland.
| | - E Harkin
- Wexford General Hospital, Newtown Rd, Carricklawn, Wexford, Ireland
| | - K Donnachie
- Waterford Regional Hospital, Dunmore Road, Waterford, X91 ER8E, Ireland
| | - S Sibartie
- Mayo University Hospital, Westport Rd, Curragh, Castlebar, Co. Mayo, Ireland
| | - M Doyle
- Waterford Regional Hospital, Dunmore Road, Waterford, X91 ER8E, Ireland
| | - G Chan
- Waterford Regional Hospital, Dunmore Road, Waterford, X91 ER8E, Ireland
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Clegg TA, Doyle M, Ryan E, More SJ, Gormley E. Characteristics of Mycobacterium bovis infected herds tested with the interferon-gamma assay. Prev Vet Med 2019; 168:52-59. [PMID: 31097123 DOI: 10.1016/j.prevetmed.2019.04.004] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/12/2019] [Accepted: 04/12/2019] [Indexed: 01/09/2023]
Abstract
The IFN-γ (interferon gamma) assay is used in Ireland as an ancillary diagnostic test to the single intradermal comparative tuberculin test (SICTT) to maximise the detection of Mycobacterium bovis infected animals (bTB) in cattle herds. Understanding the relationships between herd and animal risk factors and IFN-γ test results is critical to enable the development and evaluation of policy measures on how best to use the test. In this study, we set out to characterise Irish herds with IFN-γ test positive animals in terms of herd size, number of SICTT reactors and number of IFN-γ positive tests, and to evaluate the IFN-γ test in terms of the test cut-off values. The results showed that larger herds with more SICTT reactors were likely to have more IFN-γ positives in the herd, and herds with an IFN-γ test positive animal that was also positive for bTB lesions at post-mortem had higher numbers of IFN-γ positive animals in the herd. Raising the cut-off values for the IFN-γ test only marginally decreased the combined sensitivity of the IFN-γ and the SICTT for diagnosis of bTB lesioned animals. The analysis has provided valuable information on the performance of the IFN-γ test as it is used under current bTB infection levels in Ireland.
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Affiliation(s)
- T A Clegg
- Centre for Veterinary Epidemiology and Risk Analysis, UCD School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
| | - M Doyle
- Tuberculosis Diagnostics and Immunology Research Laboratory, School of Veterinary Medicine, University College Dublin, UCD, Belfield, Dublin 4, Ireland.
| | - E Ryan
- Department of Agriculture, Food & the Marine, Backweston, Co. Kildare, Ireland.
| | - S J More
- Centre for Veterinary Epidemiology and Risk Analysis, UCD School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
| | - E Gormley
- Tuberculosis Diagnostics and Immunology Research Laboratory, School of Veterinary Medicine, University College Dublin, UCD, Belfield, Dublin 4, Ireland.
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Mc Donald I, Doyle M, Murphy J. Gastroschisis: What can the Neonate and Parents Expect? Ir Med J 2019; 112:905. [PMID: 31124629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- I Mc Donald
- Department of Neonatology Temple St. Children’s University Hospital, Temple Street, Dublin 1
| | - M Doyle
- Department of Surgery Temple St. Children’s University Hospital, Dublin 1
| | - J Murphy
- Department of Neonatology Temple St. Children’s University Hospital, Temple Street, Dublin 1
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Shah K, Nguyen M, Seco M, Elder D, Turner L, Wu J, Doyle M, Watson D, Woldendorp K, Keech A, Ng M, Morton R. Comparing Hospital Costs Of Trans-Catheter Aortic Valve Replacement and Isolated Surgical Aortic Valve Replacement in Patients with Aortic Stenosis Treated in New South Wales, Australia. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.463] [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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38
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Villanueva C, Doyle M, Parikh R, Manganas C. Patient Safety and Current Practice During Chest Drain Insertion. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.02.012] [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: 10/26/2022]
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39
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Doyle M, Peoples G, Tang J, Anthony R, Brown M, McLennan P. Characterisation of Skeletal Muscle Oxygen Kinetics After Cardiac Surgery. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.02.044] [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: 10/26/2022]
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40
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Elder D, Ng M, Morton R, Keech A, Seco M, Shah K, Turner L, Nguyen M, Woldendorp K, Doyle M, Wu J, Watson D. A Comparison of the Number and Demographics of Patients Undergoing Either Isolated Surgical or a Trans-Catheter Aortic Valve Replacement Following the Introduction of a TAVI Program. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.459] [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: 10/26/2022]
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Monin JK, Doyle M, Van Ness PH, Schulz R, Marottoli R, Birditt K, Feeney BC. SPOUSAL ASSOCIATIONS IN COGNITIVE FUNCTIONING AND DEPRESSIVE SYMPTOMS OVER TIME IN THE CARDIOVASCULAR HEALTH STUDY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3121] [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: 11/12/2022] Open
Affiliation(s)
- J K Monin
- Yale University, New Haven, Connecticut, United States
| | - M Doyle
- Internal Medicine, Yale School of Medicine
| | | | - R Schulz
- University Center for Social and Urban Research, University of Pittsburgh
| | | | - K Birditt
- Life Course Development Program, University of Michigan
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Doña I, Caubet JC, Brockow K, Doyle M, Moreno E, Terreehorst I, Torres MJ. An EAACI task force report: recognising the potential of the primary care physician in the diagnosis and management of drug hypersensitivity. Clin Transl Allergy 2018; 8:16. [PMID: 29760877 PMCID: PMC5944153 DOI: 10.1186/s13601-018-0202-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 08/09/2017] [Accepted: 04/04/2018] [Indexed: 01/20/2023] Open
Abstract
Adverse drug reactions include drug hypersensitivity reactions (DHRs), which can be immunologically mediated (allergy) or non-immunologically mediated. The high number of DHRs that are unconfirmed and often self-reported is a frequent problem in daily clinical practice, with considerable impact on future prescription choices and patient health. It is important to distinguish between hypersensitivity and non-hypersensitivity reactions by adopting a structured diagnostic approach to confirm or discard the suspected drug, not only to avoid life-threatening reactions, but also to reduce the frequent over-diagnosis of DHRs. Primary care physicians are often the first point of contact for the sufferer of a reaction, as such they have a key role in deciding whether to discard the diagnosis or send the patient for further investigation. In this review, we highlight the importance of diagnosing DHRs, analysing in detail the role of primary care physicians. We describe the common patterns of DHRs and signs of its progression, as well as the indications and contraindications for referring the patient to an allergist. The diagnostic process is described and the possible tests are discussed, which often depend on the drug involved and the type of DHR suspected. We also describe recommendations regarding the avoidance of medication suspected to have caused the reaction and the use of alternatives.
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Affiliation(s)
- I. Doña
- Allergy Unit (Pavilion C), Regional University Hospital of Malaga, UMA, IBIMA, National Network ARADyAL, Plaza del Hospital Civil, 29009 Malaga, Spain
| | - J. C. Caubet
- Department of Child and Adolescent, Medical School of the University of Geneva, University Hospitals of Geneva, Geneva, Switzerland
| | - K. Brockow
- Department of Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany
| | - M. Doyle
- Indigo Medical, Saint Helier, Jersey
| | - E. Moreno
- Allergy Service, University Hospital of Salamanca, National Network ARADyAL, Salamanca, Spain
- Biosanitary Institute of Salamanca, Salamanca, Spain
- Department of Biomedical and Diagnostics Sciences, Salamanca Medical School, Salamanca, Spain
| | - I. Terreehorst
- Department of ENT, Academisch Medisch Centrum, Amsterdam, The Netherlands
| | - M. J. Torres
- Allergy Unit (Pavilion C), Regional University Hospital of Malaga, UMA, IBIMA, National Network ARADyAL, Plaza del Hospital Civil, 29009 Malaga, Spain
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Doyle M, Earnshaw P, Galloway A. Developing, delivering and evaluating interprofessional clinical risk training in mental health services. Psychiatr bull 2018. [DOI: 10.1192/pb.27.2.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodThe need for training to prepare mental health professionals to assess and manage risks is now well established. This paper reports on the development, delivery and evaluation of interprofessional clinical risk training in Salford and Manchester since 1998. A training-needs analysis was carried out, followed by post-training evaluation and an impact-monitoring questionnaire.ResultsThe training was very well received by participants, with over 90% of them meeting the objectives and 100% of respondents reporting that the training had a positive impact on their clinical practice more than 12 months afterwards.Clinical ImplicationsThe evaluation of the training demonstrates that a properly planned and delivered 2-day clinical risk assessment course can have a positive impact on the practice of clinicians in mental health services. However, this should be seen only as an introductory course, as more advanced risk training is required. This is currently being delivered and planned.
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Affiliation(s)
- C. Rechichi
- Western Australian Institute of Sport, Mt Claremont, WA., 6010, AUSTRALIA,
- School of Human Movement and Exercise Science, The University of Western Australia, Crawley, W.A., 6009, AUSTRALIA
| | - A. Lyttle
- Western Australian Institute of Sport, Mt Claremont, WA., 6010, AUSTRALIA,
| | - M. Doyle
- Western Australian Institute of Sport, Mt Claremont, WA., 6010, AUSTRALIA,
- School of Human Movement and Exercise Science, The University of Western Australia, Crawley, W.A., 6009, AUSTRALIA
| | - T. Polglaze
- Western Australian Institute of Sport, Mt Claremont, WA., 6010, AUSTRALIA,
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Clegg TA, Good M, Doyle M, Duignan A, More SJ, Gormley E. The performance of the interferon gamma assay when used as a diagnostic or quality assurance test in Mycobacterium bovis infected herds. Prev Vet Med 2017; 140:116-121. [PMID: 28460744 DOI: 10.1016/j.prevetmed.2017.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/28/2017] [Accepted: 03/21/2017] [Indexed: 11/29/2022]
Abstract
There are two different contexts in the Irish bTB eradication programme in which the interferon-gamma assay (IFN-γ) is applied. Firstly, the IFN-γ assay is applied routinely to high risk cohorts in herds with four or more reactors to the SICTT. The IFN-γ test is then carried out on blood samples submitted to the laboratory within 8h of collection (diagnostic testing). Secondly, the use of the IFN-γ assay has recently been extended to test SICTT reactors as part of a general quality assurance (QA) scheme to monitor the performance of the SICTT. Blood samples from reactors are tested one day after blood collection (QA testing). In this study, we analysed the relative performance of the SICTT and IFN-γ when used in parallel as an 8h diagnostic test and as a 24h QA test on SICTT reactors. A total of 17,725 IFN-γ tests were included in the analysis (11,658 diagnostic tests and 6067 QA tests). Of the samples submitted for diagnostic testing, the proportion positive to IFN-γ decreased with the severity of interpretation of the SICTT result. Of the standard reactors that were tested with IFN-γ in the QA programme, 92.2% were positive to the IFN-γ test. Among animals that were SICTT -ve/IFN-γ +ve, 18.9% were positive at post-mortem compared to 11.8% of those that were SICTT +ve (standard reactor)/IFN-γ -ve. These results highlight the risk associated with retaining SICTT -ve/IFN-γ +ve animals, and suggest that prompt removal of these animals is necessary to reduce the potential for future transmission.
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Affiliation(s)
- T A Clegg
- Centre for Veterinary Epidemiology and Risk Analysis, UCD School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
| | - M Good
- Department of Agriculture, Food & the Marine, Agriculture House, Kildare St., Dublin 2, Ireland.
| | - M Doyle
- Tuberculosis Diagnostics and Immunology Research Laboratory, UCD School of Veterinary Medicine, University College Dublin, UCD, Belfield, Dublin 4, Ireland.
| | - A Duignan
- Department of Agriculture, Food & the Marine, Agriculture House, Kildare St., Dublin 2, Ireland.
| | - S J More
- Centre for Veterinary Epidemiology and Risk Analysis, UCD School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
| | - E Gormley
- Tuberculosis Diagnostics and Immunology Research Laboratory, UCD School of Veterinary Medicine, University College Dublin, UCD, Belfield, Dublin 4, Ireland.
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Morrissey SM, Nielsen M, Ryan L, Al Dhanhani H, Meehan M, McDermott S, O'Sullivan N, Doyle M, Gavin P, O'Sullivan N, Cunney R, Drew RJ. Group B streptococcal PCR testing in comparison to culture for diagnosis of late onset bacteraemia and meningitis in infants aged 7-90 days: a multi-centre diagnostic accuracy study. Eur J Clin Microbiol Infect Dis 2017; 36:1317-1324. [PMID: 28247153 DOI: 10.1007/s10096-017-2938-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/08/2017] [Indexed: 12/15/2022]
Abstract
The aim of this study was to compare an in-house real-time PCR assay, with bacterial culture as the reference, for the diagnosis of late onset group B Streptococcal (GBS) disease. This was a retrospective review. All children aged 7-90 days presenting to four paediatric centres that had a blood or CSF sample tested by GBS PCR were included. Of 7,686 blood and 2,495 cerebrospinal fluid (CSF) samples from patients of all ages received for PCR testing, 893 and 859 samples were eligible for the study, respectively. When compared to culture, the sensitivity of blood PCR was 65% (13/20) in comparison to the CSF PCR test which was 100% (5/5). Ten of 23 PCR-positive blood samples and 17 of 22 PCR-positive CSF samples were culture negative. The median threshold Ct values for culture-positive/PCR-positive CSF samples was lower than that of culture-negative/PCR-positive CSF samples (p = 0.08). Clinical details of 17 available cases that were culture negative/PCR positive were reviewed; seven were deemed to be definite cases, eight were probable and two were possible. The results showed that detection of GBS by PCR is useful for CSF samples from infants aged 7-90 days with suspected meningitis; however, analysis of blood samples by PCR is of limited value as a routine screening test for late onset GBS sepsis and should not replace bacterial culture.
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Affiliation(s)
- S M Morrissey
- Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - M Nielsen
- Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - L Ryan
- Department of Microbiology, University Hospital Waterford, Co. Waterford, Ireland
| | - H Al Dhanhani
- Departments of Microbiology and Paediatric Infectious Diseases, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - M Meehan
- Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - S McDermott
- Department of Microbiology, Our Lady's Hospital, Co. Louth, Drogheda, Ireland
| | - N O'Sullivan
- Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - M Doyle
- Department of Microbiology, University Hospital Waterford, Co. Waterford, Ireland
| | - P Gavin
- Departments of Microbiology and Paediatric Infectious Diseases, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - N O'Sullivan
- Departments of Microbiology and Paediatric Infectious Diseases, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - R Cunney
- Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - R J Drew
- Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin 1, Ireland. .,Department of Microbiology, Rotunda Hospital, Dublin 1, Ireland. .,Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin 2, Ireland. .,Rotunda Hospital, Parnell Square, Dublin 1, Ireland.
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O'Leary C, Kroes J, Murphy G, Doyle M, Corrigan L, Rehman Z, Mannion J, Foley S, Rogan M, O'Connor M, Horgan A, Calvert P. 43: Non small cell lung cancer mutational testing in the South East of Ireland. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30093-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Moss S, Tardo D, Doyle M, Rees D. Complexities in Management of a Young Patient with Multi-Vessel Disease and Familial Hypercholesterolaemia. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Resnick C, Daniels K, Flath-Sporn S, Doyle M, Desrochers H, Heald R, Padwa B. Advanced Practice Providers Improve Efficiency and Decrease Costs in Outpatient Oral Surgery. J Oral Maxillofac Surg 2016. [DOI: 10.1016/j.joms.2016.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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