1
|
Carrette L, Santos A, Brennan M, Othman D, Collazo A, George O. Antagonists of the stress and opioid systems restore the functional connectivity of the prefrontal cortex during alcohol withdrawal through divergent mechanisms. bioRxiv 2024:2023.09.30.560339. [PMID: 37873478 PMCID: PMC10592857 DOI: 10.1101/2023.09.30.560339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Chronic alcohol consumption leads to dependence and withdrawal symptoms upon cessation, contributing to persistent use. However, the brain network mechanisms by which the brain orchestrates alcohol withdrawal and how these networks are affected by pharmacological treatments remain elusive. Recent work revealed that alcohol withdrawal produces a widespread increase in coordinated brain activity and a decrease in modularity of the whole-brain functional network using single-cell whole-brain imaging of immediate early genes. This decreased modularity and functional hyperconnectivity are hypothesized to be novel biomarkers of alcohol withdrawal in alcohol dependence, which could potentially be used to evaluate the efficacy of new medications for alcohol use disorder. However, there is no evidence that current FDA-approved medications or experimental treatments known to reduce alcohol drinking in animal models can normalize the changes in whole-brain functional connectivity. In this report, we tested the effect of R121919, a CRF1 antagonist, and naltrexone, an FDA-approved treatment for alcohol use disorder, on whole-brain functional connectivity using the cellular marker FOS combined with graph theory and advanced network analyses. Results show that both R121919 and naltrexone restored the functional connectivity of the prefrontal cortex during alcohol withdrawal, but through divergent mechanisms. Specifically, R121919 increased FOS activation in the prefrontal cortex, partially restored modularity, and normalized connectivity, particularly in CRF1-rich regions, including the prefrontal, pallidum, and extended amygdala circuits. On the other hand, naltrexone decreased FOS activation throughout the brain, decreased modularity, and increased connectivity overall except for the Mu opioid receptor-rich regions, including the thalamus. These results identify the brain networks underlying the pharmacological effects of R121919 and naltrexone and demonstrate that these drugs restored different aspects of functional connectivity of the prefrontal cortex, pallidum, amygdala, and thalamus during alcohol withdrawal. Notably, these effects were particularly prominent in CRF1- and Mu opioid receptors-rich regions highlighting the potential of whole-brain functional connectivity using FOS as a tool for identifying neuronal network mechanisms underlying the pharmacological effects of existing and new medications for alcohol use disorder.
Collapse
Affiliation(s)
- L.L.G. Carrette
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - A. Santos
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - M. Brennan
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - D. Othman
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - A. Collazo
- Beckman Institute, CalTech, Passadena, CA, United States
| | - O. George
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| |
Collapse
|
2
|
Are C, Murthy SS, Sullivan R, Schissel M, Chowdhury S, Alatise O, Anaya D, Are M, Balch C, Bartlett D, Brennan M, Cairncross L, Clark M, Deo SVS, Dudeja V, D'Ugo D, Fadhil I, Giuliano A, Gopal S, Gutnik L, Ilbawi A, Jani P, Kingham TP, Lorenzon L, Leiphrakpam P, Leon A, Martinez-Said H, McMasters K, Meltzer DO, Mutebi M, Zafar SN, Naik V, Newman L, Oliveira AF, Park DJ, Pramesh CS, Rao S, Subramanyeshwar Rao T, Bargallo-Rocha E, Romanoff A, Rositch AF, Rubio IT, Salvador de Castro Ribeiro H, Sbaity E, Senthil M, Smith L, Toi M, Turaga K, Yanala U, Yip CH, Zaghloul A, Anderson BO. Global Cancer Surgery: pragmatic solutions to improve cancer surgery outcomes worldwide. Lancet Oncol 2023; 24:e472-e518. [PMID: 37924819 DOI: 10.1016/s1470-2045(23)00412-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 11/06/2023]
Abstract
The first Lancet Oncology Commission on Global Cancer Surgery was published in 2015 and serves as a landmark paper in the field of cancer surgery. The Commission highlighted the burden of cancer and the importance of cancer surgery, while documenting the many inadequacies in the ability to deliver safe, timely, and affordable cancer surgical care. This Commission builds on the first Commission by focusing on solutions and actions to improve access to cancer surgery globally, developed by drawing upon the expertise from cancer surgery leaders across the world. We present solution frameworks in nine domains that can improve access to cancer surgery. These nine domains were refined to identify solutions specific to the six WHO regions. On the basis of these solutions, we developed eight actions to propel essential improvements in the global capacity for cancer surgery. Our initiatives are broad in scope, pragmatic, affordable, and contextually applicable, and aimed at cancer surgeons as well as leaders, administrators, elected officials, and health policy advocates. We envision that the solutions and actions contained within the Commission will address inequities and promote safe, timely, and affordable cancer surgery for every patient, regardless of their socioeconomic status or geographic location.
Collapse
Affiliation(s)
- Chandrakanth Are
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Shilpa S Murthy
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK
| | - Makayla Schissel
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sanjib Chowdhury
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Olesegun Alatise
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Daniel Anaya
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Madhuri Are
- Division of Pain Medicine, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Charles Balch
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, Global Cancer Surgery: pragmatic solutions to improve USA
| | - David Bartlett
- Department of Surgery, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Murray Brennan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lydia Cairncross
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Matthew Clark
- University of Auckland School of Medicine, Auckland, New Zealand
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Dudeja
- Division of Surgical Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Domenico D'Ugo
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - Armando Giuliano
- Cedars-Sinai Medical Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Washington DC, USA
| | - Lily Gutnik
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andre Ilbawi
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Pankaj Jani
- Department of Surgery, University of Nairobi, Nairobi, Kenya
| | | | - Laura Lorenzon
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Premila Leiphrakpam
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Augusto Leon
- Department of Surgical Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Kelly McMasters
- Division of Surgical Oncology, Hiram C Polk, Jr MD Department of Surgery, University of Louisville, Louisville, KY, USA
| | - David O Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Vibhavari Naik
- Department of Anesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Lisa Newman
- Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | | | - Do Joong Park
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - C S Pramesh
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Saieesh Rao
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - T Subramanyeshwar Rao
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | | | - Anya Romanoff
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | | | - Eman Sbaity
- Division of General Surgery, Department of Surgery, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maheswari Senthil
- Division of Surgical Oncology, Department of Surgery, University of California, Irvine, Irvine, CA, USA
| | - Lynette Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Masakazi Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | - Kiran Turaga
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ujwal Yanala
- Surgical Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Cheng-Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | | | | |
Collapse
|
3
|
Faraj W, Robson M, Tawil A, Reuter V, Mahfouz R, Cambria R, Saheb N, Ferrer CS, Vemuri S, Yaghi M, Kanso M, Abdullah A, El Nounou G, Jabbour M, Muenkel K, Kaufman K, Wakim JM, Badson S, Wilson R, Houston C, Drobnjak M, Hoballah J, Ziyadeh FN, Zaatari G, Brennan M, O'Reilly EM, Abu-Alfa AK, Abou-Alfa GK. Biospecimen Repositories in Low- and Middle-Income Countries: Insights From an American University of Beirut and Memorial Sloan Kettering Collaboration. JCO Glob Oncol 2023; 9:e2300140. [PMID: 37883726 PMCID: PMC10846789 DOI: 10.1200/go.23.00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/08/2023] [Accepted: 08/14/2023] [Indexed: 10/28/2023] Open
Abstract
PURPOSE Biobanking helps source tissue and blood for studying cancer genomics. Access to biorepository resources in low- and middle-income countries is lacking. Memorial Sloan Kettering Cancer Center (MSK) and the American University of Beirut (AUB) established a joint tissue biorepository at AUB in Beirut, Lebanon. The undertaking encountered key challenges that were unanticipated. MATERIALS AND METHODS Patients age 18 years or older were eligible for enrollment at AUB. After consent, biospecimens were obtained at the time of routine diagnostic and/or therapeutic interventions. Both normal and abnormal tissue and solid and/or liquid specimens were collected from varied body sites. Early on, declining consent was frequently observed, and this was highlighted for investigation to understand potential participants reasoning. RESULTS Of 850 patients approached, 704 (70.8%) elected to consent and 293 (29.5%) declined participation. The number of declined consents led to an amendment permitting the documentation of reasons for same. Of 100 potential participants who declined to consent and to whom outreach was undertaken, 63% indicated lack of research awareness and 27% deferral to their primary physician or family member. A financial gain for AUB was cited as concern by 5%, cultural boundaries in 4%, and 1% expressed concern about confidentiality. Of the patients who elected to consent, 682 biospecimens were procured. CONCLUSION The AUB-MSK biospecimen repository has provided a unique resource for interrogation. Patient participation rate was high, and analyses of those who elected not to consent (29%) provide important insights into educational need and the local and cultural awareness and norms.
Collapse
Affiliation(s)
- Walid Faraj
- American University of Beirut, Beirut, Lebanon
| | - Mark Robson
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Ayman Tawil
- American University of Beirut, Beirut, Lebanon
| | - Victor Reuter
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | - Roy Cambria
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nour Saheb
- American University of Beirut, Beirut, Lebanon
| | | | - Shreya Vemuri
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Mark Jabbour
- American University of Beirut, Beirut, Lebanon
- Deceased
| | - Kerri Muenkel
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Sandy Badson
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Roger Wilson
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Deceased
| | | | | | | | | | | | - Murray Brennan
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Eileen M. O'Reilly
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | - Ghassan K. Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| |
Collapse
|
4
|
Hansen CJ, Bolton S, Sulaiman AH, Duling S, Bagenal F, Brennan M, Connerney J, Clark G, Lunine J, Levin S, Kurth W, Mura A, Paranicas C, Tosi F, Withers P. Juno's Close Encounter With Ganymede-An Overview. Geophys Res Lett 2022; 49:e2022GL099285. [PMID: 37034391 PMCID: PMC10078441 DOI: 10.1029/2022gl099285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/20/2022] [Accepted: 05/28/2022] [Indexed: 06/19/2023]
Abstract
The Juno spacecraft has been in orbit around Jupiter since 2016. Two flybys of Ganymede were executed in 2021, opportunities realized by evolution of Juno's polar orbit over the intervening 5 years. The geometry of the close flyby just prior to the 34th perijove pass by Jupiter brought the spacecraft inside Ganymede's unique magnetosphere. Juno's payload, designed to study Jupiter's magnetosphere, had ample dynamic range to study Ganymede's magnetosphere. The Juno radio system was used both for gravity measurements and for study of Ganymede's ionosphere. Remote sensing of Ganymede returned new results on geology, surface composition, and thermal properties of the surface and subsurface.
Collapse
Affiliation(s)
| | - S. Bolton
- Southwest Research InstituteSan AntonioTXUSA
| | - A. H. Sulaiman
- Department of Physics and AstronomyUniversity of IowaIowa CityIAUSA
| | | | - F. Bagenal
- Laboratory for Atmospheric and Space PhysicsUniversity of ColoradoBoulderCOUSA
| | | | | | - G. Clark
- Johns Hopkins Applied Physics LaboratoryLaurelMDUSA
| | | | - S. Levin
- Jet Propulsion LaboratoryPasadenaCAUSA
| | - W. Kurth
- Department of Physics and AstronomyUniversity of IowaIowa CityIAUSA
| | - A. Mura
- Istituto Nazionale di AstroFisica – Istituto di Astrofisica e Planetologia Spaziali (INAF‐IAPS)RomeItaly
| | - C. Paranicas
- Johns Hopkins Applied Physics LaboratoryLaurelMDUSA
| | - F. Tosi
- Istituto Nazionale di AstroFisica – Istituto di Astrofisica e Planetologia Spaziali (INAF‐IAPS)RomeItaly
| | | |
Collapse
|
5
|
Brennan M, Phelan S, Breen D. 90 A RETROSPECTIVE COHORT STUDY COMPARING THE CLINICAL CHARACTERISTICS, TREATMENT AND OUTCOMES OF BIOPSY-CONFIRMED SARCOIDOSIS IN LATE-ONSET AND YOUNGER-ONSET PATIENTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.074] [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
Late-Onset Sarcoidosis (LOS) accounts for up to one-third of cases and is diagnostically challenging due to the difficulty in satisfactorily excluding malignancy and infection, often necessitating repeated investigations. Endobronchial Ultrasound (EBUS) is the gold standard for diagnosing pulmonary sarcoidosis. This study aims to compare the clinical presentation, treatment and outcomes in patients with biopsy confirmed sarcoidosis in older and younger patients
Methods
A retrospective cohort analysis was performed on all patients with EBUS-confirmed sarcoidosis at a tertiary referral centre between 2012 and 2019. Electronic healthcare records were reviewed to obtain information on clinical presentation, confirmatory investigations, treatment and outcomes. LOS was defined as patients aged >65 years
Results
In total, 247 patients were included, 68.8% were male. LOS accounted for 9.3% (n=23).Extra-pulmonary and systemic features were less common in LOS (26.1% vs 58%, p<0.002). There was no difference in systemic treatment between cohorts (84.6% vs 67.9%, p=0.21) and LOS patients experienced comparably high rates of satisfactory outcomes. At follow up, the majority of patients either improved or achieved clinical stability in both groups (92.3% vs 76.1%, p=0.18). Clinical and/or radiological progression occurred in 7% in both groups with no reported deaths. Confirmatory investigations were infrequent and EBUS was safe and well-tolerated in older patients.
Conclusion
LOS was lower than expected and extra-pulmonary involvement was uncommon suggesting a pre-selected population. Referral for EBUS should be considered as first line for older patients with unexplained thoracic adenopathy provided further diagnostic investigations are in line with their goals of care. Clinical outcomes were excellent with low rates of progression, extra-pulmonary organ involvement and systemic therapy initiation, differing from prior studies and may represent less severe disease at diagnosis, enhanced diagnostic certainty or referral bias.
Collapse
Affiliation(s)
- M Brennan
- Galway University Hospital , Galway, Ireland
| | - S Phelan
- Galway University Hospital , Galway, Ireland
| | - D Breen
- Galway University Hospital , Galway, Ireland
| |
Collapse
|
6
|
Brennan M, Walsh S, Rutherford R, Garvey J, O'Hanlon S, Gargoum F. 89 DIAGNOSIS AND TREATMENT OF SUSPECTED OBSTRUCTIVE SLEEP APNOEA (OSA) IN OLDER PEOPLE: A RETROSPECTIVE COMPARATIVE ANALYSIS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Obstructive Sleep Apnoea (OSA) is common yet often undiagnosed in older people as symptoms of fatigue and poor sleep are common and non-specific. OSA screening tools also lack validity in older patients. This study aims to review the clinical presentation, use of screening tools and treatment adherence in older people.
Methods
A retrospective cohort study of patients >65 years attending a tertiary sleep clinic who underwent polysomnography for suspected OSA was performed. Electronic patient records were reviewed to obtain information on clinical presentation, screening scores, polysomnography reports and treatment initiated. Correlation between variables was performed using Pearson’s correlation co-efficient and represented using R-score. To compare CPAP usage with younger people, a cohort of controls <65 years were matched in 2:1 ratio for OSA severity (mild, moderate or severe) at diagnosis. Comparison of adherence rates was performed using Mann-Whitney U-test and represented using Z-scores.
Results
A convenience sample of 100 consecutive older patients were included. Fatigue was present in 53% and witness reported snoring in 86% and apnoeas in 56%. Moderate or severe OSA was confirmed by polysomnography in 91% cases. BMI and the STOP-BANG questionnaire were positively correlated with OSA severity as measured by Apnoea Hypopnea Index, while ESS and Berlin Questionnaire were not. Positive pressure ventilation was initiated in 90% patients. CPAP was extremely effective with the median AHI falling to within normal range on follow up. CPAP usage was significantly higher in older patients compared with younger matched control (85% vs 66% p=013).
Conclusion
Older people with OSA present with classical symptoms. STOP -BANG questionnaire and BMI were positively correlated with AHI values while other screening tools lacked validity. Treatment with CPAP was highly efficacious in older people with high usage rates and should be considered as first-line treatment for moderate and severe OSA in older patients.
Collapse
Affiliation(s)
- M Brennan
- Galway University Hospital , Galway, Ireland
| | - S Walsh
- Galway University Hospital , Galway, Ireland
| | | | - J Garvey
- St. Vincent's University Hospital , Dublin, Ireland
| | - S O'Hanlon
- St. Vincent's University Hospital , Dublin, Ireland
| | - F Gargoum
- Galway University Hospital , Galway, Ireland
| |
Collapse
|
7
|
Brennan M, Nash D, Rutherford R. 87 VERTEBRAL FRACTURES IN OLDER PATIENTS WITH COPD: AN UNDER-DIAGNOSED AND UNDER-TREATED ENTITY. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with Chronic Obstructive Pulmonary Disease (COPD) are at increased risk of osteoporosis. Vertebral Fractures (VF) are the most common manifestation of osteoporosis. Only one fourth to one third of incident radiographically identified VF are clinically diagnosed. The aim of this study is to evaluate patients the prevalence of VF in a cohort of patients admitted with Acute Exacerbation of COPD (AECOPD).
Methods
A retrospective review of AECOPD admissions over a four-month period was performed. Information on baseline characteristics, prescribed medications and reports of radiological imaging were obtained from Electronic Healthcare Records, discharge summaries and clinic letters.
Results
In total 116 patients were included over the study period. In 24% (n=28), VF was present on imaging. In those with VF, females accounted for 64.3% (n=18). Median age was 80 (76-85) and median CFS was 6. In 12 cases a single VF was present, in 9 two VFs and in 7 patients 3+ VF were present. There was no documented diagnosis of osteoporosis in 67.8% (n=19). VF were initially detected on CT thorax imaging performed to assess for pulmonary pathology in 35.7% (n=10) cases. Vitamin D3 was prescribed in 60.7% (n=17), concurrently with calcium in 28.6% (n=8). Antiresorptive therapy was prescribed in 39.3% (n=11), oral bisphosphonates in 4 patients and denosumab in 7. Vitamin D (OH) level was measured in 78.6% (n= 22) patients and was insufficient (<50mmol) in 25% (n=7).
Conclusion
Almost one-quarter of patients who were admitted with an AECOPD had vertebral insufficiency fracture on imaging. Identification and treatment of VF was suboptimal. Most were not identified as having osteoporosis nor prescribed antiresorptive therapy. CT imaging should be routinely reviewed for the presence of insufficiency fractures as part of case finding initiatives. Bone health assessment should be routinely performed in patients with COPD, particularly those with frequent corticosteroid usage.
Collapse
Affiliation(s)
- M Brennan
- Galway University Hospital , Galway, Ireland
| | - D Nash
- Galway University Hospital , Galway, Ireland
| | | |
Collapse
|
8
|
Conroy N, Brennan M, Cianci F, Migone C, Beatty K, Hamilton D. The Importance of a Proactive, Interdisciplinary, Multi-Departmental Approach to Migrant Health. Ir Med J 2022; 115:666. [PMID: 36920309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
|
9
|
Friedman DANIEL, Rose DAVID, Calkins HUGH, Digiorgi PAUL, Ramlawi BASEL, Awasthi Y, Ferguson M, Pulugan Z, Tiegland C, Brennan M. Real world outcomes of minimally invasive epicardial surgical left atrial appendage exclusion in atrial fibrillation patients with high risk of stroke and bleeding. Europace 2022. [DOI: 10.1093/europace/euac053.296] [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
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): AtriCure, Inc
Introduction
The left atrial appendage (LAA) is the site of thrombus formation in patients with atrial fibrillation (AF) and first line therapy for reducing the risk of stroke is oral anticoagulation (OACs). A subset of patients with AF carry a very high risk of stroke and bleeding and are ineligible for OAC and percutaneous LAA occlusion; these patients may be suitable for minimally invasive thoracoscopic epicardial surgical LAA exclusion (LAAE) which can be used with a wide variety of LAA morphologies with a ~98% rate of complete exclusion. While use of LAAE is well studied as a concomitant procedure, there are relatively few data on its use as a stand-alone procedure.
Purpose
To compare real-world outcomes of LAAE versus no-LAAE in AF patients at high risk of stroke and bleeding who are not on OACs.
Methods
We performed an analysis of Medicare beneficiaries with AF who were not on OACs and received LAAE (ICD10-PCS code 02L74CK, Oct 2015 – Dec 31, 2017) in the absence of a concomitant surgical or catheter AF ablation procedure. Patients were propensity-matched (1:4) to otherwise similar patients who did not receive LAAE (control), using age, gender, race, region, AF type, CHA2DS2-VASc, HAS-BLED, and co-morbidities. The primary endpoint was hospital readmission for a thromboembolic event (ischemic stroke, systemic embolism, or transient ischemic attack). Kaplan Meier event rates were calculated and 95% CI were generated via bootstrapping.
Results
A total of 243 patients who underwent LAAE and 1.7M control patients met study criteria. In the matched cohort, the mean age was 75 years, 61% were men, 77% had non-paroxysmal AF, and the mean CHADS2-VASC and HAS-BLED scores were 5.5 and 4.2, respectively. The 1-year rate of thromboembolism in the LAAE and control arms were 7.3% (95% CI 4.3% -10.9%) and 13.6 (95% CI 11.0% -16.4%) (Figure), respectively, with an absolute and relative risk reduction of 6.2% (95% CI 2.0-10.3, p-value=0.001, NNT 17) and 0.54 (95% CI 0.29-0.68, p=0.001).
Conclusion
Among high-risk AF patients who were not on OAC, LAAE was associated with a clinically meaningful and significantly lower risk of TE. Additional studies are needed to confirm these finding.
Collapse
Affiliation(s)
- DANIEL Friedman
- Duke University, Electrophysiology, Durham, United States of America
| | - DAVID Rose
- University of South Florida, Neurology, Tampa, United States of America
| | - HUGH Calkins
- Johns Hopkins University, Electrophysiology, Baltimore, United States of America
| | - PAUL Digiorgi
- Lee Health, Cardiac Surgery, Fort Myers, United States of America
| | - BASEL Ramlawi
- Lankenau Institute for Medical Research, Cardiac Surgery, Philadelphia, United States of America
| | - Y Awasthi
- AtriCure, Minnetonka, United States of America
| | - M Ferguson
- AtriCure, Minnetonka, United States of America
| | - Z Pulugan
- Avalere, Washington, United States of America
| | - C Tiegland
- Avalere, Washington, United States of America
| | - M Brennan
- Duke University, Cardiology, Durham, United States of America
| |
Collapse
|
10
|
Sullivan R, Lewison G, Torode J, Kingham PT, Brennan M, Shulman LN, Lawler M, Aggarwal A, Gralow J. Cancer research collaboration between the UK and the USA: reflections on the 2021 G20 Summit announcement. Lancet Oncol 2022; 23:460-462. [PMID: 35358453 PMCID: PMC9099402 DOI: 10.1016/s1470-2045(22)00079-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 10/18/2022]
|
11
|
Brennan M, McDonnell MJ, Walsh SM, Gargoum F, Rutherford R. Review of the prevalence, pathogenesis and management of OSA-COPD overlap. Sleep Breath 2022; 26:1551-1560. [PMID: 35034250 DOI: 10.1007/s11325-021-02540-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE OSA-COPD overlap is an important and prevalent condition yet remains under-recognised among the vast majority of respiratory health professionals. Patients with OSA-COPD overlap experience more severe respiratory symptoms and worse quality of life, and the relative risk of exacerbations, hospitalisations, and mortality is higher than in either disease state alone. METHODS Electronic databases PUBMED and Google Scholar were searched for studies and academic papers that discussed OSA-COPD overlap. Relevant papers that discussed prevalence, pathophysiology, microbiome studies, treatment regimens and outcomes were included in this paper. RESULTS High-risk patients with either COPD or OSA should be screened for overlap syndrome as part of routine clinical practice. Screening questionnaires can identify high-risk patients with COPD who may benefit from formal polysomnography. Patients with OSA who are aged over 40 with a significant smoking history or environmental exposures have an increased pre-test probability of obstructive airway disease. The potential roles of gastro-oesophageal reflux disease and lung-gut microbiome are evolving and merit further investigation. A tailored approach to reach a timely diagnosis and thus optimisation of both conditions are key to management. CPAP is the primary therapy for OSA; however, patients with more advanced COPD, with daytime hypercapnia or severe nocturnal desaturations, may benefit from bilevel positive airway pressure. CONCLUSION Increased awareness, access to timely investigations and initiation of therapy will improve overall outcomes in OSA-COPD overlap by reducing hospitalisations for exacerbations of COPD and improve mortality rates.
Collapse
Affiliation(s)
- M Brennan
- Department of Respiratory Medicine, Galway University Hospital, Saolta University Hospital Group, Newcastle Road, Galway, Ireland.
| | - M J McDonnell
- Department of Respiratory Medicine, Galway University Hospital, Saolta University Hospital Group, Newcastle Road, Galway, Ireland
| | - S M Walsh
- Department of Respiratory Medicine, Galway University Hospital, Saolta University Hospital Group, Newcastle Road, Galway, Ireland
| | - F Gargoum
- Department of Respiratory Medicine, Galway University Hospital, Saolta University Hospital Group, Newcastle Road, Galway, Ireland
| | - R Rutherford
- Department of Respiratory Medicine, Galway University Hospital, Saolta University Hospital Group, Newcastle Road, Galway, Ireland
| |
Collapse
|
12
|
Brennan M, McDonnell M, Duignan N, Gargoum F, Rutherford R. The use of cough peak flow in the assessment of respiratory function in clinical practice- A narrative literature review. Respir Med 2022; 193:106740. [DOI: 10.1016/j.rmed.2022.106740] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 12/12/2022]
|
13
|
Alatise OI, Knapp GC, Sharma A, Chatila WK, Arowolo OA, Olasehinde O, Famurewa OC, Omisore AD, Komolafe AO, Olaofe OO, Katung AI, Ibikunle DE, Egberongbe AA, Olatoke SA, Agodirin SO, Adesiyun OA, Adeyeye A, Kolawole OA, Olakanmi AO, Arora K, Constable J, Shah R, Basunia A, Sylvester B, Wu C, Weiser MR, Seier K, Gonen M, Stadler ZK, Kemel Y, Vakiani E, Berger MF, Chan TA, Solit DB, Shia J, Sanchez-Vega F, Schultz N, Brennan M, Smith JJ, Kingham TP. Molecular and phenotypic profiling of colorectal cancer patients in West Africa reveals biological insights. Nat Commun 2021; 12:6821. [PMID: 34819518 PMCID: PMC8613248 DOI: 10.1038/s41467-021-27106-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
Understanding the molecular and phenotypic profile of colorectal cancer (CRC) in West Africa is vital to addressing the regions rising burden of disease. Tissue from unselected Nigerian patients was analyzed with a multigene, next-generation sequencing assay. The rate of microsatellite instability is significantly higher among Nigerian CRC patients (28.1%) than patients from The Cancer Genome Atlas (TCGA, 14.2%) and Memorial Sloan Kettering Cancer Center (MSKCC, 8.5%, P < 0.001). In microsatellite-stable cases, tumors from Nigerian patients are less likely to have APC mutations (39.1% vs. 76.0% MSKCC P < 0.001) and WNT pathway alterations (47.8% vs. 81.9% MSKCC, P < 0.001); whereas RAS pathway alteration is more prevalent (76.1% vs. 59.6%, P = 0.03). Nigerian CRC patients are also younger and more likely to present with rectal disease (50.8% vs. 33.7% MSKCC, P < 0.001). The findings suggest a unique biology of CRC in Nigeria, which emphasizes the need for regional data to guide diagnostic and treatment approaches for patients in West Africa. Understanding the molecular and phenotypic profile of colorectal cancer (CRC) in West Africa is important for early detection and treatment. Here, the authors use a multigene next-generation sequencing panel to identify genomic differences in Nigerian CRCs compared to those from TCGA and MSKCC cohorts.
Collapse
Affiliation(s)
- Olusegun Isaac Alatise
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Gregory C Knapp
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Avinash Sharma
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Walid K Chatila
- Marie-Jose and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Tri-Institutional Program in Computational Biology and Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Olukayode A Arowolo
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olalekan Olasehinde
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olusola C Famurewa
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Adeleye D Omisore
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Akinwumi O Komolafe
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olaejinrinde O Olaofe
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Aba I Katung
- Federal Medical Centre, Owo, Ondo State, Nigeria
| | | | | | - Samuel A Olatoke
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Sulaiman O Agodirin
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Olusola A Adesiyun
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Ademola Adeyeye
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Oladapo A Kolawole
- Department of Surgery, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Akinwumi O Olakanmi
- Department of Surgery, University of Medical Sciences, Ondo, Ondo State, Nigeria
| | - Kanika Arora
- Marie-Jose and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeremy Constable
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronak Shah
- Marie-Jose and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Azfar Basunia
- Marie-Jose and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brooke Sylvester
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chao Wu
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Weiser
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ken Seier
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zsofia K Stadler
- Clinical Genetics Service and the Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yelena Kemel
- Niehaus Center for Inherited Cancer Genomics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Efsevia Vakiani
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael F Berger
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timothy A Chan
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David B Solit
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Francisco Sanchez-Vega
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nikolaus Schultz
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Murray Brennan
- Bobst International Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Joshua Smith
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T Peter Kingham
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
14
|
Brennan M, Mulkerrin L, Wall D, O' Shea PM, Mulkerrin EC. A Comparison of Community-Acquired and Hospital-Acquired Hypernatraemia in Patients who are Acutely Admitted to Hospital. Ir Med J 2021; 114:407. [PMID: 34520642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background Hypernatraemia is associated with a short-term mortality of 20-60%. Age-related physiological changes predispose patients to hypernatraemia. This study reviewed acutely admitted patients comparing those with community-acquired (CAH) and hospital-acquired hypernatraemia (HAH). Methods A retrospective study of 102 consecutive acute medical in-patients with serum [Na]>145 mmol/L was conducted. Baseline characteristics, clinical presentation, laboratory values, monitoring, management and outcomes were compared between CAH and HAH groups. Results Patients were exclusively older (>69 years). Forty patients (39.2%) had CAH and sixty-two (61.8%) had HAH. Those with CAH were more likely to be NH residents, have dementia and reduced mobility. Most HAH patients had mild hypernatraemia initially (75.8%, n=47), and higher rates of acute kidney injury (27% (n=11) vs 8% (n=3)/p=0.02) were observed. Monitoring was inadequate and no patient had a free water deficit documented. Medication review and intravenous fluid prescribing was similar between groups. The median length of stay of discharged HAH patients was longer (22.5 vs 8 days/p=0.005). Mortality rates were similar (47% (n=29) vs 37% (n=15)/p=0.416). Time from admission to death was higher in HAH patients (16 vs 8 days/p=0.008). Conclusions Both CAH and HAH present similarly, however, older patients with cognitive/physical impairments are at an increased risk. Early identification of high-risk patients and adherence to best practice guidelines is required.
Collapse
Affiliation(s)
- M Brennan
- Department of Geriatric Medicine, Saolta University Health Care Group (SUHCG), University Hospital Galway, Co. Galway
| | - L Mulkerrin
- Department of Geriatric Medicine, Saolta University Health Care Group (SUHCG), University Hospital Galway, Co. Galway
| | - D Wall
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway
| | - P M O' Shea
- Department of Clinical Biochemistry, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - E C Mulkerrin
- Department of Geriatric Medicine, Saolta University Health Care Group (SUHCG), University Hospital Galway, Co. Galway
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
15
|
Kapadia A, Brennan M, Poniatowski L, Perito P, Walsh T. 150 Evaluation and Treatment of Complications of Penuma Penile Implant. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
16
|
Brennan M, Brennan M, Naumovski J. Should We Calculate CrCl in Advance for All Our Patients in Our Nursing Homes to Prepare for Flu Season? J Am Med Dir Assoc 2021; 22:B16-B17. [PMID: 34287157 DOI: 10.1016/j.jamda.2021.01.038] [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: 11/26/2022]
|
17
|
Jung C, Jung C, Jongyotha K, De I, Brennan M, Naumovski J. Using Virtual Pet to Replace Pet Therapy Visits in Our Nursing Facility During the COVID-19 Pandemic. J Am Med Dir Assoc 2021; 22:B18. [PMID: 34287164 PMCID: PMC7902228 DOI: 10.1016/j.jamda.2021.01.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
|
18
|
Brennan M, Mulkerrin L, O'Keeffe ST, O'Shea PM. Approach to the Management of Hypernatraemia in Older Hospitalised Patients. J Nutr Health Aging 2021; 25:1161-1166. [PMID: 34866143 DOI: 10.1007/s12603-021-1692-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hypernatraemia is associated with high morbidity and mortality and is more common in patients of older age, nursing home residents and those with cognitive impairment and restricted mobility. The most common cause in hospital settings is water dehydration due to reduced intake although other causes should be identified. Once identified, prompt management is necessary to avoid delayed correction as prolonged hypernatremia is associated with increased hospital stay and mortality. Comprehensive history-taking and physical examination, basic investigations and medication review are essential to identify causative and remediable factors in those admitted with hypernatraemia. Accurate calculation of fluid deficit and ongoing losses is essential in order to ensure adequate fluid replacement, The administration of appropriate, usually hypotonic, fluids is also essential to the timely restoration of eunatraemia. Although evidence of definite harm resulting from rapid correction is lacking, a serum sodium reduction rate of <12 mmol/l day is advised with the caveat that close monitoring of electrolytes is required to ensure the desired correction rate is being achieved. Medical and nursing professionals should have access to a local hospital protocol to guide management of patients with hypernatraemia to improve patient outcomes and mitigate the risk of harm, particularly from under-recognition and slow correction.
Collapse
Affiliation(s)
- M Brennan
- Dr Michelle Brennan, Specialist Registrar in Geriatric and General Internal Medicine, Department of Geriatric Medicine, Saolta University Healthcare Group, University Hospital Galway, Newcastle Road, Galway H91 YR71, Ireland. Tel No: 00535 91 524222,
| | | | | | | |
Collapse
|
19
|
Lin A, Helgeson E, Treister N, Schmidt B, Patton L, Elting L, Lalla R, Brennan M, Sollecito T. The Impact Of Head And Neck Cancer Radiotherapy On Salivary Flow And Quality Of Life: Results Of The OraRad Study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
20
|
Frizelle F, Brennan M. Could comprehensive cancer centres improve cancer outcomes and equity in New Zealand? N Z Med J 2020; 133:9-14. [PMID: 32994611] [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)
- Frank Frizelle
- Department of Surgery, Christchurch Hospital, Christchurch
| | - Murray Brennan
- Chairman Emeritus of Surgery, Memorial Sloan Kettering Cancer Center, New York
| |
Collapse
|
21
|
Bambra W, Daly JM, Kendall NR, Gardner DS, Brennan M, Kydd JH. Equine influenza vaccination as reported by horse owners and factors influencing their decision to vaccinate or not. Prev Vet Med 2020; 180:105011. [PMID: 32438206 DOI: 10.1016/j.prevetmed.2020.105011] [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: 11/26/2019] [Revised: 03/27/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Equine influenza virus is a highly contagious respiratory pathogen that causes pyrexia, anorexia, lethargy and coughing in immunologically naïve horses. Vaccines against equine influenza are available and vaccination is mandatory for horses that participate in affiliated competitions, but this group forms a small proportion of the total horse population. The aims of this study were to: i) identify the equine influenza vaccination rate as reported in 2016 by horse owners in the United Kingdom (UK); ii) examine the demographics of owners and horses which were associated with significantly lower influenza vaccination rates and iii) explore factors that influence horse owners' decisions around influenza vaccine uptake. RESULTS Responses from 4837 UK horse owners who were responsible for 10,501 horses were analysed. An overall equine influenza vaccination rate of 80% (8385/10501) was reported. Several owner demographic characteristics were associated with significantly lower (p<0.05) reported equine influenza vaccination rates including: some geographical locations, increasing horse owner age, annual household income of less that £15,000 and owning more than one horse. Horse-related features which were associated with significantly lower reported equine influenza vaccination rates included age ranges of <4 years and > 20 years, use as a companion or breeding animal or leaving their home premises either never or at most once a year. The most common reasons cited for failing to vaccinate horses was no competition activity, lack of exposure to influenza and expense of vaccines. In contrast, the most common underlying reasons given by horse owners who vaccinated their horse were protection of the individual horse against disease, veterinary advice and to protect the national herd. Owners of vaccinated horses had less previous experience of an influenza outbreak or adverse reaction to vaccination compared with owners of unvaccinated horses. CONCLUSIONS This study documented a high rate of equine influenza vaccination as reported by owners in a substantial number of horses in the UK, but this does not reflect the level of protection. Sub-populations of horses which were less likely to be vaccinated and the factors that influence each owner's decision around vaccination of their horses against equine influenza were identified, but may alter following the 2019 European influenza outbreak. This information may nevertheless help veterinary surgeons identify "at-risk" patients and communicate more personalised advice to their horse-owning clients. It may also influence educational campaigns about equine influenza directed to horse owners, which aim to improve uptake of vaccination against this pathogen.
Collapse
Affiliation(s)
- W Bambra
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, Leicestershire, LE12 5RD, United Kingdom.
| | - J M Daly
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, Leicestershire, LE12 5RD, United Kingdom.
| | - N R Kendall
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, Leicestershire, LE12 5RD, United Kingdom.
| | - D S Gardner
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, Leicestershire, LE12 5RD, United Kingdom.
| | - M Brennan
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, Leicestershire, LE12 5RD, United Kingdom.
| | - J H Kydd
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, Leicestershire, LE12 5RD, United Kingdom.
| |
Collapse
|
22
|
Brennan M, Murray O, O'Shea PM, Mulkerrin EC. Increased rates of hypernatraemia during modest heatwaves in temperate climates. QJM 2020; 113:266-270. [PMID: 31665466 DOI: 10.1093/qjmed/hcz280] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/25/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hypernatraemia is associated with morbidity and mortality, particularly in the older person. Last summer, Ireland experienced prolonged periods of excessive heat. The Irish meteorological service defines a heatwave as temperatures exceeding 25°C for five consecutive days. AIM This study sought to compare the frequency of hypernatraemia (sodium (Na+) >145 mmol/l) observed during a modest heatwave with that during average ambient temperature in the temperate Irish climate. DESIGN Retrospective cross-sectional analysis with nested case-control study. METHODS The 10-day period from 24 June to 3 July in 2017 and 2018 were chosen as the control and heatwave periods, respectively. Patients aged >65 with at least one Na+ value recorded on the laboratory information system were included. Local meteorological data, age, gender and Na+ levels were evaluated. RESULTS Maximum air temperatures were significantly higher during the heatwave period (mean 27°C vs. 16.8°C, P < 0.0001). Hypernatraemia was present in 3.6% (66/1840) of samples collected during the heatwave compared to 1.4% (23/1593) in the control period. The mean age of affected patients was similar in both groups, 75 years ±7 (P = 1.000). Almost half of participants (49.5%) were male. The frequency of hypernatraemia observed was not influenced by gender, P = 0.33. The median sodium concentrations were similar in both groups, P = 1.00. CONCLUSION Hypernatraemia was 2.5 times more frequent in samples drawn during the heatwave compared to the control period. In this study, neither age nor gender impacted the profile of patients diagnosed with hypernatraemia. A modest rise in temperatures increases hypernatraemia rates in temperate climates.
Collapse
Affiliation(s)
- M Brennan
- Department of Geriatric Medicine, Saolta University Health Care Group (SUHCG), University Hospital Galway, Newcastle Road, Galway, Ireland
| | - O Murray
- Department of Pharmacology & Therapeutics, National University of Ireland, Newcastle Road, Galway, Ireland
| | - P M O'Shea
- Department of Clinical Biochemistry, Saolta University Health Care Group (SUHCG), University Hospital Galway, Newcastle Road, Galway, Ireland
| | - E C Mulkerrin
- Department of Geriatric Medicine, Saolta University Health Care Group (SUHCG), University Hospital Galway, Newcastle Road, Galway, Ireland
| |
Collapse
|
23
|
Fedotov AV, Altinbas Z, Belomestnykh S, Ben-Zvi I, Blaskiewicz M, Brennan M, Bruno D, Brutus C, Costanzo M, Drees A, Fischer W, Fite J, Gaowei M, Gassner D, Gu X, Halinski J, Hamdi K, Hammons L, Harvey M, Hayes T, Hulsart R, Inacker P, Jamilkowski J, Jing Y, Kewisch J, Kankiya P, Kayran D, Lehn R, Liaw CJ, Litvinenko V, Liu C, Ma J, Mahler G, Mapes M, Marusic A, Mernick K, Mi C, Michnoff R, Miller T, Minty M, Narayan G, Nayak S, Nguyen L, Paniccia M, Pinayev I, Polizzo S, Ptitsyn V, Rao T, Robert-Demolaize G, Roser T, Sandberg J, Schoefer V, Schultheiss C, Seletskiy S, Severino F, Shrey T, Smart L, Smith K, Song H, Sukhanov A, Than R, Thieberger P, Trabocchi S, Tuozzolo J, Wanderer P, Wang E, Wang G, Weiss D, Xiao B, Xin T, Xu W, Zaltsman A, Zhao H, Zhao Z. Experimental Demonstration of Hadron Beam Cooling Using Radio-Frequency Accelerated Electron Bunches. Phys Rev Lett 2020; 124:084801. [PMID: 32167359 DOI: 10.1103/physrevlett.124.084801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/24/2020] [Accepted: 02/03/2020] [Indexed: 06/10/2023]
Abstract
Cooling of beams of gold ions using electron bunches accelerated with radio-frequency systems was recently experimentally demonstrated in the Relativistic Heavy Ion Collider at Brookhaven National Laboratory. Such an approach is new and opens the possibility of using this technique at higher energies than possible with electrostatic acceleration of electron beams. The challenges of this approach include generation of electron beams suitable for cooling, delivery of electron bunches of the required quality to the cooling sections without degradation of beam angular divergence and energy spread, achieving the required small angles between electron and ion trajectories in the cooling sections, precise velocity matching between the two beams, high-current operation of the electron accelerator, as well as several physics effects related to bunched-beam cooling. Here we report on the first demonstration of cooling hadron beams using this new approach.
Collapse
Affiliation(s)
- A V Fedotov
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - Z Altinbas
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - S Belomestnykh
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - I Ben-Zvi
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Blaskiewicz
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Brennan
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - D Bruno
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - C Brutus
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Costanzo
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - A Drees
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - W Fischer
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - J Fite
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Gaowei
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - D Gassner
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - X Gu
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - J Halinski
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - K Hamdi
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - L Hammons
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Harvey
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - T Hayes
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - R Hulsart
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - P Inacker
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - J Jamilkowski
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - Y Jing
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - J Kewisch
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - P Kankiya
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - D Kayran
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - R Lehn
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - C J Liaw
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - V Litvinenko
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - C Liu
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - J Ma
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - G Mahler
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Mapes
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - A Marusic
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - K Mernick
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - C Mi
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - R Michnoff
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - T Miller
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Minty
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - G Narayan
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - S Nayak
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - L Nguyen
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Paniccia
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - I Pinayev
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - S Polizzo
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - V Ptitsyn
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - T Rao
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | | | - T Roser
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - J Sandberg
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - V Schoefer
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - C Schultheiss
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - S Seletskiy
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - F Severino
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - T Shrey
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - L Smart
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - K Smith
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - H Song
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - A Sukhanov
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - R Than
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - P Thieberger
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - S Trabocchi
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - J Tuozzolo
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - P Wanderer
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - E Wang
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - G Wang
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - D Weiss
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - B Xiao
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - T Xin
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - W Xu
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - A Zaltsman
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - H Zhao
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - Z Zhao
- Brookhaven National Laboratory, Upton, New York 11973, USA
| |
Collapse
|
24
|
O'Brien S, Garvey P, Baker K, Brennan M, Cormican M, Cuddihy J, De Lappe N, Ellard R, Fallon Ú, Irvine N, Murphy S, O'Brien D, O'Connor M, O'Hare C, O'Sullivan MB, Part AM, Rooney P, Ryan A, Waldron G, Ward M, McKeown PJ. Investigation of a foodborne outbreak of Shigella sonnei in Ireland and Northern Ireland, December 2016: the benefits of cross-border collaboration and commercial sales data. Public Health 2020; 182:19-25. [PMID: 32120067 DOI: 10.1016/j.puhe.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/27/2019] [Revised: 12/11/2019] [Accepted: 01/09/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe a cross-border foodborne outbreak of Shigella sonnei that occurred in Ireland and Northern Ireland (NI) in December 2016 whilst also highlighting the valuable roles of sales data and international collaboration in the investigation and control of this outbreak. STUDY DESIGN A cross-border outbreak control team was established to investigate the outbreak. METHODS Epidemiological, microbiological, and environmental investigations were undertaken. Traditional analytical epidemiological studies were not feasible in this investigation. The restaurant chain provided sales data, which allowed assessment of a possible increased risk of illness associated with exposure to a particular type of heated food product (product A). RESULTS Confirmed cases demonstrated sole trimethoprim resistance: an atypical antibiogram for Shigella isolates in Ireland. Early communication and the sharing of information within the outbreak control team facilitated the early detection of the international dimension of this outbreak. A joint international alert using the European Centre for Disease Control's confidential Epidemic Intelligence Information System for Food- and Waterborne Diseases and Zoonoses (EPIS-FWD) did not reveal further cases outside of the island of Ireland. The outbreak investigation identified that nine of thirteen primary case individuals had consumed product A from one of multiple branches of a restaurant chain located throughout the island of Ireland. Product A was made specifically for this chain in a food production facility in NI. S. sonnei was not detected in food samples from the food production facility. Strong statistical associations were observed between visiting a branch of this restaurant chain between 5 and 9 December 2016 and eating product A and developing shigellosis. CONCLUSIONS This outbreak investigation highlights the importance of international collaboration in the efficient identification of cross-border foodborne outbreaks and the value of using sales data as the analytical component of such studies.
Collapse
Affiliation(s)
- S O'Brien
- HSE-Health Protection Surveillance Centre, Dublin, Ireland; Department of Public Health HSE-NW, Sligo, Ireland.
| | - P Garvey
- HSE-Health Protection Surveillance Centre, Dublin, Ireland
| | - K Baker
- Food Standards Agency Northern Ireland, Belfast, Northern Ireland, Ireland
| | - M Brennan
- Food Safety Authority of Ireland, Dublin, Ireland
| | - M Cormican
- National Salmonella, Shigella and Listeria Reference Laboratory, Galway, Ireland
| | - J Cuddihy
- Department of Public Health HSE-SE, Kilkenny, Ireland
| | - N De Lappe
- National Salmonella, Shigella and Listeria Reference Laboratory, Galway, Ireland
| | - R Ellard
- Food Safety Authority of Ireland, Dublin, Ireland
| | - Ú Fallon
- Department of Public Health HSE-Midlands, Co Offaly, Ireland
| | - N Irvine
- Public Health Agency Northern Ireland, Belfast, Northern Ireland, UK
| | - S Murphy
- Environmental Health Department, Newry, Mourne & Down District Council, Northern Ireland, UK
| | - D O'Brien
- HSE Environmental Health Service Dublin Specialist Section, Dublin, Ireland
| | - M O'Connor
- Department of Public Health HSE-E, Dublin, Ireland
| | - C O'Hare
- Department of Public Health HSE-SE, Kilkenny, Ireland
| | | | - A M Part
- HSE Environmental Health Service Dublin Mid Leinster, Dublin, Ireland
| | - P Rooney
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - A Ryan
- Department of Public Health HSE-NW, Sligo, Ireland
| | - G Waldron
- Public Health Agency Northern Ireland, Belfast, Northern Ireland, UK
| | - M Ward
- Department of Public Health HSE-E, Dublin, Ireland
| | - P J McKeown
- HSE-Health Protection Surveillance Centre, Dublin, Ireland
| | | |
Collapse
|
25
|
Suarez-Sarmiento A, Brennan M, Suarez-Sarmiento A, Perito P. 394 Out-patient Penile Prosthesis Surgery: an institutional Study. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.238] [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: 10/25/2022]
|
26
|
Suarez-Sarmiento A, Houlihan M, Brennan M, Perito P, Kohler T, Suarez-Sarmiento A, Alom M, Ziegelmann M, Trost L, Fakhoury M. 389 Penile Prosthesis Glans Hypermobility Scale (GHS): Incidence, Severity, and Predictors in a Multi-Institutional Series. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.233] [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: 10/25/2022]
|
27
|
Wen L, Suarez-Sarmiento A, Suarez-Sarmiento A, Brennan M, Dodge N, Houlihan M, Kohler T, Perito P. 392 Do We Really Need a Catheter Post IPP? Urinary Retention Prevalence and Considerations. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
28
|
Brennan M, Crowe A, Tiernan C, Smith M, Cogan L, Purcell R, Griffin C, Crowe M. 183 Risk of Hypoglycaemia in Older Patients in Residential Care on Oral Hypoglycaemic Medication. Age Ageing 2019. [DOI: 10.1093/ageing/afz103.107] [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
Diabetes mellitus (DM) is common in older patients in residential care(RC) with prevalence ranging from 11-36%.Guidlines(1) on glucose targets to avoid the risk of hypoglycaemia or hyperglycaemia respectively in older people recommend avoiding a fasting glucose on treatment of 6mmol/L or a random glucose level higher than 11.0mmol/L. An HbA1c of 53to 59mmol/mol(7-7.5%) should be aimed for although this may need adjusting in RC and StoppFrail guidelines suggest a target of HbA1c of <8%(64mmol/mol). We assessed the prevalence, drug treatment and glycaemic control in 107 older patients in residential care at two sites in Dublin.
Methods
Patients with DM were identified from review of medical notes. Hypoglycaemic treatment whether oral hypoglycemic drugs(OHD) or insulin, capillary blood glucose measurements(CBGM) over the previous 28 day period, HbA1c values and weight change over the previous year respectively were tabulated from patient records.
Results
Sixteen patients (15%) aged 66-93 were documented with DM. Eight (50%) were on no hypoglycaemic treatment in whom OHD had been discontinued in 2 patients over the previous 6 months because of risk of hypoglycaemia.. Six patients (38%) were only on OHD, whilst 2 were on insulin. Of the 6 patients on OHD, CABGM were below 6mmol/L in 3 patients (50%) with no values above 11mmol/L. All 3 patients had lost weight ( 2.5-6.8Kg) over the previous year and HbA1c levels were below 53mmol/mol (7%) in all 3 patients.
Conclusion
Although our numbers are small, 50% of our patients in residential care on OHD are at risk of hypoglycemia possibly related to weight loss. Reducing or discontinuing their OHD may be appropriate.
Collapse
Affiliation(s)
- M Brennan
- The Royal Hospital Donnybrook, Dublin, Ireland
| | - A Crowe
- The Royal Hospital Donnybrook, Dublin, Ireland
| | - C Tiernan
- The Royal Hospital Donnybrook, Dublin, Ireland
| | - M Smith
- The Royal Hospital Donnybrook, Dublin, Ireland
| | - L Cogan
- The Royal Hospital Donnybrook, Dublin, Ireland
| | - R Purcell
- Our Lady's Hospice Harold's Cross, Dublin, Ireland
| | - C Griffin
- Our Lady's Hospice Harold's Cross, Dublin, Ireland
| | - M Crowe
- The Royal Hospital Donnybrook, Dublin, Ireland
| |
Collapse
|
29
|
Affiliation(s)
- M Costello
- From the Department of Diabetes, Endocrinology and Metabolism University College Hospital Galway, Galway, Ireland
| | - M Brennan
- Department of Geriatric Medicine University College Hospital Galway, Galway, Ireland
| | - C Newman
- From the Department of Diabetes, Endocrinology and Metabolism University College Hospital Galway, Galway, Ireland
| | - P O'Shea
- Department of Clinical Biochemistry, University College Hospital Galway, Galway, Ireland
| | - M Bell
- From the Department of Diabetes, Endocrinology and Metabolism University College Hospital Galway, Galway, Ireland
| |
Collapse
|
30
|
Clooney L, Ronayne A, Glennon K, Brennan M, Hickey N, Magee C, Cooley S, Eogan M, Drew RJ. Impact of Introduction of a Clinical Pathway for the Management of Pyelonephritis on Obstetric Patients: a Quality Improvement Project. Ir Med J 2019; 112:951. [PMID: 31538439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Aim To determine whether the introduction of a clinical pathway for the treatment of pyelonephritis in obstetric patients would improve outcomes. Methods This was a retrospective study conducted in a maternity hospital using quantitative analysis methods. Patients who met laboratory and clinical criteria for pyelonephritis during data collection were included. Results The study included analysis of 23 patients pre-intervention and 19 post-intervention. Baseline and patient characteristics were similar for both groups. A statistically significant difference was seen in 3 of 7 outcome measures. Increased use of gentamicin (13% Vs 52% p=0.006), Increased number of renal ultrasounds (17% Vs 47%, p=0.04) and increased use of prophylaxis (21% Vs 68%, p=0.003). The proportion of patients receiving ≥ 10 days of IV antimicrobials decreased from 48% to 21% post-intervention (p=0.07). Discussion This study has shown that the introduction of a pathway for the treatment of pyelonephritis in pregnancy had a positive impact on several important clinical outcomes.
Collapse
Affiliation(s)
- L Clooney
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - A Ronayne
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - K Glennon
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - M Brennan
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - N Hickey
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - C Magee
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - S Cooley
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - M Eogan
- The Rotunda Hospital, Parnell Square, Dublin 1
| | - R J Drew
- The Rotunda Hospital, Parnell Square, Dublin 1
| |
Collapse
|
31
|
Brennan M, Suarez-Sarmiento A, Suarez-Sarmiento A, Gheiler E, Perito P. 283 Midline Reservoir Placement Via the Infrapubic Approach: An Excellent Option In Patients with Previous Bilateral Inguinal Surgery. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
32
|
Brennan M, Suarez-Sarmiento A, Perito P, Gheiler E. 038 Analgesic Implant Soaks with Ropivacaine are as Effective as Perioperative Penile Blocks. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.049] [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: 10/27/2022]
|
33
|
Brennan M, Suarez-Sarmiento A, Suarez-Sarmiento A, Gheiler E, Perito P. 205 Replacement of Malleable and Two-Piece Implants with an Inflatable Penile Prosthesis is Associated with High Patient Satisfaction and Improved Quality of Life. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
34
|
Suarez-Sarmiento A, Perito P, Brennan M, Suarez-Sarmiento A, Gheiler E. 300 Pain Associated with Abdominal Wall Reservoir Placement during IPP Surgery. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.302] [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]
|
35
|
Brennan M, Suarez-Sarmiento A, Suarez-Sarmiento A, Gheiler E, Perito P. 304 Narrow Cylinders: Establishing a Guideline for Use. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.306] [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: 10/27/2022]
|
36
|
Brennan M, Suarez-Sarmiento A, Gheiler E. 039 In-Vivo Width Assessment of Penile Implants. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.050] [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: 10/27/2022]
|
37
|
Brennan M, Suarez-Sarmiento A, Perito P, Gheiler E. 284 Early Experience with Optimized Tubing Length Penoscrotal Implants. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.288] [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: 10/27/2022]
|
38
|
Brennan M, O'Flaherty N, O'Shea PM, O'Keeffe S, Mulkerrin E. Fulminant Skeletal Failure in a Centenarian: The Impact of Nutrition and Immobility. J Nutr Health Aging 2019; 23:700-702. [PMID: 31560026 DOI: 10.1007/s12603-019-1233-7] [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] [Indexed: 10/26/2022]
Abstract
This case describes a 103-year-old lady who presented from home with an incidental diagnosis of a left femoral fracture. She had no history of trauma and denied pain. She had a known diagnosis of osteoporosis, and sustained a fracture of the contralateral femur aged 93 which was managed conservatively. She was bed-bound with fixed contractures, poor oral intake and was non-compliant with prescribed calcium/vitamin D supplementation. Clinical biochemical measurements showed severe vitamin D deficiency and mild hypocalcaemia. Secondary hyperparathyroidism in the setting of an inappropriately normal phosphate suggested concurrent renal bone disease. Biomarkers of bone turnover were also consistent with bone remodelling. The history of prior fragility fractures, severe vitamin D deficiency and immobility supports a diagnosis of osteoporotic fracture, however other causes of spontaneous fracture were also considered. This case highlights the complexity of interpreting clinical biochemistry results in the setting of multi-morbidity and addresses the challenges of bone health management in the frail older person.
Collapse
Affiliation(s)
- M Brennan
- M. Brennan, Specialist Registrar Geriatrics and General Internal Medicine, Galway University Hospitals, Geriatric Medicine, Newcastle Road, Galway, Ireland,
| | | | | | | | | |
Collapse
|
39
|
Abstract
Spontaneous insufficiency fractures are caused by normal or physiological stress on weakened bone. The leading cause of insufficiency fractures is osteoporosis which has a propensity to affect older patients. Other causes or associated factors are disorders which affect bone metabolism, collagen formation, bone remodelling and medications such as bisphosphonates and glucocorticoids. Pathological fractures and abuse are important causes of unexplained fractures which warrant careful consideration. Spontaneous fractures of the long bones affect on average 1% of nursing home residents per year and tend to occur in patients who are bed-bound with joint contractures. Preventative measures for spontaneous insufficiency fractures include optimising nutrition to include an adequate intake of protein, calcium and vitamin D, maintaining mobility and preventing long periods of bed-rest and treatment of underlying pre-disposing conditions.
Collapse
Affiliation(s)
- M Brennan
- M. Brennan, Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland,
| | | | | | | |
Collapse
|
40
|
Elsworth P, Berman D, Brennan M. Changes in small native animal populations following control of European rabbits (Oryctolagus cuniculus) by warren ripping in the Australian arid zone. Wildl Res 2019. [DOI: 10.1071/wr18088] [Citation(s) in RCA: 4] [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
Context
European rabbits have a great impact on native vegetation and small vertebrates in Australia. Rabbits consume vegetation and promote invasive plants and invasive predators, and compete directly and indirectly with native animals suppressing those populations.
Aims
We explored the changes in small native vertebrates and invertebrates following the removal of rabbits.
Methods
Warren ripping was undertaken on a property in south-western Queensland at four sites and the results of pitfall trapping were compared with four nearby paired control sites. Invertebrates and small mammals were counted in pitfall traps, and bird surveys were conducted in all treatment and control sites.
Key results
Following a rabbit-control program, we observed a four-fold increase in the number of dunnarts trapped in treatment plots, whereas no change was observed in control plots. The spring following the rabbit-control program also saw an increase in some lizards in treatment plots.
Conclusions
The presence of rabbits in arid-zone Australia can suppress native animal populations.
Implications
Many species of small native mammals and lizards rely on food sources that fluctuate greatly with environmental conditions. The presence of rabbits altering the landscape, supporting introduced predators, reducing vegetation and, therefore, insects, adds increased pressure for insectivorous species. Rabbit control through warren ripping in arid-zone Australia is an effective method to reduce rabbit numbers, and allowed for an increase in small vertebrates in treated areas.
Collapse
|
41
|
Belshaw Z, Brennan M. Are nutraceuticals better than carprofen at controlling osteoarthritis in dogs? Vet Rec 2018; 183:507-508. [PMID: 30361225 DOI: 10.1136/vr.k4486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
42
|
Cooke BD, Brennan M, Elsworth P. Ability of wild rabbit, Oryctolagus cuniculus, to lactate successfully in hot environments explains continued spread in Australia. Wildl Res 2018. [DOI: 10.1071/wr17177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Context European rabbits evolved in Spain and Portugal and are adapted to winter-rainfall Mediterranean habitats. On introduction into Australia in 1859, wild rabbits quickly colonised similar habitats across the southern two-thirds of the continent. However, over the past 40 years, they have spread further into monsoonal savanna habitats in northern Queensland. Aims To explain this, we considered adaptive responses of wild rabbits to hot conditions, particularly potential mechanisms for reducing the heat load of lactation, which has been identified as a likely limiting factor. Methods We analysed data from captive wild rabbits to identify mechanisms that could potentially reduce lactational heat load, and obtained data from shot samples of wild rabbits from northern Queensland to determine which of these might be most important in the field. Key results Rabbits spread food intake evenly across the 20-day lactation period and under hot conditions, captive wild individuals used body reserves to meet energy requirements for lactation, which is more energy efficient than converting digestible foods to milk. Conclusions This strategy reduces the heat load of lactation, enabling rabbits to suckle young successfully under hot conditions, but it comes at a cost. Rabbits need extra body reserves before breeding and need to regain those reserves between litters. Implications The slow spread of rabbits into Australia’s monsoonal savannas is likely to continue, given the rabbit’s reproductive flexibility and further natural selection for breeding in this environment.
Collapse
|
43
|
Linsenmeyer K, Strymish JM, Smith D, Brennan M, Gupta K. Electronic consults for improving vancomycin use. J Hosp Infect 2017; 99:158-159. [PMID: 29225053 DOI: 10.1016/j.jhin.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/01/2017] [Indexed: 12/19/2022]
Affiliation(s)
- K Linsenmeyer
- Veterans Affairs Boston Healthcare System, West Roxbury, MA, USA; Boston University School of Medicine, Boston, MA, USA.
| | - J M Strymish
- Veterans Affairs Boston Healthcare System, West Roxbury, MA, USA; Harvard Medical School, Boston, MA, USA
| | - D Smith
- Veterans Affairs Boston Healthcare System, West Roxbury, MA, USA
| | - M Brennan
- Veterans Affairs Boston Healthcare System, West Roxbury, MA, USA
| | - K Gupta
- Veterans Affairs Boston Healthcare System, West Roxbury, MA, USA; Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
44
|
Brennan M, Shepherd T, Mitchell S, Topp CFE, Hoad SP. Husk to caryopsis adhesion in barley is influenced by pre- and post-anthesis temperatures through changes in a cuticular cementing layer on the caryopsis. BMC Plant Biol 2017; 17:169. [PMID: 29058624 PMCID: PMC5651604 DOI: 10.1186/s12870-017-1113-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 10/09/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND At ripeness, the outer husk of "covered" barley grains firmly adheres to the underlying caryopsis. A cuticular cementing layer on the caryopsis is required for husk adhesion, however the quality of adhesion varies significantly among cultivars which produce the cementing layer, resulting in the economically important malting defect, grain skinning. The composition of the cementing layer, and grain organ development have been hypothesised to influence the quality of husk adhesion. Plants of Hordeum vulgare 'Concerto' were grown at different temperatures pre- and post-anthesis to effect changes in the development of the husk, caryopsis and cuticular cementing layer, to determine how these variables influence the quality of husk-to-caryopsis adhesion. RESULTS Warm conditions pre-anthesis decreased the quality of husk adhesion, and consequently increased the incidence of grain skinning. Cool post-anthesis conditions further decreased the quality of husk adhesion. The composition of the cementing layer, rather than its structure, differed with respect to husk adhesion quality. This cementing layer was produced at the late milk stage, occurring between nine and 29 days post-anthesis, conditional on the temperature-dependent growth rate. The compounds octadecanol, tritriacontane, campesterol and β-sitosterol were most abundant in caryopses with high-quality husk adhesion. The differences in adhesion quality were not due to incompatible husk and caryopsis dimensions affecting organ contact. CONCLUSIONS This study shows that husk-to-caryopsis adhesion is dependent on cementing layer composition, and implies that this composition is regulated by temperature before, and during grain development. Understanding this regulation will be key to improving husk-to-caryopsis adhesion.
Collapse
Affiliation(s)
- M. Brennan
- Scotland’s Rural College, King’s Buildings, West Mains Road, EH9 3JG Edinburgh, Scotland
| | - T. Shepherd
- James Hutton Institute, Invergowrie, DD2 5DA Dundee, Scotland
| | - S. Mitchell
- University of Edinburgh, King’s Buildings, Mayfield Road, EH9 3JH Edinburgh, Scotland
| | - C. F. E. Topp
- Scotland’s Rural College, King’s Buildings, West Mains Road, EH9 3JG Edinburgh, Scotland
| | - S. P. Hoad
- Scotland’s Rural College, King’s Buildings, West Mains Road, EH9 3JG Edinburgh, Scotland
| |
Collapse
|
45
|
Gholami S, Cassidy MR, Kirane A, Kuk D, Zanchelli B, Antonescu CR, Singer S, Brennan M. Size and Location are the Most Important Risk Factors for Malignant Behavior in Resected Solitary Fibrous Tumors. Ann Surg Oncol 2017; 24:3865-3871. [PMID: 29039030 DOI: 10.1245/s10434-017-6092-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE While previously thought to be clinically indolent, recent data suggest significant late metastatic capacity of solitary fibrous tumors (SFTs). We define prognostic factors for recurrence and disease-specific death (DSD) in resected primary SFTs. METHODS Resected primary SFTs from 1982 to 2015 were identified from a prospective, single institutional database. Risk factors for local (LR) and distant recurrence (DR), and DSD were assessed using competing risk analysis. RESULTS A total of 219 patients with median follow-up of 6.1 (0.1-22) years were included. Five- and 10-year cumulative DSD was 9 and 11%, respectively. Size greater than the median 8 cm, gender, location, and complete gross resection were significantly associated with DSD (p < 0.05). Five- and 10-year cumulative risk (CR) of LR was 4 and 7%, whereas 5- and 10-year CR of DR was 13 and 16%, respectively. LR was associated with location (p = 0.02) and tumor size (p = 0.02), and DR was associated with size (p < 0.01). Histopathologic classification did not predict long-term behavior with both malignant and benign tumors demonstrating capacity for DR and associated death. Tumors in the thoracic cavity and abdomen/retroperitoneum presented the greatest risk of DR (16 and 27% 10-year CR). On multivariate analysis, size ≥ 8 cm (hazard ratio 2.89, p = 0.05) and tumor location in chest or abdominal/retroperitoneal cavity (hazard ratio 2.68, p = 0.01) significantly impacted DSD. CONCLUSIONS Recurrence is highly associated with DSD and events occur as late as 16 years after initial presentation, including in patients with initially considered benign tumors. Patients with large (≥ 8 cm) tumors in the chest or abdominal/retroperitoneal cavity are at greatest risk.
Collapse
Affiliation(s)
- Sepideh Gholami
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael R Cassidy
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amanda Kirane
- Department of Surgery, University of California - Davis Medical Center, Sacramento, CA, USA
| | - Deborah Kuk
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bhumika Zanchelli
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Murray Brennan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
46
|
Agass RF, Brennan M, Rendle DI. Extrapyramidal side effects following subcutaneous metoclopramide injection for the treatment of post operative ileus. EQUINE VET EDUC 2017. [DOI: 10.1111/eve.12586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R. F. Agass
- Rainbow Equine Hospital; Old Malton Malton North Yorkshire UK
| | - M. Brennan
- Rainbow Equine Hospital; Old Malton Malton North Yorkshire UK
| | - D. I. Rendle
- Rainbow Equine Hospital; Old Malton Malton North Yorkshire UK
| |
Collapse
|
47
|
Dean R, Brennan M, Ewers R, Hudson C, Daly JM, Baillie S, Eisler MC, Place EJ, Brearley J, Holmes M, Handel I, Shaw D, McLauchlan G, McBrearty A, Cripps P, Jones P, Smith R, Verheyen K. The challenge of teaching undergraduates evidence-based veterinary medicine. Vet Rec 2017; 181:298-299. [PMID: 28916694 DOI: 10.1136/vr.j3441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The Royal College of Veterinary Surgeons now lists 'How to evaluate evidence' as a day one competence for newly qualified vets. In this article, representatives from each of the veterinary schools in the UK discuss how the challenge of delivering and assessing the concepts of evidence-based veterinary medicine in a crowded undergraduate curriculum can be met.
Collapse
Affiliation(s)
- R Dean
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire LE12 5RD, UK
| | - M Brennan
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire LE12 5RD, UK
| | - R Ewers
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire LE12 5RD, UK
| | - C Hudson
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire LE12 5RD, UK
| | - J M Daly
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire LE12 5RD, UK
| | - S Baillie
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK
| | - M C Eisler
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK
| | - E J Place
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK
| | - J Brearley
- Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK
| | - M Holmes
- Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK
| | - I Handel
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush Campus, Roslin, Midlothian EH25 9RG, UK
| | - D Shaw
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush Campus, Roslin, Midlothian EH25 9RG, UK
| | - G McLauchlan
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Garscube Campus, Bearsden Road, Glasgow G61 1QH, UK
| | - A McBrearty
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Garscube Campus, Bearsden Road, Glasgow G61 1QH, UK
| | - P Cripps
- School of Veterinary Science, University of Liverpool, Neston, Cheshire CH64 7TE, UK
| | - P Jones
- School of Veterinary Science, University of Liverpool, Neston, Cheshire CH64 7TE, UK
| | - R Smith
- School of Veterinary Science, University of Liverpool, Neston, Cheshire CH64 7TE, UK
| | - K Verheyen
- Royal Veterinary College, North Mymms, Hertfordshire AL9 7TA, UK
| |
Collapse
|
48
|
Page A, O’Rourke S, Brennan M, Clooney L, Le Blanc D, Griffin J, Eogan M, Drew RJ. Impact of Xpert MRSA/SA blood culture PCR assay on management of positive blood cultures in obstetric patients: a retrospective audit. Ir J Med Sci 2017; 186:995-998. [DOI: 10.1007/s11845-017-1581-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/08/2017] [Indexed: 12/15/2022]
|
49
|
|
50
|
Kelly KJ, Wong J, Gönen M, Allen P, Brennan M, Coit D, Fong Y. Human Trial of a Genetically Modified Herpes Simplex Virus for Rapid Detection of Positive Peritoneal Cytology in the Staging of Pancreatic Cancer. EBioMedicine 2016; 7:94-9. [PMID: 27322463 PMCID: PMC4909379 DOI: 10.1016/j.ebiom.2016.03.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/29/2016] [Accepted: 03/29/2016] [Indexed: 01/16/2023] Open
Abstract
Introduction Patients with peritoneal dissemination of pancreatic adenocarcinoma do not benefit from surgical resection, but radiologic and cytologic detection of peritoneal cancer lack sensitivity. This trial sought to determine if an oncolytic virus may be used as a diagnostic agent to detect peritoneal cancer. Methods Peritoneal washings from patients with pancreatic adenocarcinoma were incubated with the enhanced green fluorescent protein (eGFP)-expressing oncolytic herpes simplex virus (HSV) NV1066. eGFP-positive or negative status was recorded for each specimen and compared to results obtained by conventional cytologic evaluation. These results were correlated with recurrence and survival for patients who underwent R0 resection. Results Of 82 patients entered in this trial, 12 (15%) had positive cytology and 50 (61%) had virally-mediated eGFP positive cells in peritoneal washings. All cytology-positive patients were also eGFP positive. HSV-mediated fluorescence detection had sensitivities of 94% and 100% for detection of any and peritoneal metastatic disease; respectively. Median recurrence free and disease specific survival were 6.5 and 18.3 months for eGFP positive patients, versus 12.2 and 36.2 months for eGFP negative patients (P = 0.01 and 0.19); respectively. Conclusions A genetically modified HSV can be used as a highly sensitive diagnostic agent for detection of micro-metastatic disease in patients with pancreatic adenocarcinoma and may improve patient selection for surgery. Oncolytic virus-mediated fluorescence is a sensitive assay for detection of cancer cells in peritoneal fluid. Pancreatic cancer patients with eGFP-positive cells in peritoneal washings had a poor prognosis following surgery.
Pancreatic cancer is an aggressive disease. Even with complete surgical removal of a pancreatic tumor, recurrence is common. Patients with microscopic spread of cancer cells into the abdomen, or peritoneum, do not benefit from surgery. Current methods of detection of this kind of spread are not very sensitive. This study utilized a virus that specifically infects cancer cells and expresses a green fluorescent protein within them to detect peritoneal disease. Viral fluorescence was more sensitive than standard methods for detecting peritoneal disease and may help to identify which patients with pancreas cancer will benefit from surgery.
Collapse
Affiliation(s)
- Kaitlyn J Kelly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States
| | - Joyce Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States
| | - Mithat Gönen
- Department of Epidemiology and Statistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States
| | - Peter Allen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States
| | - Murray Brennan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States
| | - Daniel Coit
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States
| | - Yuman Fong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
| |
Collapse
|