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McMullan P, Gochnauer H, Brown-Joel Z, O'Donnell P, Belazarian L. Superficial erosions in a pediatric patient. Pediatr Dermatol 2024. [PMID: 38712655 DOI: 10.1111/pde.15636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/13/2024] [Indexed: 05/08/2024]
Affiliation(s)
- Patrick McMullan
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Heather Gochnauer
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Zoe Brown-Joel
- Department of Pathology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Patrick O'Donnell
- Department of Pathology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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O'Brien L, Wassall N, Cadoret D, Petrović A, O'Donnell P, Neville S. Perceptions of and preparedness for cross-cultural care: a survey of final-year medical students in Ireland. BMC Med Educ 2024; 24:472. [PMID: 38685005 PMCID: PMC11059656 DOI: 10.1186/s12909-024-05392-4] [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] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 04/04/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Migration is increasing globally, and societies are becoming more diverse and multi-ethnic. Medical school curricula should prepare students to provide high-quality care to all individuals in the communities they serve. Previous research from North America and Asia has assessed the effectiveness of medical cultural competency training, and student preparedness for delivery of cross-cultural care. However, student preparedness has not been explored in the European context. The aim of this study was to investigate how prepared final-year medical students in the Republic of Ireland (ROI) feel to provide care to patients from other countries, cultures, and ethnicities. In addition, this study aims to explore students' experiences and perceptions of cross-cultural care. METHODS Final-year medical students attending all six medical schools within the ROI were invited to participate in this study. A modified version of the Harvard Cross-Cultural Care Survey (CCCS) was used to assess their preparedness, skill, training/education, and attitudes. The data were analysed using IBM SPSS Statistics 28.0, and Fisher's Exact Test was employed to compare differences within self-identified ethnicity groups and gender. RESULTS Whilst most respondents felt prepared to care for patients in general (80.5%), many felt unprepared to care for specific ethnic patient cohorts, including patients from a minority ethnic background (50.7%) and the Irish Traveller Community (46.8%). Only 20.8% of final-year students felt they had received training in cross-cultural care during their time in medical school. Most respondents agreed that they should be assessed specifically on skills in cultural competence whilst in medical school (83.2%). CONCLUSIONS A large proportion of final-year medical students surveyed in Ireland feel inadequately prepared to care for ethnically diverse patients. Similarly, they report feeling unskilled in core areas of cross-cultural care, and a majority agree that they should be assessed on aspects of cultural competency. This study explores shortcomings in cultural competency training and confidence amongst Irish medical students. These findings have implications for future research and curricular change, with opportunities for the development of relevant educational initiatives in Irish medical schools.
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Affiliation(s)
- Lesley O'Brien
- School of Medicine, University of Limerick, Limerick, Republic of Ireland.
| | - Nicola Wassall
- School of Medicine, University of Limerick, Limerick, Republic of Ireland
| | - Danielle Cadoret
- School of Medicine, University of Limerick, Limerick, Republic of Ireland
| | | | - Patrick O'Donnell
- School of Medicine, University of Limerick, Limerick, Republic of Ireland
| | - Siobhán Neville
- School of Medicine, University of Limerick, Limerick, Republic of Ireland
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3
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Connolly N, Kelly D, O'Donnell P, Hyde S. Scoping review of smoking cessation interventions in pregnant women attending primary care. BJGP Open 2024:BJGPO.2023.0185. [PMID: 38490678 DOI: 10.3399/bjgpo.2023.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/05/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Smoking during pregnancy has many adverse effects for infant and mother. Despite this, many pregnant women continue smoking. Primary care is a suitable area to provide smoking cessation interventions. AIM To investigate available literature regarding effectiveness of smoking cessation interventions for pregnant women in primary care, the factors contributing to this effectiveness and to provide suggestions for future research. DESIGN & SETTING Systematic scoping literature review. METHOD The methodology followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. Five electronic databases were searched. Inclusion criteria included original research studies and studies published in English. Data were extracted using a modified Johanna Briggs Institute data charting tool. RESULTS The initial search yielded 878 articles. Following article screening, twelve studies were included. Five studies found a statistically significant increase in smoking cessation rates or reduction in tobacco consumed in the intervention group. The remaining studies showed no significant difference between the groups. However, ten studies showed the control group received usual antenatal care involving smoking cessation promotion. An increase in smoking cessation rates was seen in intervention and control groups, demonstrating the effectiveness of these interventions. Interventions included education, counselling, self-help and financial incentives. They were delivered by general practitioners, midwives, counsellors and pregnancy advisors. CONCLUSION Primary care is suitable to offer smoking cessation interventions to pregnant women, as it is often the first point of care and more easily accessible than secondary care. Future research is needed to determine the most effective types of interventions.
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Affiliation(s)
- Niamh Connolly
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Dervla Kelly
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Sarah Hyde
- School of Medicine, University of Limerick, Limerick, Ireland
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4
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Abdalla ME, Taha MH, Onchonga D, Magzoub ME, Au H, O'Donnell P, Neville S, Taylor D. Integrating the social determinants of health into curriculum: AMEE Guide No. 162. Med Teach 2024; 46:304-316. [PMID: 37677074 DOI: 10.1080/0142159x.2023.2254920] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
The World Health Organization (WHO) defines the Social Determinants of Health (SDOH) as the non-medical factors influencing health outcomes. SDOH is associated with conditions in which people are born, grow, work, and live. Medical schools and licensing bodies are increasingly recognizing the need for doctors and healthcare professionals to be aware of their patient's social context and how it impacts their states of health and disease. However, there is considerable variation in the approaches of different institutions and countries to incorporating SDOH into their curricula. In order to allow clinicians to adopt a holistic approach to patient health, equipping them with extensive knowledge of SDOH would give learners the confidence, skills, knowledge, and attitudes needed to effectively engage with patients and their families. This approach aids health professionals with knowledge of the influence of the social context and cultural factors that affect patients' behaviors in relation to health. Incorporating the SDOH in medical and health professional school curricula would contribute towards adequately preparing future healthcare practitioners to provide effective, comprehensive, and equitable care, especially to marginalized and underserved populations. The Guide will take an evidence-based approach grounded in the available contemporary literature and case studies. The focus will be on integrating SDOH into undergraduate and postgraduate medical curricula to promote an understanding of the social factors that influence patients' and communities' health. Ultimately, this guide seeks to contribute to the reduction of inequalities in health.
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Affiliation(s)
| | - Mohamed Hassan Taha
- College of Medicine and Medical Education Center, University of Sharjah, Sharjah, UAE
| | - David Onchonga
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Hosanna Au
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Siobhán Neville
- School of Medicine, University of Limerick, Limerick, Ireland
| | - David Taylor
- Gulf Medical University, Al Jurf, Ajman, United Arab Emirates
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5
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O Shea M, Kiely B, O'Donnell P, Smith SM. An evaluation of the social deprivation practice grant in Irish general practice. BJGP Open 2024:BJGPO.2023.0195. [PMID: 38395435 DOI: 10.3399/bjgpo.2023.0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The Inverse Care Law states that availability of good medical care varies inversely with the need for it in the population served. In 2019 the main medical union and the Department of Health in Ireland, agreed on funding a Social Deprivation Practice grant for GP practices in urban deprived areas. AIM The aim of this study was to examine the implementation and impact of the Social Deprivation Practice Grant in participating General Practices. DESIGN & SETTING A mixed methods study with sequential design based in Irish General Practice. METHOD Data were collected using a questionnaire and online semi-structured interviews with GPs and practice staff. Data were analysed separately, and the findings compared to examine the extent to which they converged or diverged. RESULTS There were 25 survey responses and nine interviews. All practices reported the grant was beneficial and most practices utilised the grant to fund additional doctor hours (17/25). Both surveys and interviews indicated that a small amount of additional funding allowed additional clinical need in areas of deprivation to be addressed but there were some barriers identified in accessing the grant and implementing planned expenditure. CONCLUSION Delivery of healthcare in areas of socioeconomic deprivation presents significant challenges. While there were some problems with implementation, the introduction of a small, targeted grant for GP practices in areas of social deprivation allowed those practices to enhance their services with tailored initiatives seeking to meet the needs of their patient populations.
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Affiliation(s)
- Muireann O Shea
- Discipline of Public Health and Primary Care, Trinity College, Dublin, Ireland
| | - Bridget Kiely
- Department of General Practice, Royal College of Surgeons in Ireland University of Medicine and Health Science, Dublin, Ireland
| | | | - Susan M Smith
- Discipline of Public Health and Primary Care, Trinity College, Dublin, Ireland
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Zhang Y, Chen R, Nguyen D, Choi S, Gabel C, Leonard N, Yim K, O'Donnell P, Elaba Z, Deng A, Levin NA. Assessing the ability of an artificial intelligence chatbot to translate dermatopathology reports into patient-friendly language: A cross-sectional study. J Am Acad Dermatol 2024; 90:397-399. [PMID: 37804932 DOI: 10.1016/j.jaad.2023.09.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/30/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Yuying Zhang
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Ryan Chen
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Dan Nguyen
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Stephanie Choi
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Colleen Gabel
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Nicholas Leonard
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Kaitlyn Yim
- Department of Pathology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Patrick O'Donnell
- Department of Pathology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Zendee Elaba
- Department of Pathology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - April Deng
- Department of Pathology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Nikki A Levin
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
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Cornejo KM, Hutchinson L, O'Donnell P, Meng X, Tomaszewicz K, Shalin SC, Cassarino DS, Chan MP, Quinn TR, Googe PB, Nazarian RM. Molecular Profiling of Syringocystadenocarcinoma Papilliferum Reveals RAS-Activating Mutations. Arch Pathol Lab Med 2024; 148:215-222. [PMID: 37074845 DOI: 10.5858/arpa.2022-0474-oa] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 04/20/2023]
Abstract
CONTEXT.— Syringocystadenocarcinoma papilliferum (SCACP) is a rare adnexal carcinoma and the malignant counterpart of syringocystadenoma papilliferum (SCAP), which is commonly located on the head and neck and may arise in association with a nevus sebaceus. RAS mutations have been identified in both SCAP and nevus sebaceus. OBJECTIVE.— To evaluate the clinicopathologic and molecular features of SCACPs, which have not been previously explored. DESIGN.— We obtained 11 SCACPs from 6 institutions and reviewed the clinicopathologic features. We also performed molecular profiling using next-generation sequencing. RESULTS.— The cohort comprised 6 women and 5 men with ages ranging from 29 to 96 years (mean, 73.6 years). The neoplasms occurred on the head and neck (n = 8; 73%) and extremities (n = 3; 27%). Three tumors possibly arose in a nevus sebaceus. A total of 4 cases showed at least carcinoma in situ (adenocarcinoma, n = 3; squamous cell carcinoma [SCC], n = 1), and 7 cases were invasive (SCC, n = 5; mixed adenocarcinoma + SCC, n = 2). A total of 8 of 11 cases (73%) had hot spot mutations consisting of HRAS (n = 4), KRAS (n = 1), BRAF (n = 1), TP53 (n = 4), ATM (n = 2), FLT3 (n = 1), CDKN2A (n = 1), and PTEN (n = 1). All 4 cases with HRAS mutations occurred on the head and neck, whereas the KRAS mutation occurred on the extremity. CONCLUSIONS.— RAS-activating mutations were detected in 50% of the cases, of which most (80%) involved HRAS and occurred on the head and neck, which shows overlapping features with SCAP, supporting that a subset may arise as a result of malignant transformation and likely an early oncogenic event.
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Affiliation(s)
- Kristine M Cornejo
- From the Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (Cornejo, Nazarian)
| | - Lloyd Hutchinson
- Department of Pathology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts (Hutchinson, O'Donnell, Meng, Tomaszewicz)
| | - Patrick O'Donnell
- Department of Pathology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts (Hutchinson, O'Donnell, Meng, Tomaszewicz)
| | - Xiuling Meng
- Department of Pathology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts (Hutchinson, O'Donnell, Meng, Tomaszewicz)
| | - Keith Tomaszewicz
- Department of Pathology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts (Hutchinson, O'Donnell, Meng, Tomaszewicz)
| | - Sara C Shalin
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (Shalin)
| | - David S Cassarino
- Southern California Permanente Medical Group, Sunset Medical Center, Department of Pathology, Los Angeles, California (Cassarino)
| | - May P Chan
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan (Chan)
| | - Timothy R Quinn
- Massachusetts General Physicians Organization Dermatopathology Associates, Newton, Massachusetts (Quinn)
| | - Paul B Googe
- the Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina (Googe)
| | - Rosalynn M Nazarian
- From the Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (Cornejo, Nazarian)
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Santacruz E, Plumptre I, Yim K, O'Donnell P, Baltz J. Onychodystrophy in an 8-week-old male. Pediatr Dermatol 2024; 41:124-126. [PMID: 37357345 DOI: 10.1111/pde.15376] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/25/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Elise Santacruz
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Isabella Plumptre
- Department of Dermatology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Kaitlyn Yim
- Department of Pathology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Patrick O'Donnell
- Department of Pathology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Julia Baltz
- Department of Dermatology, University of Massachusetts, Worcester, Massachusetts, USA
- Dermatology Professionals, Inc, East Greenwich, Rhode Island, USA
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Tuli S, Sparrow-Downes VM, de Oliveira Santana MA, Scully R, O'Donnell P, Hayes P, Glynn L. Enhancing early career professionals' representation and engagement at international conferences: WONCA "Rural Early Career Ambassador Integration" project. Rural Remote Health 2023; 23:7999. [PMID: 37915227 DOI: 10.22605/rrh7999] [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: 11/03/2023] Open
Abstract
INTRODUCTION International conferences offer an excellent opportunity for career development and are global academic opportunities with the potential to foster educational and professional growth. However, equitable access to participation and meaningful involvement in such events remains an issue. In this article we describe the novel Rural Early Career Ambassador Integration project and its implications for the 2022 World Rural Health Conference, held at the University of Limerick, Ireland. METHODS The project offered vertical and cross-country collaborative opportunities to early career professionals with a passion for rural medicine. Three ambassadors of diverse nationalities, ethnicities and professional backgrounds were selected. They bore no personal cost for travel, transport or accommodation relating to the conference. Each ambassador was matched to and clinically shadowed an expert rural GP for a week preceding the conference, who provided mentorship. Mentors and ambassadors collaborated on goal-setting and work-planning throughout the conference, and were offered one-on-one career and networking support. The ambassadors were welcomed and integrated within a larger working party, the WONCA Working Party for Rural Health. RESULTS The project was well received by conference delegates and organisers, and achieved its stated goal of enhancing conference equity through the representation and meaningful involvement of diverse early career professionals. Vertical and cross-country collaboration generated actionable policy implications as is evidenced by the ambassadors' co-authorship on the Limerick Declaration on Rural Healthcare. CONCLUSION Although sponsorship for these initiatives remains a challenge, this project highlights the importance of actively including early career professionals at international conferences.
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Affiliation(s)
- Shagun Tuli
- University of Global Health Equity, Rwanda; and Department of General Practice, University of Limerick, Castletroy, Ireland
| | - Victoria M Sparrow-Downes
- Department of Family Medicine, Memorial University of Newfoundland, Newfoundland, Canada; and Pangnirtung Community Health Centre & Qikiqtani General Hospital, Nunavut, Canada
| | - Marcela A de Oliveira Santana
- Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; and Rural WONCA Rural Seeds Ambassador - Ibero America
| | - Robert Scully
- University of St Andrews School of Medicine, Scotland
| | | | - Peter Hayes
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Liam Glynn
- School of Medicine, University of Limerick, Limerick, Ireland; and North Clare Primary Care Team, Ballyvaughan, Co Clare, Ireland
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Guilfoyle S, Daly A, Craig S, Corroon-Sweeney E, O'Donnell P. Revisiting the Profile of Patients with No Fixed Abode Admitted to Psychiatric Inpatient Units, 2017-2021. Ir Med J 2023; 116:786. [PMID: 37552551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
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Cecchi M, Adachi M, Basile A, Buhl DL, Chadchankar H, Christensen S, Christian E, Doherty J, Fadem KC, Farley B, Forman MS, Honda S, Johannesen J, Kinon BJ, Klamer D, Marino MJ, Missling C, O'Donnell P, Piser T, Puryear CB, Quirk MC, Rotte M, Sanchez C, Smith DG, Uslaner JM, Javitt DC, Keefe RSE, Mathalon D, Potter WZ, Walling DP, Ereshefsky L. Validation of a suite of ERP and QEEG biomarkers in a pre-competitive, industry-led study in subjects with schizophrenia and healthy volunteers. Schizophr Res 2023; 254:178-189. [PMID: 36921403 DOI: 10.1016/j.schres.2023.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 11/23/2022] [Accepted: 02/10/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Complexity and lack of standardization have mostly limited the use of event-related potentials (ERPs) and quantitative EEG (QEEG) biomarkers in drug development to small early phase trials. We present results from a clinical study on healthy volunteers (HV) and patients with schizophrenia (SZ) that assessed test-retest, group differences, variance, and correlation with functional assessments for ERP and QEEG measures collected at clinical and commercial trial sites with standardized instrumentation and methods, and analyzed through an automated data analysis pipeline. METHODS 81 HV and 80 SZ were tested at one of four study sites. Subjects were administered two ERP/EEG testing sessions on separate visits. Sessions included a mismatch negativity paradigm, a 40 Hz auditory steady-state response paradigm, an eyes-closed resting state EEG, and an active auditory oddball paradigm. SZ subjects were also tested on the Brief Assessment of Cognition (BAC), Positive and Negative Syndrome Scale (PANSS), and Virtual Reality Functional Capacity Assessment Tool (VRFCAT). RESULTS Standardized ERP/EEG instrumentation and methods ensured few test failures. The automated data analysis pipeline allowed for near real-time analysis with no human intervention. Test-retest reliability was fair-to-excellent for most of the outcome measures. SZ subjects showed significant deficits in ERP and QEEG measures consistent with published academic literature. A subset of ERP and QEEG measures correlated with functional assessments administered to the SZ subjects. CONCLUSIONS With standardized instrumentation and methods, complex ERP/EEG testing sessions can be reliably performed at clinical and commercial trial sites to produce high-quality data in near real-time.
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Affiliation(s)
| | | | - A Basile
- Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | | | | | | | | | | | | | | | | | | | - D Klamer
- Anavex Life Sciences Corp., NY, USA
| | | | | | | | - T Piser
- Onsero Therapeutics, MA, USA
| | | | | | | | | | | | | | | | | | - D Mathalon
- University of California, San Francisco, CA, USA
| | - W Z Potter
- Independent Consultant, Philadelphia, PA, USA
| | | | - L Ereshefsky
- CenExel Research, USA; University of Texas Health Science Center at San Antonio, TX, USA
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Glynn L, Murphy AW, Scully R, Strasser R, Quinlan D, Cowley J, Hayes P, O'Donnell P, O'Regan A, Tuli S, Santana MADO, Sparrow-Downes VM, Petrazzuoli F, Nowlan S, Collins C, Fogarty F, MacFarlane A, Wynn-Jones J, Chater AB. The Limerick Declaration on Rural Health Care 2022. Rural Remote Health 2023; 23:7905. [PMID: 36631080 DOI: 10.22605/rrh7905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The 19th World Rural Health Conference, hosted in rural Ireland and the University of Limerick, with over 650 participants coming from 40 countries and an additional 1600 engaging online, has carefully considered how best rural communities can be empowered to improve their own health and the health of those around them. The conference also considered the role of national health systems and all stakeholders, in keeping with the commitments made through the Sustainable Development Goals and the enjoyment of the highest attainable standard of health as one of the fundamental rights of every human being. This conference declaration, the Limerick Declaration on Rural Healthcare, is designed to inform rural communities, academics and policymakers about how to achieve the goal of delivering high quality health care in rural and remote areas most effectively, with a particular focus on the Irish healthcare system. Congruent with current evidence and best international practice, the participants of the conference endorsed a series of recommendations for the creation of high quality, sustainable and cost-effective healthcare delivery for rural communities in Ireland and globally. The recommendations focused on four major themes: rural healthcare needs and delivery, rural workforce, advocacy and policy, and research for rural health care. Equal access to health care is a crucial marker of democracy. Hence, we call on all governments, policymakers, academic institutions and communities globally to commit to providing their rural dwellers with equitable access to health care that is properly resourced and fundamentally patient-centred in its design.
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Affiliation(s)
- Liam Glynn
- SLÁINTE Research and Education Alliance in General Practice, Primary Healthcare and Public Health, School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland; and Health Research Board Primary Care Clinical Trials Network Ireland
| | - Andrew W Murphy
- Department of General Practice, National University of Ireland Galway, Galway, Ireland; and Health Research Board Primary Care Clinical Trials Network Ireland
| | - Robert Scully
- School of Medicine, Medical and Biological Sciences Building, St Andrews KY69TF Fife, Scotland
| | - Roger Strasser
- Rural Health, University of Waikato; Rural Health and Founding Dean Emeritus Northern Ontario School of Medicine (NOSM), Sudbury, ON, Canada
| | - Diarmuid Quinlan
- Woodview Family Doctors, Glanmire, Cork, Ireland; and Irish College of General Practitioners, Dublin, Ireland
| | - Jerry Cowley
- Institute of Rural Health Ltd t/a Rural, Island & Dispensing Doctors of Ireland; and Mulranny Surgery, Mulranny, County Mayo, Ireland
| | - Peter Hayes
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Andrew O'Regan
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | | | - Victoria M Sparrow-Downes
- Department of Family Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Ferdinando Petrazzuoli
- European Rural and Isolated Practitioners Association Scientific Board; Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Shelley Nowlan
- School of Nursing and Midwifery, University of Queensland, St Lucia, Qld, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia; School of Nursing and Midwifery, University of Southern Queensland, Ipswich, Qld, Australia; School of Medicine, Griffith University, Brisbane, Qld, Australia; and Association Queensland Nursing and Midwifery Leaders
| | - Claire Collins
- Irish College of General Practitioners, Dublin, Ireland; and Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | | | - Anne MacFarlane
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland; and Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Alan Bruce Chater
- Rural WONCA (WONCA Working Party on Rural Practice); and Mayne Academy of Rural and Remote Medicine, Rural and Remote Medicine Clinical Unit, University of Queensland, Herston, Qld, Australia
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Mineva G, McCool A, Rogers B, Volz M, Pearl D, Kiroplis I, Abo Halima Y, O'Donnell P, Hayes P. Access to general practice during the COVID-19 pandemic - a cross-sectional view of the opinions of adults who use social media. Rural Remote Health 2023; 23:8087. [PMID: 36802864 DOI: 10.22605/rrh8087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has had a significant impact on the health and wellbeing of people worldwide. General practices were forced to adapt to constantly changing circumstances, leading to predominance of virtual consultations. The aim of this study was to examine the impact the pandemic had on the ability of patients to access general practice. Other focuses included determining the nature of changes to appointment cancellations or delays and the level of disruption to long-term medication regimes during this period. METHODS A 25-question online survey was administered using Qualtrics®. Adult patients of Irish general practices were recruited via social media between October 2020 and February 2021. The data were examined for associations between participant groupings and key findings using chi-squared tests. RESULTS 670 persons participated. Half of all doctor-patient consultations during that time were completed virtually, predominantly via telephone. Overall, 497 (78%) participants accessed their healthcare teams as scheduled, and without disruption. 18% of participants (n=104) reported difficulty in accessing their long-term medications; those who were younger, and those who typically attend general practice on a quarterly or more basis, were associated most with this disruption (p<0.05; p<0.05). DISCUSSION Despite the COVID-19 pandemic, Irish general practice has maintained its schedule for appointments in greater than three quarters of cases. There was a clear shift away from face-to-face consultations to telephone appointments. Maintaining the prescription of long-term medications for patients remains a challenge. Further work needs to be done to ensure the continuation of care and undisrupted medication schedules during any future pandemics.
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Affiliation(s)
- Gabriela Mineva
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Aoibhin McCool
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Bethany Rogers
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Monika Volz
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Dana Pearl
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Irene Kiroplis
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | | | - Peter Hayes
- School of Medicine, University of Limerick, Limerick, Ireland
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Abo Halima Y, Kiroplis I, Hickey O, Hayes P, O'Donnell P. Nasal flu vaccine: attitudes and perceptions of parents who use social media. Rural Remote Health 2023; 23:8169. [PMID: 36802656 DOI: 10.22605/rrh8169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND/AIM In October of 2020, a live attenuated Nasal Flu Vaccine (NFV) was licensed for the first time in Ireland for children aged 2&ndash17 years of age. The uptake of the NFV in Ireland was much lower than expected. The aim of this study was to determine the attitudes of Irish parents towards the NFV, and to examine the relationship between the perceptions of vaccines and the uptake rate. METHODS An 18-question online questionnaire, developed through Qualtrics software®, was distributed via various social media platforms. Data were examined using SPSS to run associations using chi-squared tests. Free text boxes were assessed using thematic analysis. RESULTS Of the 183 people who participated, 76% of parents had vaccinated their children. 81% of parents would vaccinate all their children, while 65% disagreed with vaccinating only children 5 years or older. The majority of parents agreed that the NFV was safe and effective. Analysis of the text included requests for alternative vaccine locations (22%), difficulties getting an appointment (6%), and a lack of public awareness of the vaccine campaign (19%). CONCLUSIONS Parents are willing to have their children vaccinated but there are barriers to vaccination contributing to the low uptake of the NFV. Increasing the availability of the NFV in pharmacies and schools can increase uptake. Public health messaging around the availability of the NFV is excellent but a more succinct message is needed to highlight the importance of under 5s receiving the vaccine. Future studies should examine the promotion of the NFV by healthcare professionals and general practitioners' attitudes towards the NFV.
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Affiliation(s)
- Yasmin Abo Halima
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Castletroy, Limerick, Ireland
| | - Irene Kiroplis
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Castletroy, Limerick, Ireland
| | - Olivia Hickey
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Castletroy, Limerick, Ireland
| | - Peter Hayes
- Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
| | - Patrick O'Donnell
- Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
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Davidson H, Leo R, McKittrick S, O'Donnell P, Jalali A, Spain E. Decision making capacity assessment in general practice in Ireland. Rural Remote Health 2023; 23:8181. [PMID: 36802708 DOI: 10.22605/rrh8181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION It has been reported internationally that doctors have a limited understanding of the legal standard that applies to decision making capacity (DMC). No research on this has been conducted in Ireland to date. We sought to assess the understanding of legal principles relating to capacity and consent among Irish general practitioners (GPs), alongside how DMC assessments are conducted. METHODS This study utilised a cross-sectional cohort model circulating online questionnaires to Irish GPs associated with a university research network. Data were analysed using SPSS to conduct a variety of statistical tests. RESULTS There were 64 participants, with 50% aged 35-44 years and 60.9% being female. Of these, 62.5% found DMC assessments time-consuming. Only 10.9% of participants felt extremely confident in their abilities; most participants (59.4%) felt 'somewhat confident' in their ability to assess DMC. Also, 90.6% of GPs routinely engaged with families when assessing capacity. GPs felt their medical training did not prepare them for DMC assessment (undergraduate 90.6%, non-consultant hospital doctor 78.1%, GP training 65.6%). 70.3% felt guidelines relating to DMC would be helpful and 65.6% felt they needed additional training. DISCUSSION AND CONCLUSIONS Most GPs recognise the importance of DMC assessment, and it is not considered a complex or burdensome task. There was limited knowledge of the legal instruments relevant to DMC. GPs felt there should be extra support available to assist them with DMC assessment; specific guidelines for different categories of patients was found to be the most popular resource requested.
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Mineva G, Kiroplis I, Rogers B, Pearl D, Abohalima Y, O'Donnell P, McCool A, Hayes P, Volz M. Access to general practice during COVID-19: a cross-sectional view of the opinions of adults who use social media. Ann Fam Med 2022; 20:3117. [PMID: 36706378 PMCID: PMC10549029 DOI: 10.1370/afm.20.s1.3117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background/Aim: Since the onset of the COVID-19 pandemic, virtual consultations have become commonplace, and access to healthcare more complex. The study was designed to examine the impact COVID-19 has had on access to general practice care in Ireland. Methods: A 25-question online survey was designed in Qualtrics®. Adult patients of Irish general practices were recruited via social media between October 2020 and February 2021 and volunteered their opinions. Results: 670 persons participated. Half of all doctor-patient consultations were now completed virtually-predominantly via telephone. Overall, 497 (78%) participants accessed their healthcare teams as scheduled, and without disruption. 18% of participants (n=104) reported difficulty in accessing their long-term medications; those who are younger, and those who typically attend general practice quarterly or more, were associated most with this disruption (p<0.05). Fifty-nine instances where a new health concern was subject to an appointment cancellation or rescheduling were reported. Conclusions: Despite the COVID-19 pandemic, Irish general practice has maintained its schedule for appointments in 78% of cases despite the challenges of the pandemic. Half of consultations were provided virtually; teleconsultation use was very infrequent. Maintaining the supply chain for long-term medications for patients remains a challenge during a pandemic. Authors accept that study participants were confined to those who use social media. A protocol may need to be designed by each practice to optimize the continuation of care and of medication schedules during any future pandemics.
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O'Donnell P, Hannigan A, Ibrahim N, O'Donovan D, Elmusharaf K. Developing a tool for the measurement of social exclusion in healthcare settings. Int J Equity Health 2022; 21:35. [PMID: 35292025 PMCID: PMC8922776 DOI: 10.1186/s12939-022-01636-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background Social exclusion is a complex concept that is recognised as a key determinant of health. Many measurement tools developed looked at people from single excluded groups in isolation. We know from experience and literature that exclusion is often intersectional and multi-layered. Therefore, the aim of this research was to develop a social exclusion measurement tool for use in healthcare settings with individuals from any excluded group that would include questions to investigate socioeconomic elements and subjective experiences in their lives. Methods Inductive and deductive methods were used to develop the tool. Early drafts were tested with experts (both academic and experts by experience) and modified in line with feedback received. The tool was then piloted with people in the community, and this allowed us to assess the internal consistency and validity of the tool. Exploratory factor analysis was carried out as part of this evaluation. Results The measurement tool was initially evaluated by 17 academic and ‘real world’ experts. It was then piloted with seven experts by experience, two gatekeepers and two participants who were presumed not to be excluded, resulting in the development of the final tool. This was then tested with 276 participants (127 presumed excluded, 149 presumed not excluded). The socioeconomic characteristics of these participants were documented, and exploratory factor analysis was carried out on data relating to subjective items. A four-factor structure emerged comprising 22 items. Internal consistency of the factors was high, and their ability to discriminate between the two groups was notable. Conclusions A tool for measuring the social exclusion of individuals has been developed by engaging with people from a variety of excluded groups. Socioeconomic indicators were combined with subjective items. The input of experts by experience, academics and others was sought to enhance the tool. The tool was applied to two distinct samples, showing obvious differences both in the socioeconomic items, and the items included in the factor analysis. The potential use of this tool could have positive implications for people who are excluded. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01636-1.
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Affiliation(s)
- Patrick O'Donnell
- School of Medicine, University of Limerick, Limerick, Ireland. .,Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Ailish Hannigan
- School of Medicine, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Nuha Ibrahim
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Diarmuid O'Donovan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University, Belfast, Northern Ireland
| | - Khalifa Elmusharaf
- School of Medicine, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
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Muldoon OT, Bradshaw D, Jay S, Kinsella EL, Maher P, Murphy R, Taaffe C, O'Donnell P. Vaccination roll-out: a time to develop and maintain trust in science and health care. Br J Gen Pract 2021; 71:518-519. [PMID: 34711570 PMCID: PMC8544138 DOI: 10.3399/bjgp21x717629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/31/2022] Open
Affiliation(s)
- Orla T Muldoon
- Centre for Social Issues Research, University of Limerick, Limerick
| | - Daragh Bradshaw
- Centre for Social Issues Research, University of Limerick, Limerick
| | - Sarah Jay
- Centre for Social Issues Research, University of Limerick, Limerick
| | | | - Paul Maher
- Centre for Social Issues Research, University of Limerick, Limerick
| | - Robert Murphy
- Research Services and Policy Unit, Department of Health, Dublin
| | - Carol Taaffe
- Research Services and Policy Unit, Department of Health, Dublin
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Carroll C, Evans K, Elmusharaf K, O'Donnell P, Dee A, O'Donovan D, Casey M. A review of the inclusion of equity stratifiers for the measurement of health inequalities within health and social care data collections in Ireland. BMC Public Health 2021; 21:1705. [PMID: 34538235 PMCID: PMC8451151 DOI: 10.1186/s12889-021-11717-5] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health equity differs from the concept of health inequality by taking into consideration the fairness of an inequality. Inequities may be culturally specific, based on social relations within a society. Measuring these inequities often requires grouping individuals. These groupings can be termed equity stratifiers. The most common groupings affected by health inequalities are summarised by the acronym PROGRESS (Place of residence, Race, Occupation, Gender, Religion, Education, Socioeconomic status, Social capital). The aim of this review was to examine the use of equity stratifiers in routinely collected health and social care data collections in Ireland. METHODS One hundred and twenty data collections were identified from the Health Information and Quality Authority (HIQA) document, "Catalogue of national health and social care data collections: Version 3.0". Managers of all the data collections included were contacted and a data dictionary was requested where one was not available via the HIQA website. Each of the data dictionaries available was reviewed to identify the equity stratifiers recorded. RESULTS Eighty-three of the 120 data collections were considered eligible to be included for review. Twenty-nine data dictionaries were made available. There was neither a data dictionary available nor a response to our query from data collection managers for twenty-three (27.7%) of the data collections eligible for inclusion. Data dictionaries were from national data collections, regional data collections and national surveys. All data dictionaries contained at least one of the PROGRESS equity stratifiers. National surveys included more equity stratifiers compared with national and regional data collections. Definitions used for recording social groups for the stratifiers examined lacked consistency. CONCLUSIONS While there has been much discussion on tackling health inequalities in Ireland in recent years, health and social care data collections do not always record the social groupings that are most commonly affected. In order to address this, it is necessary to consider which equity stratifiers should be used for the Irish population and, subsequently, for agreed stratifiers to be incorporated into routine health data collection. These are lessons that can be shared internationally as other countries begin to address deficits in their use of equity stratifiers.
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Affiliation(s)
- Christopher Carroll
- Department of Public Health HSE Mid-West, Mount Kennett House, Henry Street, Limerick City, Ireland.
| | - Katie Evans
- Department of Public Health HSE Mid-West, Mount Kennett House, Henry Street, Limerick City, Ireland
| | - Khalifa Elmusharaf
- Public Health Programme, School of Medicine, Faculty of Education and Health Services, Garraun, Castletroy, Co. Limerick, Limerick City, Ireland
| | - Patrick O'Donnell
- Public Health Programme, School of Medicine, Faculty of Education and Health Services, Garraun, Castletroy, Co. Limerick, Limerick City, Ireland
| | - Anne Dee
- Department of Public Health HSE Mid-West, Mount Kennett House, Henry Street, Limerick City, Ireland
| | - Diarmuid O'Donovan
- Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland
| | - Marie Casey
- Department of Public Health HSE Mid-West, Mount Kennett House, Henry Street, Limerick City, Ireland
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20
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O'Donnell P, May T, DeMartin K, Ferguson J, Halait H, Wei W, Yu K, Scudder S. Performance Characteristics of a Real-Time Polymerase Chain Reaction Assay for the Detection of Epidermal Growth Factor Receptor (EGFR) Mutations in Plasma Samples of Non-Small Cell Lung Cancer (NSCLC) Patients. Mol Diagn Ther 2021; 24:451-460. [PMID: 32406048 DOI: 10.1007/s40291-020-00458-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Circulating free DNA in plasma is an alternative source of tumor-derived DNA that can be a surrogate for tissue epidermal growth factor receptor (EGFR) testing. OBJECTIVE We evaluated the analytical performance of the cobas® EGFR Mutation Test v2 (cobas test), a real-time polymerase chain reaction assay designed to detect defined EGFR gene mutations in plasma from patients with advanced non-small cell lung cancer (NSCLC). METHODS We used K2-ethylenediaminetetraacetic acid plasma samples from NSCLC patients and healthy donors (HDs), along with cell line DNA. Results from a complete technical performance evaluation are described, including a comparison between NSCLC and HD plasma to support the use of surrogate samples and an independent confirmation of the limit of detection (LoD). RESULTS The cobas test reported an overall percent agreement of approximately 88% for plasma samples when compared with a next-generation sequencing method. The LoD for all EGFR mutations was ≤ 100 copies/mL for plasma samples. An external study confirmed the LoD for exon 19 deletion, L858R, and T790M at ≤ 100 copies/mL using samples derived from NSCLC patient specimens. The cobas test showed linearity between at least 50 and 10,000 copies/mL for plasma samples. An internal repeatability study reported a correct call accuracy of 99.2% for plasma samples. The performance of the cobas test is equivalent when using sheared or intact cell line DNA diluted into either HD plasma or NSCLC patient plasma. CONCLUSIONS The cobas test is a sensitive, robust, and accurate assay that delivers reproducible results.
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Affiliation(s)
- Patrick O'Donnell
- Roche Molecular Systems, 4300 Hacienda Drive, Pleasanton, CA, 94588, USA.
| | - Theresa May
- Roche Molecular Systems, 4300 Hacienda Drive, Pleasanton, CA, 94588, USA
| | - Kelli DeMartin
- Roche Molecular Systems, 4300 Hacienda Drive, Pleasanton, CA, 94588, USA
| | - Jane Ferguson
- Thermo Fisher Scientific, 46500 Kato Road, Fremont, CA, 94538, USA
| | - Harkanwal Halait
- Roche Molecular Systems, 4300 Hacienda Drive, Pleasanton, CA, 94588, USA
| | - Wen Wei
- Roche Molecular Systems, 4300 Hacienda Drive, Pleasanton, CA, 94588, USA
| | - Karen Yu
- Roche Molecular Systems, 4300 Hacienda Drive, Pleasanton, CA, 94588, USA
| | - Sid Scudder
- Roche Molecular Systems, 4300 Hacienda Drive, Pleasanton, CA, 94588, USA
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21
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Bashir AY, Moloney N, Elzain ME, Delaunois I, Sheikhi A, O'Donnell P, Dunne CP, Kelly BD, Gulati G. From nowhere to nowhere. Homelessness and incarceration: a systematic review and meta-analysis. Int J Prison Health 2021; 17:452-461. [PMID: 34107200 DOI: 10.1108/ijph-01-2021-0010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/17/2022]
Abstract
PURPOSE This study aims to review international literature systematically to estimate the prevalence of homelessness among incarcerated persons at the time of imprisonment and the time of discharge. DESIGN/METHODOLOGY/APPROACH A systematic review methodology was used to identify quantitative observational studies that looked at the prevalence of homelessness at the time of imprisonment, or up to 30 days prior to that point (initial homelessness), and at the time of discharge from prisons. Studies reported in English from inception to 11 September 2019 were searched for using eight databases (PsycInfo, Medline, Embase, CINAHL, PsycArticles, Scopus, Web of Science and the Campbell Collaboration), in addition to grey literature. Studies were screened independently by three researchers. Results of studies meeting inclusion criteria were meta-analysed using a random effects model to generate pooled prevalence data. FINDINGS A total of 18 out of 2,131 studies met the inclusion criteria. All studies originated from the USA, Canada, UK, Ireland or Australia. The estimated prevalence of initial homelessness was 23.41% and at time of discharge was 29.94%. Substantial heterogeneity was observed among studies. ORIGINALITY/VALUE People in prisons are over twenty times more likely to be homeless than those in the general population. This is likely attributable to a range of health and social factors. Studies in this analysis suggest higher rates of homelessness in minority populations and among those with mental illnesses and neurodevelopmental disorders. While there was significant heterogeneity among studies, the results highlight the global burden of this issue and a clear necessity for targeted interventions to address homelessness in this population.
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Affiliation(s)
- Ahmad Y Bashir
- University of Limerick Hospitals Groups, Limerick, Ireland
| | - Noreen Moloney
- University of Limerick Hospitals Groups, Limerick, Ireland
| | | | | | - Ali Sheikhi
- Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Colum P Dunne
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Gautam Gulati
- School of Medicine, University of Limerick, Limerick, Ireland
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22
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Kiely B, Connolly D, Clyne B, Boland F, O'Donnell P, Shea EO, Smith SM. Primary care-based link workers providing social prescribing to improve health and social care outcomes for people with multimorbidity in socially deprived areas (the LinkMM trial): Pilot study for a pragmatic randomised controlled trial. J Comorb 2021; 11:26335565211017781. [PMID: 34094992 PMCID: PMC8142241 DOI: 10.1177/26335565211017781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 11/16/2022]
Abstract
Introduction Individuals with multimorbidity in deprived areas experience worse health outcomes and fragmented care. Research suggests that primary care-based link workers providing social prescribing have potential to improve health and well-being. This paper reports the results of a pilot study conducted in preparation for a randomised controlled trial (RCT) that aims to test the effectiveness of primary care-based link workers providing social prescribing in improving health outcomes for people with multimorbidity who attend general practices in deprived areas in Ireland. Methods An uncontrolled pilot study of an intervention based on the Glasgow Deep End links worker programme, in a single general practice, tested the feasibility and acceptability of planned processes for a RCT. Outcomes were recruitment and retention rates and acceptability of the trial processes and intervention to patients, general practitioners (GPs) and the link worker. Structured interviews were conducted with six patients, the link worker and two GPs within the practice and analysed using descriptive qualitative analysis. Feedback from a Public Patient Involvement group and an Implementation Advisory Group of key stakeholders was incorporated into the evaluation process. Results Twelve out of 14 patients completed the intervention. Selection and recruitment processes were lengthier than expected. GPs recommended including psychosocial need in the selection process. Interviewed patients, the GPs and the link worker were positive about the intervention. Conclusion A range of adaptations were identified for the main trial, mainly considering psychosocial need in the selection process to reflect normal referral pathways. This has resulted in a pragmatic RCT design.
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Affiliation(s)
- Bridget Kiely
- HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland
| | - Deirdre Connolly
- Discipline of Occupational Therapy, Trinity College, Dublin, Ireland
| | - Barbara Clyne
- HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre and HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland
| | | | - Eamon O Shea
- Centre for Economic and Social Research on Dementia, National University of Ireland, Galway, Galway, Ireland
| | - Susan M Smith
- HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland
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23
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Kiely B, O'Donnell P, Byers V, Galvin E, Boland F, Smith SM, Connolly D, O'Shea E, Clyne B. Protocol for a mixed methods process evaluation of the LinkMM randomised controlled trial "Use of link workers to provide social prescribing and health and social care coordination for people with complex multimorbidity in socially deprived areas". HRB Open Res 2021; 4:38. [PMID: 37901156 PMCID: PMC10605865 DOI: 10.12688/hrbopenres.13258.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 10/31/2023] Open
Abstract
Background Multimorbidity, defined as two or more chronic conditions is increasing in prevalence and is associated with increased health care use, fragmented care and poorer health outcomes. Link workers are non-health or social care professionals who support people to connect with resources in their community to improve their well-being, a process commonly referred to as social prescribing. The use of link workers in primary care may be an effective intervention in helping those with long-term conditions manage their illness and improve health and well-being, but the evidence base in limited. The LinkMM study is a randomised controlled trial of the effectiveness of link workers based in primary care, providing social prescribing and health and social care coordination for people with multimorbidity. The aim of the LinkMM process evaluation is to investigate the implementation of the link worker intervention, mechanisms of impact and influence of the specific context on these, as per the Medical Research Council framework, using quantitative and qualitative methods. Methods Quantitative data will be gathered from a number of sources including researcher logbooks, participant baseline questionnaires, client management database, and will be analysed using descriptive statistics. Semi structured interviews with participants will investigate their experiences of the intervention. Interviews with link workers, practices and community stakeholders will explore how the intervention was implemented and barriers and facilitators to this. Thematic analysis of interview transcripts will be conducted. Discussion The process evaluation of the LinkMM trial will provide important information allowing a more in-depth understanding of how the intervention worked and lessons for future wider scale implementation.
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Affiliation(s)
- Bridget Kiely
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland, D02Vn51, Ireland
| | - Patrick O'Donnell
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland, Ireland
| | - Vivienne Byers
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland, D02Vn51, Ireland
| | - Emer Galvin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland, D02Vn51, Ireland
| | - Fiona Boland
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland, D02Vn51, Ireland
| | - Susan M. Smith
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland, D02Vn51, Ireland
| | - Deirdre Connolly
- Discipline of Occupational Therapy, Trinity College Dublin, Dublin, Ireland, Ireland
| | - Eamon O'Shea
- School of Business and Economics, National Univeristy of Ireland, Galway, Galway, Ireland
| | - Barbara Clyne
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland, D02Vn51, Ireland
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Gopal DP, Chetty U, O'Donnell P, Gajria C, Blackadder-Weinstein J. Implicit bias in healthcare: clinical practice, research and decision making. Future Healthc J 2021; 8:40-48. [PMID: 33791459 DOI: 10.7861/fhj.2020-0233] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Bias is the evaluation of something or someone that can be positive or negative, and implicit or unconscious bias is when the person is unaware of their evaluation. This is particularly relevant to policymaking during the coronavirus pandemic and racial inequality highlighted during the support for the Black Lives Matter movement. A literature review was performed to define bias, identify the impact of bias on clinical practice and research as well as clinical decision making (cognitive bias). Bias training could bridge the gap from the lack of awareness of bias to the ability to recognise bias in others and within ourselves. However, there are no effective debiasing strategies. Awareness of implicit bias must not deflect from wider socio-economic, political and structural barriers as well ignore explicit bias such as prejudice.
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Affiliation(s)
- Dipesh P Gopal
- Barts and The London School of Medicine and Dentistry, London, UK
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25
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Abstract
Primary cutaneous marginal zone lymphoma (PCMZL) is a low-grade B-cell lymphoma that arises in the skin. An adolescent male presented with dermal nodules on the arms, legs, and back with a positive Darier sign, ultimately diagnosed as PCMZL. The nodules demonstrated a partial response to doxycycline in the setting of prior Lyme disease followed by a complete response to rituximab.
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Affiliation(s)
- Nicholas Leonard
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Karan Lal
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Christina Luffman
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Pathology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Patrick O'Donnell
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Pathology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lindsey Jolley
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
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Brown R, Blankenship K, Amano SU, O'Donnell P, Belazarian L. Solitary blue-black nodule on the back of a teenage boy. Pediatr Dermatol 2021; 38:492-493. [PMID: 33870569 DOI: 10.1111/pde.14395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Regina Brown
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Kaitlin Blankenship
- Department of Dermatology, UMass Memorial Medical Center, Worcester, MA, USA
| | - Shinya U Amano
- Department of Pathology, UMass Memorial Medical Center, Worcester, MA, USA
| | - Patrick O'Donnell
- Department of Pathology, UMass Memorial Medical Center, Worcester, MA, USA
| | - Leah Belazarian
- Department of Dermatology, UMass Memorial Medical Center, Worcester, MA, USA.,Department of Pediatrics, UMass Memorial Medical Center, Worcester, MA, USA
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27
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O'Doherty J, Hyde S, O'Connor R, Brown MEL, Hayes P, Niranjan V, Culhane A, O'Dwyer P, O'Donnell P, Glynn L, O'Regan A. Development and sustainment of professional relationships within longitudinal integrated clerkships in general practice (LICs): a narrative review. Ir J Med Sci 2021; 191:447-459. [PMID: 33641086 DOI: 10.1007/s11845-021-02525-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Longitudinal integrated clerkships (LICs) are a relatively new model of clinical medical education, whereby students participate in patient care over time and develop relationships with those patients', their clinicians, and other health care staff involved in the care of those patients. It has been called 'relationship-based education' but, to date, no review has investigated the development and impact of these central relationships within this curricula model. AIMS The aim of this study is to review the literature pertaining to relationships in LICs, specifically to understand how they come about and how they affect learning. METHODS The search strategy systematically explored PubMed, ERIC (EBSCO) and Academic Search Complete, using key words and MESH terms. Original research published in peer-reviewed journals between January 2007 and August 2020 that were written in the English language were included in the review. RESULTS After applying set inclusion and exclusion criteria, 43 studies were included in this review. A qualitative thematic analysis was undertaken, and results were synthesised narratively. Four distinct categories were identified: defining relationships in LICs, developing relationships in LICs, relationship maintenance and multi-stakeholder impact. CONCLUSIONS The longitudinal integrated clerkship model of clinical education facilitates the development of meaningful triangular relationships between student, clinical teacher and patient, which are the central drivers of successful learning within the context of an LIC. These relationships are nested in a set of important supporting relationships involving other supervisors, the medical school and university, the practice clinical and administrative team and peers.
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Affiliation(s)
- Jane O'Doherty
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland.
| | - Sarah Hyde
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
| | - Raymond O'Connor
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
- Mid-West Specialist Training Programme in General Practice, University of Limerick, Plassey, Limerick, Ireland
| | - Megan E L Brown
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Peter Hayes
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
| | - Vikram Niranjan
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
| | - Aidan Culhane
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
| | - Pat O'Dwyer
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
| | - Patrick O'Donnell
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
| | - Liam Glynn
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
| | - Andrew O'Regan
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
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28
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Kiely B, Clyne B, Boland F, O'Donnell P, Connolly D, O'Shea E, Smith SM. Link workers providing social prescribing and health and social care coordination for people with multimorbidity in socially deprived areas (the LinkMM trial): protocol for a pragmatic randomised controlled trial. BMJ Open 2021; 11:e041809. [PMID: 33526499 PMCID: PMC7852975 DOI: 10.1136/bmjopen-2020-041809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Link workers are non-health or social care professionals based in primary care who support people to develop and achieve a personalised set of health and social goals by engaging with community resources. Link workers have been piloted in areas of deprivation, but there remains insufficient evidence to support their effectiveness. Multimorbidity is increasing in prevalence, but there are limited evidence-based interventions. This paper presents the protocol for a randomised controlled trial (RCT) that will test the effectiveness of link workers based in general practices in deprived areas in improving health outcomes for people with multimorbidity. METHODS AND ANALYSIS The protocol presents the proposed pragmatic RCT, involving 10 general practitioner (GP) practices and 600 patients. Eligible participants will be community dwelling adults with multimorbidity (≥two chronic conditions) identified as being suitable for referral to a practice-based link worker. Following baseline data collection, the patients will be randomised into intervention group that will meet the link worker over a1-month period, or a 'wait list' control that will receive usual GP care. Primary outcomes are health-related quality of life as assessed by EQ-5D-5L and mental health assessed by Hospital Anxiety and Depression Scale. Secondary outcomes are based on the core outcome set for multimorbidity. Data will be collected at baseline and on intervention completion at 1 month using questionnaires self-completed by participants and GP records. Parallel process and economic analyses will be conducted to explore participants' experiences and examine cost-effectiveness of the link worker intervention. ETHICS AND DISSEMINATION Ethical approval has been granted by the Irish College of General Practitioners Ethics Committee. The findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN10287737;Pre-results.
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Affiliation(s)
- Bridget Kiely
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland
| | - Fiona Boland
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland
| | - Patrick O'Donnell
- Primary Healthcare, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Deirdre Connolly
- Discipline of Occupational Therapy, Trinity College, Dublin, Ireland
| | - Eamon O'Shea
- School of Business and Economics, National University of Ireland, Galway, Ireland
| | - Susan M Smith
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland
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29
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Trivedi A, Cornejo KM, O'Donnell P, Dresser K, Deng A. Employing immunohistochemical staining to labial minor salivary gland biopsies from patients with Sjogren's syndrome increases diagnostic certainty. J Oral Pathol Med 2020; 50:98-102. [PMID: 33150616 DOI: 10.1111/jop.13119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/31/2020] [Revised: 09/27/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sjogren's syndrome (SjS) is an autoimmune disease characterized clinically by dry eyes and dry mouth, and histopathologically by lymphocytic infiltrates in the salivary glands. Labial minor salivary gland biopsy (MSGB) is a major diagnostic test for SjS, deemed positive by a focus score of ≥1, meaning that ≥50 lymphocytes were found in 4 mm2 tissue on hematoxylin and eosin (H&E)-stained slides. The diagnosis can be challenging, and the above diagnostic criteria has low and variable sensitivity. METHODS We performed a retrospective study on MSGBs done for possible SjS. We compared the percent of MSGBs which met the histologic criteria by H&E stain alone and that with the addition of CD45, CD3, and CD20 immunohistochemical (IHC) staining for these patients. A total of 45 cases with complete data were analyzed. RESULTS Thirty-five of the 45 patients had the diagnosis of Sjogren's syndrome (SjS+) based on ACR criteria. However, based on H&E staining alone, only 22/35 cases (63%) met the histologic criteria. After adding IHC staining with CD45, CD3, and CD20 to MSGBs of SjS + patients, 29/35 (83%) cases met the histological criteria for SjS. All MSGBs from patients without SjS had no significant lymphocyte infiltrate on either H&E or IHC stains. CONCLUSIONS Immunohistochemical better identifies lymphocytic infiltrates in MSGB and increases diagnostic certainty. Due to high cost, their use should be restricted to cases where there is high clinical suspicion of SjS and negative H&E evaluation alone, or if the diagnosis is uncertain.
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Affiliation(s)
- Apoorva Trivedi
- Department of Dermatology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA
| | - Kristine M Cornejo
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick O'Donnell
- Department of Pathology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA
| | - Karen Dresser
- Department of Pathology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA
| | - April Deng
- Department of Pathology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA
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30
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Brett BL, Breedlove K, McAllister TW, Broglio SP, McCrea MA, Hoy AMR, Hazzard JB, Kelly LA, Port N, Putukian M, Pasquina P, Jackson J, McGinty G, O'Donnell P, Cameron KL, Houston MN, Giza C, Benjamin HJ, Buckley T, Clugston JR, Schmidt JD, Feigenbaum LA, Mihalik JP, Guskiewicz K, Anderson S, Master CL, Collins MW, Kontos AP, Chrisman SPD, Brooks MA, Rowson S, Miles CM, Susmarski A. Investigating the Range of Symptom Endorsement at Initiation of a Graduated Return-to-Play Protocol After Concussion and Duration of the Protocol: A Study From the National Collegiate Athletic Association-Department of Defense Concussion, Assessment, Research, and Education (CARE) Consortium. Am J Sports Med 2020; 48:1476-1484. [PMID: 32298132 DOI: 10.1177/0363546520913252] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Organizations recommend that athletes should be asymptomatic or symptom-limited before initiating a graduated return-to-play (GRTP) protocol after sports-related concussion, although asymptomatic or symptom-limited is not well-defined. HYPOTHESES (1) There will be a range (ie, beyond zero as indicator of "symptom-free") in symptom severity endorsement when athletes are deemed ready to initiate a GRTP protocol. (2) Baseline symptom severity scores and demographic/preinjury medical history factors influence symptom severity scores at the commencement of the GRTP protocol. (3) Greater symptom severity scores at GRTP protocol initiation will result in longer protocol duration. (4) Symptom severity scores will not differ between those who did and did not sustain a repeat injury within 90 days of their initial injury. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Across 30 universities, athletes (N = 1531) completed assessments at baseline and before beginning the GRTP protocol, as determined by local medical staff. Symptom severity scores were recorded with the symptom checklist of the Sport Concussion Assessment Tool-3rd Edition. Nonparametric comparisons were used to examine the effect of medical, demographic, and injury factors on symptom endorsement at GRTP protocol initiation, as well as differences in symptom severity scores between those who did and did not sustain a repeat injury within 90 days. A Cox regression was used to examine the association between symptom severity scores at GRTP protocol initiation and protocol duration. RESULTS Symptom severity scores at the time when the GRTP protocol was initiated were as follows: 0 to 5 (n = 1378; 90.0%), 6 to 10 (n = 76; 5.0%), 11 to 20 (n = 42; 3.0%), and ≥21 (n = 35; 2.0%). Demographic (sex and age), medical (psychiatric disorders, attention-deficit/hyperactivity disorder, learning disorder), and other factors (baseline symptom endorsement and sleep) were significantly associated with higher symptom severity scores at the GRTP initiation (P < .05). The 4 GRTP initiation time point symptom severity score groups did not significantly differ in total time to unrestricted RTP, χ2(3) = 1.4; P = .73. When days until the initiation of the GRTP protocol was included as a covariate, symptom severity scores between 11 and 20 (P = .02; hazard ratio = 1.44; 95% CI, 1.06-1.96) and ≥21 (P < .001; hazard ratio = 1.88; 95% CI, 1.34-2.63) were significantly associated with a longer GRTP protocol duration as compared with symptom severity scores between 0 and 5. Symptom severity scores at GRTP initiation did not significantly differ between those who sustained a repeat injury within 90 days and those who did not (U = 29,893.5; P = .75). CONCLUSION A range of symptom severity endorsement was observed at GRTP protocol initiation, with higher endorsement among those with higher baseline symptom endorsement and select demographic and medical history factors. Findings suggest that initiation of a GRTP protocol before an absolute absence of all symptoms is not associated with longer progression of the GRTP protocol, although symptom severity scores >10 were associated with longer duration of a GRTP protocol. Results can be utilized to guide clinicians toward optimal GRTP initiation (ie, balancing active recovery with avoidance of premature return to activity).
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Affiliation(s)
- Benjamin L Brett
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine Breedlove
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas W McAllister
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven P Broglio
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael A McCrea
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | -
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - April Marie Reed Hoy
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joseph B Hazzard
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Louise A Kelly
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nicholas Port
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Margot Putukian
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Paul Pasquina
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonathan Jackson
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Gerald McGinty
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Patrick O'Donnell
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kenneth L Cameron
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Megan N Houston
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christopher Giza
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Holly J Benjamin
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas Buckley
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - James R Clugston
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Julianne D Schmidt
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Luis A Feigenbaum
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jason P Mihalik
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kevin Guskiewicz
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Scott Anderson
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christina L Master
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael W Collins
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anthony P Kontos
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sara P D Chrisman
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - M Alison Brooks
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven Rowson
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christopher M Miles
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Adam Susmarski
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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O'Regan A, Hayes P, O'Connor R, Casey M, O'Dwyer P, Culhane A, O'Donnell P, Stack G, Cuddihy J, O'Connell B, O'Flynn J, Cullen W, O'Doherty J, O'Connell M, Glynn L. The University of Limerick Education and Research Network for General Practice (ULEARN-GP): practice characteristics and general practitioner perspectives. BMC Fam Pract 2020; 21:25. [PMID: 32024480 PMCID: PMC7003418 DOI: 10.1186/s12875-020-1100-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 01/29/2020] [Indexed: 11/17/2022]
Abstract
Background A well-functioning general practice sector that has a strong research component is recognised as a key foundation of any modern health system. General practitioners (GPs) are more likely to collaborate in research if they are part of an established research network. The primary aims of this study are to describe Ireland’s newest general practice-based research network and to analyse the perspectives of the network’s members on research engagement. Method A survey was sent to all GPs participating in the network in order to document practice characteristics so that this research network’s profile could be compared to other national profiles of Irish general practice. In depth interviews were then conducted and analysed thematically to explore the experiences and views of a selection of these GPs on research engagement. Results All 134 GPs responded to the survey. Practices have similar characteristics to the national profile in terms of location, size, computerisation, type of premises and out of hours arrangements. Twenty-two GPs were interviewed and the resulting data was categorised into subthemes and four related overarching themes: GPs described catalysts for research in their practices, the need for coherence in how research is understood in this context, systems failures, whereby the current health system design is prohibitive of GP participation and aspirations for a better future. Conclusion This study has demonstrated that the research network under examination is representative of current trends in Irish general practice. It has elucidated a better understanding of factors that need to be addressed in order to encourage more GPs to engage in the research process.
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Affiliation(s)
- Andrew O'Regan
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland. .,Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Peter Hayes
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ray O'Connor
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Monica Casey
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Pat O'Dwyer
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Aidan Culhane
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Patrick O'Donnell
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Gary Stack
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - John Cuddihy
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Billy O'Connell
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Jerry O'Flynn
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Walter Cullen
- School of Medicine, Health Sciences Centre, University College Dublin, Belfield, Dublin, Ireland
| | - Jane O'Doherty
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Maurice O'Connell
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Liam Glynn
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
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32
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Evan-Browning E, Rork J, O'Donnell P, Elaba Z, Deng A, Wiss K. Verruciform xanthoma in recessive dystrophic epidermolysis bullosa and keratitis-ichthyosis-deafness syndrome: Report of two cases and a review of the literature. Pediatr Dermatol 2020; 37:176-179. [PMID: 31710113 DOI: 10.1111/pde.14046] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Verruciform xanthoma is a benign, wart-like lesion that can clinically mimic squamous cell carcinoma. We describe two teenage patients with severe genodermatoses, recessive dystrophic epidermolysis bullosa (RDEB), and keratitis-ichthyosis-deafness (KID) syndrome, respectively, each found to have plaques suspicious for malignancy, later demonstrated on histopathologic examination to be verruciform xanthoma. We discuss the connection between these severe genodermatoses and the suspected pathophysiology of verruciform xanthoma. In addition, we highlight the importance of recognizing verruciform xanthoma as a clinical mimicker of squamous cell carcinoma, for which patients with RDEB and KID syndrome are at increased risk.
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Affiliation(s)
- Eric Evan-Browning
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jillian Rork
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Manchester, NH, USA
| | - Patrick O'Donnell
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Zendee Elaba
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA, USA
| | - April Deng
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Karen Wiss
- Departments of Dermatology and Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
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Li J, Trone D, Mendell J, O'Donnell P, Cook N. A drug-drug interaction study to assess the potential effect of acid-reducing agent, lansoprazole, on quizartinib pharmacokinetics. Cancer Chemother Pharmacol 2019; 84:799-807. [PMID: 31385001 PMCID: PMC6768889 DOI: 10.1007/s00280-019-03915-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/26/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Quizartinib, a potent, selective FMS-like tyrosine kinase 3 (FLT3) inhibitor, is currently in phase 3 development for patients with FLT3-internal tandem duplication-mutated acute myeloid leukemia (AML). Acid-reducing agents (ARAs; e.g., proton pump inhibitors) are frequently used during AML treatment. Since quizartinib demonstrates pH-dependent solubility, the effect of lansoprazole coadministration on pharmacokinetics (PK) of quizartinib tablet formulation was assessed. METHODS An open-label, parallel-group study randomized 64 healthy adults to single-dose quizartinib 30 mg alone (reference) or lansoprazole (60 mg once daily, days 1-5) + single-dose quizartinib 30 mg (day 5) (test). Plasma concentrations of quizartinib and its active metabolite, AC886, were measured to 504 h postdose; the effect of lansoprazole on quizartinib PK was assessed by analysis of variance. RESULTS Quizartinib geometric mean ratios (test/reference) and 90% confidence intervals for maximum observed plasma concentration (Cmax), area under the concentration-time curve to last measurable drug concentration (AUClast), and AUC to infinity were 86.11% (78.4%, 94.6%), 93.96% (79.6%, 110.9%), and 95.30% (80.2%, 113.3%), respectively. Comparisons showed a modest decrease in quizartinib absorption when co-administered with lansoprazole, with lower limits for Cmax and AUClast just below 80-125% limits. Treatment-emergent adverse events were mild or moderate; the most frequent in either treatment group were headache [quizartinib alone: (n = 3) 10%], upper respiratory tract infection [quizartinib alone: (n = 2) 6.7%; lansoprazole + quizartinib: (n = 3) 9.1%], and muscle tightness [quizartinib alone: (n = 2) 6.7%]. CONCLUSIONS Concomitant lansoprazole had minimal effect on quizartinib PK as a formulated tablet, indicating that quizartinib can be administered with ARAs.
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Affiliation(s)
- Jianke Li
- Daiichi Sankyo, Inc., 10201 Wateridge Circle, Suite 240, San Diego, CA, 92121, USA.
| | - Denise Trone
- Daiichi Sankyo, Inc., 10201 Wateridge Circle, Suite 240, San Diego, CA, 92121, USA
| | | | - Patrick O'Donnell
- Daiichi Sankyo, Inc., 10201 Wateridge Circle, Suite 240, San Diego, CA, 92121, USA
| | - Natalie Cook
- Daiichi Sankyo, Inc., 10201 Wateridge Circle, Suite 240, San Diego, CA, 92121, USA
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34
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Caccese JB, Iverson GL, Cameron KL, Houston MN, McGinty GT, Jackson JC, O'Donnell P, Pasquina PF, Broglio SP, McCrea M, McAllister T, Buckley TA. Estimated Age of First Exposure to Contact Sports Is Not Associated with Greater Symptoms or Worse Cognitive Functioning in Male U.S. Service Academy Athletes. J Neurotrauma 2019; 37:334-339. [PMID: 31375052 DOI: 10.1089/neu.2019.6571] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This study examined the association between estimated age of first exposure (eAFE) to contact sport participation and neurocognitive performance and symptom ratings in U.S. service academy National Collegiate Athletic Association (NCAA) athletes. Male cadets (N = 891), who participate in lacrosse (n = 211), wrestling (n = 170), ice hockey (n = 81), soccer (n = 119), rugby (n = 10), or non-contact sports (n = 298), completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test before the season. Generalized linear modeling was used to predict each neurocognitive domain score and total symptom severity score. Predictor variables were entered in the following order: group (contact vs. non-contact); eAFE (eAFE <12 years vs. eAFE ≥12 years); group-by-eAFE; and covariates for learning accommodation status, concussion history, and age. The group-by-eAFE interaction was not significant for any of the ImPACT composite scores (Verbal Memory, Wald χ2 = 0.073, p = 0.788; Visual Memory, Wald χ2 = 2.71, p = 0.100; Visual Motor Speed, Wald χ2 = 0.078, p = 0.780; Reaction Time, Wald χ2 = 0.003, p = 0.955; Symptom Severity, Wald χ2 = 2.87, p = 0.090). Learning accommodation history was associated with lower scores on Visual Motor Speed (χ2 = 6.19, p = 0.013, B = -2.97). Older age was associated with faster reaction time (χ2 = 4.40, p = 0.036, B = -0.006) and lesser symptom severity (χ2 = 5.55, p = 0.019, B = -0.068). No other parameters were significant. We observed no association between eAFE, contact sport participation, neurocognitive functioning, or subjectively experienced symptoms in this cohort. Earlier eAFE to contact sport participation is not related to worse neurocognitive performance or greater subjectively experienced symptoms in male U.S. service academy NCAA athletes.
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Affiliation(s)
- Jaclyn B Caccese
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; Spaulding Research Institute; MassGeneral Hospital for Children Sports Concussion Program; and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts; Center for Health and Rehabilitation Research, Charlestown, Massachusetts
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York
| | - Megan N Houston
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York
| | - Gerald T McGinty
- United States Air Force Academy, U.S. Air Force Academy, Colorado
| | | | - Patrick O'Donnell
- United States Coast Guard Academy Regional Clinic, New London, Connecticut
| | - Paul F Pasquina
- Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences; Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan
| | - Michael McCrea
- Medical College of Wisconsin, Department of Neurosurgery, Milwaukee, Wisconsin
| | | | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware.,Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware
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35
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O'Donnell P, O'Donovan D, Elmusharaf K. Social inclusion in the Irish health context: Policy and stakeholder mapping. Ir J Med Sci 2019; 189:11-26. [PMID: 31302862 DOI: 10.1007/s11845-019-02060-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Social inclusion is a complex concept, and its relationship to health has been widely debated. Across the European Union, there has been a move towards policies promoting social inclusion. Despite this, there has been a limited analysis of how the concept of social inclusion is operationalised in Irish policy. The aim of this research was to document and map the development of social inclusion policies in the Irish context. The objectives were to identify all the relevant stakeholders and policies and to describe the relevance of social inclusion policy in the domain of health. METHODS We utilised a widely recognised policy analysis framework. We conducted a systematic search of relevant government policies, grey literature databases, statutory agencies and stakeholders in the Irish context since 2006. The researchers initially identified a total of 954 results. RESULTS The relevant stakeholders discovered were the research community, service providers, civil society organisations, policy makers and government, philanthropists and socially excluded people. Most policy documents included refer to one of two national policies created to drive social inclusion activities. Social inclusion was being operationalised in the context of health, but the relationship between policymakers and those planning and providing services was unclear. CONCLUSIONS The concept of social inclusion was being operationalised in the Irish policy context. A multitude of stakeholders were involved, reflecting the wide reach of this concept in society. Social inclusion was a particularly important concept in the realm of health, and in the primary care domain in particular.
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Affiliation(s)
- Patrick O'Donnell
- Research Area GEMS 3-026, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| | - Diarmuid O'Donovan
- School of Medicine, Dentistry and Bisomedical Sciences, Queens University, University Road, Belfast, Northern Ireland, BT7 1NN, UK
| | - Khalifa Elmusharaf
- GEMS 3-009A, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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Richey JD, Deng AC, Dresser K, O'Donnell P, Cornejo KM. Distinguishing between irritated seborrheic keratosis and squamous cell carcinoma in situ using BCL-2 and IMP3 immunohistochemistry. J Cutan Pathol 2018; 45:603-609. [DOI: 10.1111/cup.13269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/23/2018] [Accepted: 05/01/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Justin D. Richey
- Department of Pathology; University of Massachusetts Medical School, UMass Memorial Medical Center; Worcester Massachusetts
| | - April C. Deng
- Department of Pathology; University of Massachusetts Medical School, UMass Memorial Medical Center; Worcester Massachusetts
| | - Karen Dresser
- Department of Pathology; University of Massachusetts Medical School, UMass Memorial Medical Center; Worcester Massachusetts
| | - Patrick O'Donnell
- Department of Pathology; University of Massachusetts Medical School, UMass Memorial Medical Center; Worcester Massachusetts
| | - Kristine M. Cornejo
- Department of Pathology; University of Massachusetts Medical School, UMass Memorial Medical Center; Worcester Massachusetts
- Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
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37
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Weber ML, Dean JHL, Hoffman NL, Broglio SP, McCrea M, McAllister TW, Schmidt JD, Hoy AR, Hazzard JB, Kelly LA, Ortega JD, Port N, Putukian M, Langford TD, Tierney R, Campbell DE, McGinty G, O'Donnell P, Svoboda SJ, DiFiori JP, Giza CC, Benjamin HJ, Buckley T, Kaminski TW, Clugston JR, Feigenbaum LA, Eckner JT, Guskiewicz K, Mihalik JP, Miles JD, Anderson S, Master CL, Collins M, Kontos AP, Bazarian JJ, Chrisman SPD, Brooks A, Duma S, Bullers CT, Miles CM, Dykhuizen BH. Influences of Mental Illness, Current Psychological State, and Concussion History on Baseline Concussion Assessment Performance. Am J Sports Med 2018; 46:1742-1751. [PMID: 29672135 DOI: 10.1177/0363546518765145] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A student-athlete's mental state, including history of trait anxiety and depression, or current psychological state may affect baseline concussion assessment performance. PURPOSE (1) To determine if mental illness (anxiety, depression, anxiety with depression) influences baseline scores, (2) to determine if psychological state correlates with baseline performance, and (3) to determine if history of concussion affects Brief Symptom Inventory-18 (BSI-18) subscores of state anxiety, depression, and somatization. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A sample of 8652 collegiate student-athletes (54.5% males, 45.5% females) participated in the Concussion Assessment, Research and Education (CARE) Consortium. Baseline assessments included a demographic form, a symptom evaluation, Standardized Assessment of Concussion, Balance Error Scoring System, a psychological state assessment (BSI-18), and Immediate Post-concussion Assessment and Cognitive Test. Baseline scores were compared between individuals with a history of anxiety (n = 59), depression (n = 283), and anxiety with depression (n = 68) and individuals without a history of those conditions (n = 8242). Spearman's rho correlations were conducted to assess the relationship between baseline and psychological state subscores (anxiety, depression, somatization) (α = .05). Psychological state subscores were compared between individuals with a self-reported history of concussions (0, 1, 2, 3, 4+) using Kruskal-Wallis tests (α = .05). RESULTS Student-athletes with anxiety, depression, and anxiety with depression demonstrated higher scores in number of symptoms reported (anxiety, 4.3 ± 4.2; depression, 5.2 ± 4.8; anxiety with depression, 5.4 ± 3.9; no anxiety/depression, 2.5 ± 3.4), symptom severity (anxiety, 8.1 ± 9.8; depression, 10.4 ± 12.4; anxiety with depression, 12.4 ± 10.7; no anxiety/depression, 4.1 ± 6.9), and psychological distress in state anxiety (anxiety, 3.7 ± 4.7; depression, 2.5 ± 3.6; anxiety with depression, 3.8 ± 4.2; no anxiety/depression, 0.8 ± 1.8), depression (anxiety, 2.4 ± 4.0; depression, 3.2 ± 4.5; anxiety with depression, 3.8 ± 4.8; no anxiety/depression, 0.8 ± 1.8), and somatization (anxiety, 2.3 ± 2.9; depression, 1.8 ± 2.8; anxiety with depression, 2.2 ± 2.4; no anxiety/depression, 0.9 ± 1.7). A moderate positive relationship existed between all BSI-18 subscores and total symptom number (n = 8377; anxiety: rs = 0.43, P < .001; depression: rs = 0.42, P < .001; somatization: rs = 0.45, P < .001), as well as total symptom severity (anxiety: rs = 0.43, P < .001; depression: rs = 0.41, P < .001; somatization: rs = 0.45, P < .001). Anxiety, depression, and somatization subscores were greater among student-athletes that self-reported more concussions. CONCLUSION Clinicians should be cognizant that student-athletes with a history of trait anxiety, depression, and anxiety with depression may report higher symptom score and severity at baseline. Individuals with extensive concussion history may experience greater state anxiety, depression, and somatization.
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Affiliation(s)
- Michelle L Weber
- Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia, USA
| | - John-Henry L Dean
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Nicole L Hoffman
- Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia, USA
| | - Steven P Broglio
- NeuroTrauma Research Laboratory, University of Michigan Injury Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Julianne D Schmidt
- Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia, USA
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- Contributing investigators are listed in the Acknowledgment
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38
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Kelly S, Jahanshad N, Zalesky A, Kochunov P, Agartz I, Alloza C, Andreassen OA, Arango C, Banaj N, Bouix S, Bousman CA, Brouwer RM, Bruggemann J, Bustillo J, Cahn W, Calhoun V, Cannon D, Carr V, Catts S, Chen J, Chen JX, Chen X, Chiapponi C, Cho KK, Ciullo V, Corvin AS, Crespo-Facorro B, Cropley V, De Rossi P, Diaz-Caneja CM, Dickie EW, Ehrlich S, Fan FM, Faskowitz J, Fatouros-Bergman H, Flyckt L, Ford JM, Fouche JP, Fukunaga M, Gill M, Glahn DC, Gollub R, Goudzwaard ED, Guo H, Gur RE, Gur RC, Gurholt TP, Hashimoto R, Hatton SN, Henskens FA, Hibar DP, Hickie IB, Hong LE, Horacek J, Howells FM, Hulshoff Pol HE, Hyde CL, Isaev D, Jablensky A, Jansen PR, Janssen J, Jönsson EG, Jung LA, Kahn RS, Kikinis Z, Liu K, Klauser P, Knöchel C, Kubicki M, Lagopoulos J, Langen C, Lawrie S, Lenroot RK, Lim KO, Lopez-Jaramillo C, Lyall A, Magnotta V, Mandl RCW, Mathalon DH, McCarley RW, McCarthy-Jones S, McDonald C, McEwen S, McIntosh A, Melicher T, Mesholam-Gately RI, Michie PT, Mowry B, Mueller BA, Newell DT, O'Donnell P, Oertel-Knöchel V, Oestreich L, Paciga SA, Pantelis C, Pasternak O, Pearlson G, Pellicano GR, Pereira A, Pineda Zapata J, Piras F, Potkin SG, Preda A, Rasser PE, Roalf DR, Roiz R, Roos A, Rotenberg D, Satterthwaite TD, Savadjiev P, Schall U, Scott RJ, Seal ML, Seidman LJ, Shannon Weickert C, Whelan CD, Shenton ME, Kwon JS, Spalletta G, Spaniel F, Sprooten E, Stäblein M, Stein DJ, Sundram S, Tan Y, Tan S, Tang S, Temmingh HS, Westlye LT, Tønnesen S, Tordesillas-Gutierrez D, Doan NT, Vaidya J, van Haren NEM, Vargas CD, Vecchio D, Velakoulis D, Voineskos A, Voyvodic JQ, Wang Z, Wan P, Wei D, Weickert TW, Whalley H, White T, Whitford TJ, Wojcik JD, Xiang H, Xie Z, Yamamori H, Yang F, Yao N, Zhang G, Zhao J, van Erp TGM, Turner J, Thompson PM, Donohoe G. Widespread white matter microstructural differences in schizophrenia across 4322 individuals: results from the ENIGMA Schizophrenia DTI Working Group. Mol Psychiatry 2018; 23:1261-1269. [PMID: 29038599 PMCID: PMC5984078 DOI: 10.1038/mp.2017.170] [Citation(s) in RCA: 412] [Impact Index Per Article: 68.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 05/02/2017] [Accepted: 06/07/2017] [Indexed: 12/15/2022]
Abstract
The regional distribution of white matter (WM) abnormalities in schizophrenia remains poorly understood, and reported disease effects on the brain vary widely between studies. In an effort to identify commonalities across studies, we perform what we believe is the first ever large-scale coordinated study of WM microstructural differences in schizophrenia. Our analysis consisted of 2359 healthy controls and 1963 schizophrenia patients from 29 independent international studies; we harmonized the processing and statistical analyses of diffusion tensor imaging (DTI) data across sites and meta-analyzed effects across studies. Significant reductions in fractional anisotropy (FA) in schizophrenia patients were widespread, and detected in 20 of 25 regions of interest within a WM skeleton representing all major WM fasciculi. Effect sizes varied by region, peaking at (d=0.42) for the entire WM skeleton, driven more by peripheral areas as opposed to the core WM where regions of interest were defined. The anterior corona radiata (d=0.40) and corpus callosum (d=0.39), specifically its body (d=0.39) and genu (d=0.37), showed greatest effects. Significant decreases, to lesser degrees, were observed in almost all regions analyzed. Larger effect sizes were observed for FA than diffusivity measures; significantly higher mean and radial diffusivity was observed for schizophrenia patients compared with controls. No significant effects of age at onset of schizophrenia or medication dosage were detected. As the largest coordinated analysis of WM differences in a psychiatric disorder to date, the present study provides a robust profile of widespread WM abnormalities in schizophrenia patients worldwide. Interactive three-dimensional visualization of the results is available at www.enigma-viewer.org.
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Affiliation(s)
- S Kelly
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA,Harvard Medical School, Boston, MA, USA,Imaging Genetics Center, Keck School of Medicine, University of Southern California, Marina del Rey, CA 90292, USA. E-mail:
| | - N Jahanshad
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - A Zalesky
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, VIC, Australia
| | - P Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - I Agartz
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - C Alloza
- University of Edinburgh, Edinburgh, UK
| | | | - C Arango
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - N Banaj
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - S Bouix
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - C A Bousman
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, VIC, Australia,Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia,Department of General Practice, The University of Melbourne, Parkville, VIC, Australia,Swinburne University of Technology, Melbourne, VIC, Australia
| | - R M Brouwer
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Bruggemann
- Neuroscience Research Australia and School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - J Bustillo
- University of New Mexico, Albuquerque, NM, USA
| | - W Cahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - V Calhoun
- The Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, USA,The Mind Research Network, Albuquerque, NM, USA
| | - D Cannon
- Centre for Neuroimaging and Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland
| | - V Carr
- Neuroscience Research Australia and School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - S Catts
- Discipline of Psychiatry, School of Medicine, University of Queensland, Herston, QLD, Australia
| | - J Chen
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, USA
| | - J-x Chen
- Beijing Huilongguan Hospital, Beijing, China
| | - X Chen
- Worldwide Research and Development, Pfizer, Cambridge, MA, USA
| | | | - Kl K Cho
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - V Ciullo
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - A S Corvin
- Department of Psychiatry and Neuropsychiatric Genetics Research Group, Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
| | - B Crespo-Facorro
- University Hospital Marqués de Valdecilla, IDIVAL, Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain,CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Santander, Spain
| | - V Cropley
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, VIC, Australia
| | - P De Rossi
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy,Department NESMOS, Faculty of Medicine and Psychology, University ‘Sapienza’ of Rome, Rome, Italy,Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - C M Diaz-Caneja
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - E W Dickie
- Center for Addiction and Mental Health, Toronto, ON, Canada
| | - S Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Technische Universität Dresden, Faculty of Medicine, University Hospital C.G. Carus, Dresden, Germany
| | - F-m Fan
- Beijing Huilongguan Hospital, Beijing, China
| | - J Faskowitz
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - H Fatouros-Bergman
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - L Flyckt
- University of New South Wales, School of Psychiatry, Sydney, NSW, Australia,The University of Queensland, Queensland Brain Institute and Centre for Advanced Imaging, Brisbane, QLD, Australia
| | - J M Ford
- University of California, VAMC, San Francisco, CA, USA
| | - J-P Fouche
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - M Fukunaga
- Division of Cerebral Integration, National Institute for Physiological Sciences, Aichi, Japan
| | - M Gill
- Department of Psychiatry and Neuropsychiatric Genetics Research Group, Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
| | - D C Glahn
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital and Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - R Gollub
- Harvard Medical School, Boston, MA, USA,Departments of Psychiatry and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - E D Goudzwaard
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - H Guo
- Zhumadian Psychiatry Hospital, Henan Province, China
| | - R E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - R C Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - T P Gurholt
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - R Hashimoto
- Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, Osaka, Japan,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - S N Hatton
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - F A Henskens
- School of Electrical Engineering and Computer Science, University of Newcastle, Callaghan, NSW, Australia,Health Behaviour Research Group, University of Newcastle, Callaghan, NSW, Australia,Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - D P Hibar
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - I B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - L E Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - J Horacek
- National Institute of Mental Health, Klecany, Czech Republic,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - F M Howells
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - H E Hulshoff Pol
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C L Hyde
- Worldwide Research and Development, Pfizer, Cambridge, MA, USA
| | - D Isaev
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - A Jablensky
- University of Western Australia, Perth, WA, Australia
| | - P R Jansen
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Janssen
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain,Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E G Jönsson
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - L A Jung
- Laboratory for Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt/Main, Germany
| | - R S Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Z Kikinis
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - K Liu
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, VIC, Australia
| | - P Klauser
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, VIC, Australia,Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences and Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia,Department of Psychiatry, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - C Knöchel
- Laboratory for Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt/Main, Germany
| | - M Kubicki
- Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J Lagopoulos
- Sunshine Coast Mind and Neuroscience Institute, University of the Sunshine Coast QLD, Australia, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - C Langen
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S Lawrie
- University of Edinburgh, Edinburgh, UK
| | - R K Lenroot
- Neuroscience Research Australia and School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - K O Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - C Lopez-Jaramillo
- Research Group in Psychiatry (GIPSI), Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Mood Disorder Program, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - A Lyall
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - R C W Mandl
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D H Mathalon
- University of California, VAMC, San Francisco, CA, USA
| | | | - S McCarthy-Jones
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - C McDonald
- Centre for Neuroimaging and Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland
| | - S McEwen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - T Melicher
- Third Faculty of Medicine, Charles University, Prague, Czech Republic,The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - R I Mesholam-Gately
- Harvard Medical School and Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess, Medical Center, Boston, MA, USA
| | - P T Michie
- Hunter Medical Research Institute, Newcastle, NSW, Australia,The University of Newcastle, Newcastle, NSW, Australia,Schizophrenia Research Institute, Sydney, NSW, Australia
| | - B Mowry
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia and Queensland Centre for Mental Health Research, Brisbane and Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - B A Mueller
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - D T Newell
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - P O'Donnell
- Worldwide Research and Development, Pfizer, Cambridge, MA, USA
| | - V Oertel-Knöchel
- Laboratory for Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt/Main, Germany
| | - L Oestreich
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia and Queensland Centre for Mental Health Research, Brisbane and Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - S A Paciga
- Worldwide Research and Development, Pfizer, Cambridge, MA, USA
| | - C Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, VIC, Australia,Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia,Schizophrenia Research Institute, Sydney, NSW, Australia,Centre for Neural Engineering (CfNE), Department of Electrical and Electronic Engineering, University of Melbourne, Parkville, VIC, Australia
| | - O Pasternak
- Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - G Pearlson
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital and Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - G R Pellicano
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - A Pereira
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - F Piras
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy,School of Biomedical Sciences, Faculty of Health, the University of Newcastle, Callaghan, NSW, Australia
| | - S G Potkin
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - A Preda
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - P E Rasser
- Hunter Medical Research Institute, Newcastle, NSW, Australia,Priority Centre for Brain and Mental Health Research, The University of Newcastle, Newcastle, NSW, Australia
| | - D R Roalf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - R Roiz
- University Hospital Marqués de Valdecilla, IDIVAL, Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain,CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Santander, Spain
| | - A Roos
- SU/UCT MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - D Rotenberg
- Center for Addiction and Mental Health, Toronto, ON, Canada
| | - T D Satterthwaite
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - P Savadjiev
- Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - U Schall
- Hunter Medical Research Institute, Newcastle, NSW, Australia,Priority Centre for Brain and Mental Health Research, The University of Newcastle, Newcastle, NSW, Australia
| | - R J Scott
- Hunter Medical Research Institute, Newcastle, NSW, Australia,School of Biomedical Sciences, Faculty of Health, the University of Newcastle, Callaghan, NSW, Australia
| | - M L Seal
- Murdoch Childrens Research Institute, The Royal Children’s Hospital, Parkville, VIC, Australia
| | - L J Seidman
- Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Harvard Medical School and Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess, Medical Center, Boston, MA, USA
| | - C Shannon Weickert
- Schizophrenia Research Institute, Sydney, NSW, Australia,Neuroscience Research Australia, Sydney, NSW, Australia,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - C D Whelan
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - M E Shenton
- Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA,VA Boston Healthcare System, Boston, MA, USA
| | - J S Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - G Spalletta
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy,Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - F Spaniel
- National Institute of Mental Health, Klecany, Czech Republic,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - E Sprooten
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital and Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - M Stäblein
- Laboratory for Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt/Main, Germany
| | - D J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa,Department of Psychiatry and MRC Unit on Anxiety and Stress Disorders, University of Cape Town, Cape Town, South Africa
| | - S Sundram
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia,Department of Psychiatry, School of Clinical Sciences, Monash University and Monash Health, Clayton, VIC, Australia
| | - Y Tan
- Beijing Huilongguan Hospital, Beijing, China
| | - S Tan
- Beijing Huilongguan Hospital, Beijing, China
| | - S Tang
- Chongqing Three Gorges Central Hospital, Chongqing, China
| | - H S Temmingh
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - L T Westlye
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Psychology, University of Oslo, Oslo, Norway
| | - S Tønnesen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - D Tordesillas-Gutierrez
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Santander, Spain,Neuroimaging Unit, Technological Facilities, Valdecilla Biomedical Research Institute IDIVAL, Santander, Spain
| | - N T Doan
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J Vaidya
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - N E M van Haren
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C D Vargas
- Research Group in Psychiatry (GIPSI), Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - D Vecchio
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - D Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - A Voineskos
- Kimel Family Translational Imaging-Genetics Research Laboratory, Campbell Family Mental Health Research Institute, CAMH Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - J Q Voyvodic
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Z Wang
- Beijing Huilongguan Hospital, Beijing, China
| | - P Wan
- Zhumadian Psychiatry Hospital, Henan Province, China
| | - D Wei
- Luoyang Fifth People's Hospital, Henan Province, China
| | - T W Weickert
- Schizophrenia Research Institute, Sydney, NSW, Australia,Neuroscience Research Australia, Sydney, NSW, Australia,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - H Whalley
- University of Edinburgh, Edinburgh, UK
| | - T White
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - T J Whitford
- University of New South Wales, School of Psychiatry, Sydney, NSW, Australia
| | - J D Wojcik
- Harvard Medical School and Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess, Medical Center, Boston, MA, USA
| | - H Xiang
- Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Z Xie
- Worldwide Research and Development, Pfizer, Cambridge, MA, USA
| | - H Yamamori
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - F Yang
- Beijing Huilongguan Hospital, Beijing, China
| | - N Yao
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - G Zhang
- Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore, MD, USA
| | - J Zhao
- Centre for Neuroimaging and Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland,School of Psychology, Shaanxi Normal University and Key Laboratory for Behavior and Cognitive Neuroscience of Shaanxi Province, Xi’an, Shaanxi, China
| | - T G M van Erp
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - J Turner
- Psychology Department & Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - P M Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - G Donohoe
- Centre for Neuroimaging and Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland
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O'Donnell P, O'Donovan D, Elmusharaf K. Measuring social exclusion in healthcare settings: a scoping review. Int J Equity Health 2018; 17:15. [PMID: 29391016 PMCID: PMC5796599 DOI: 10.1186/s12939-018-0732-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 01/24/2018] [Indexed: 12/05/2022] Open
Abstract
Background Social exclusion is a concept that has been widely debated in recent years; a particular focus of the discussion has been its significance in relation to health. The meanings of the phrase “social exclusion”, and the closely associated term “social inclusion”, are contested in the literature. Both of these concepts are important in relation to health and the area of primary healthcare in particular. Thus, several tools for the measurement of social exclusion or social inclusion status in health care settings have been developed. Methods A scoping review of the peer-reviewed and grey literature was conducted to examine tools developed since 2000 that measure social exclusion or social inclusion. We focused on those measurement tools developed for use with individual patients in healthcare settings. Efforts were made to obtain a copy of each of the original tools, and all relevant background literature. All tools retrieved were compared in tables, and the specific domains that were included in each measure were tabulated. Results Twenty-two measurement tools were included in the final scoping review. The majority of these had been specifically developed for the measurement of social inclusion or social exclusion, but a small number were created for the measurement of other closely aligned concepts. The majority of the tools included were constructed for engaging with patients in mental health settings. The tools varied greatly in their design, the scoring systems and the ways they were administered. The domains covered by these tools varied widely and some of the tools were quite narrow in the areas of focus. A review of the definitions of both social inclusion and social exclusion also revealed the variations among the explanations of these complex concepts. Conclusions There are several definitions of both social inclusion and social exclusion in use and they differ greatly in scope. While there are many tools that have been developed for measuring these concepts in healthcare settings, these do not have a primary healthcare focus. There is a need for the development of a tool for measuring social inclusion or social exclusion in primary healthcare settings. Electronic supplementary material The online version of this article (10.1186/s12939-018-0732-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patrick O'Donnell
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| | - Diarmuid O'Donovan
- School of Medicine, Clinical Science Institute, National University of Ireland, Room 342, Galway, Ireland
| | - Khalifa Elmusharaf
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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40
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Nicholson GP, Cvetanovich GL, Rao AJ, O'Donnell P. Posterior glenoid bone grafting in total shoulder arthroplasty for osteoarthritis with severe posterior glenoid wear. J Shoulder Elbow Surg 2017; 26:1844-1853. [PMID: 28483434 DOI: 10.1016/j.jse.2017.03.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/07/2017] [Accepted: 03/13/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) in cases with posterior wear can be addressed by eccentric reaming of the anterior glenoid or by augmenting the posterior glenoid with bone grafting or augmented glenoid implants. We report the results of TSA with posterior glenoid bone grafting (PGBG) with humeral head autograft in patients with shoulder osteoarthritis and severe posterior glenoid wear. METHODS A retrospective review of cases from 2004 to 2014 revealed 34 patients. Preoperative and postoperative radiographs were evaluated for glenoid version and humeral head subluxation as well as component loosening. Patient-reported outcomes were compared preoperatively and postoperatively. Complications and reoperations were also evaluated. RESULTS Of the 34 patients, 28 (82.4%) were available at a minimum of 2 years' follow-up. PGBG corrected glenoid retroversion from -28° ± 4° preoperatively to -4° ± 2° (P < .001). Humeral head subluxation also improved after PGBG with respect to the scapular axis and to the midglenoid face (P < .001). Radiographic analysis revealed all PGBGs had incorporated. Radiographically, 3 patients (10.7%) had a total of 5 broken or displaced screws. In addition, 3 patients (10.7%) had a broken metal marker in the center peg of the glenoid component. No patients required component revision surgery by final follow-up. Only 1 reoperation occurred for capsular release. Patients showed significant improvements in all patient-reported outcomes. CONCLUSION Patients undergoing primary TSA with humeral head autograft PGBG showed significant improvements in glenoid version, humeral head subluxation, patient-reported outcomes, and range of motion at an average of 4 years' follow-up. There was a low revision rate and a high rate of graft incorporation.
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Affiliation(s)
- Gregory P Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | | | - Allison J Rao
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Patrick O'Donnell
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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41
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Zhang T, Harrison M, O'Donnell P, Alva A, Hahn N, Appleman L, Cetnar J, Burke J, Fleming M, Milowsky M, Mortazavi A, Shore N, Schmidt E, Kresja C, Chen T, Bitman B, Izumi R, Hamdy A, George D. Phase 2 study of pembrolizumab alone or combined with acalabrutinib in platinum-refractory metastatic urothelial carcinoma (mUC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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42
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Steullet P, Cabungcal JH, Coyle J, Didriksen M, Gill K, Grace AA, Hensch TK, LaMantia AS, Lindemann L, Maynard TM, Meyer U, Morishita H, O'Donnell P, Puhl M, Cuenod M, Do KQ. Oxidative stress-driven parvalbumin interneuron impairment as a common mechanism in models of schizophrenia. Mol Psychiatry 2017; 22:936-943. [PMID: 28322275 PMCID: PMC5491690 DOI: 10.1038/mp.2017.47] [Citation(s) in RCA: 234] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/21/2016] [Accepted: 01/17/2017] [Indexed: 02/08/2023]
Abstract
Parvalbumin inhibitory interneurons (PVIs) are crucial for maintaining proper excitatory/inhibitory balance and high-frequency neuronal synchronization. Their activity supports critical developmental trajectories, sensory and cognitive processing, and social behavior. Despite heterogeneity in the etiology across schizophrenia and autism spectrum disorder, PVI circuits are altered in these psychiatric disorders. Identifying mechanism(s) underlying PVI deficits is essential to establish treatments targeting in particular cognition. On the basis of published and new data, we propose oxidative stress as a common pathological mechanism leading to PVI impairment in schizophrenia and some forms of autism. A series of animal models carrying genetic and/or environmental risks relevant to diverse etiological aspects of these disorders show PVI deficits to be all accompanied by oxidative stress in the anterior cingulate cortex. Specifically, oxidative stress is negatively correlated with the integrity of PVIs and the extracellular perineuronal net enwrapping these interneurons. Oxidative stress may result from dysregulation of systems typically affected in schizophrenia, including glutamatergic, dopaminergic, immune and antioxidant signaling. As convergent end point, redox dysregulation has successfully been targeted to protect PVIs with antioxidants/redox regulators across several animal models. This opens up new perspectives for the use of antioxidant treatments to be applied to at-risk individuals, in close temporal proximity to environmental impacts known to induce oxidative stress.
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Affiliation(s)
- P Steullet
- Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly-Lausanne, Switzerland
| | - J-H Cabungcal
- Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly-Lausanne, Switzerland
| | - J Coyle
- Laboratory for Psychiatric and Molecular Neuroscience, Harvard Medical School, McLean Hospital, Belmont, MA, USA
| | - M Didriksen
- Synaptic transmission H. Lundbeck A/S, Valby, Denmark
| | - K Gill
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - A A Grace
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - T K Hensch
- Center for Brain Science, Department of Molecular Cellular Biology, Harvard University, Cambridge, MA USA,FM Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - A-S LaMantia
- George Washington Institute for Neuroscience, The George Washington University, Washington, DC, USA
| | - L Lindemann
- F. Hoffmann-La Roche, Roche Pharmaceutical and Early Development, Neuroscience, Opthalmology & Rare Disease (NORD) DTA, Discovery Neuroscience, Roche Innovation Center Basel, Basel, Switzerland
| | - T M Maynard
- George Washington Institute for Neuroscience, The George Washington University, Washington, DC, USA
| | - U Meyer
- Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse, Zurich, Switzerland
| | - H Morishita
- Center for Brain Science, Department of Molecular Cellular Biology, Harvard University, Cambridge, MA USA,FM Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Neuroscience, and Ophthalmology, Friedman Brain Institute, Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, NY, USA
| | - P O'Donnell
- Neuroscience and Pain Research Unit, BioTherapeutics Research and Development, Pfizer, Cambridge, MA, USA
| | - M Puhl
- Laboratory for Psychiatric and Molecular Neuroscience, Harvard Medical School, McLean Hospital, Belmont, MA, USA
| | - M Cuenod
- Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly-Lausanne, Switzerland
| | - K Q Do
- Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly-Lausanne, Switzerland,Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly-Lausanne CH-1008, Switzerland. E-mail:
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43
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Mellano CR, Kupfer N, Thorsness R, Chalmers PN, Feldheim TF, O'Donnell P, Cole BJ, Verma NN, Romeo AA, Nicholson GP. Functional results of bilateral reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26:990-996. [PMID: 28094191 DOI: 10.1016/j.jse.2016.10.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to analyze a population of patients with bilateral reverse total shoulder arthroplasty (RTSA) to evaluate their ability to perform activities of daily living and personal hygiene tasks. METHODS At a minimum 2-year follow-up, we retrospectively reviewed 50 patients (100 shoulders) with a mean age of 72 years who underwent staged bilateral RTSA. The average follow-up period was 61 months (range, 24-121 months), with a minimum 2-year follow-up after the second surgical procedure. Functional outcomes were assessed with American Shoulder and Elbow Surgeons, Simple Shoulder Test, and Short Form 12 (SF-12) scores. In addition, a unique questionnaire regarding personal hygiene habits and activities of daily living reliant on shoulder rotation was administered to all patients. RESULTS Patients showed significant improvements in pain (mean improvement in visual analog scale score from 5.7 to 1.0, P < .001) and forward elevation (mean improvement from 71° to 136°, P < .001). Clinical outcome scores showed significant improvements: The mean American Shoulder and Elbow Surgeons score improved from 35.8 to 76.5 (P < .001), Simple Shoulder Test score improved from 2.4 to 8.0 (P < .001), SF-12 mental component subscore improved from 51.9 to 54.1 (P < .001), and SF-12 physical component subscore improved from 30.5 to 39.7 (P < .001). Internal and external rotation showed significant improvements (from 33° to 53° [P < .005] and from 27° to 44° [P < .001], respectively). All patients retained independence with personal hygiene and activities of daily living. Complications included prosthetic instability (3%), acromial fracture (5%), and periprosthetic joint infection (1%). The overall reoperation rate was 5%. CONCLUSIONS Bilateral RTSA provides predictable pain relief and improved function. Hygiene practices are unaltered for most patients, and the other patients rapidly develop simple compensatory strategies and retain independence in activities of daily living.
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Affiliation(s)
- Chris R Mellano
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Noam Kupfer
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Robert Thorsness
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Terrence F Feldheim
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Patrick O'Donnell
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Anthony A Romeo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Gregory P Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
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Spitzer TR, Sugrue MW, Gonzalez C, O'Donnell P, Confer D, Fuchs E, Pulsipher MA, Schwartz J, Linenberger M. Transfusion practices for bone marrow harvests: a survey analysis from the AABB Bone Marrow Quality Improvement Initiative Working Group. Bone Marrow Transplant 2017; 52:1199-1200. [PMID: 28530670 DOI: 10.1038/bmt.2017.92] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- T R Spitzer
- Massachusetts General Hospital, Boston, MA, USA
| | - M W Sugrue
- University of Florida, Gainesville, FL, USA
| | - C Gonzalez
- Georgetown University Medical Center, Washington, DC, USA
| | - P O'Donnell
- Massachusetts General Hospital, Boston, MA, USA
| | - D Confer
- National Marrow Donor Program, Minneapolis, MN, USA
| | - E Fuchs
- Johns Hopkins University, Baltimore, MD, USA
| | - M A Pulsipher
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - J Schwartz
- Columbia University Medical Center, New York, NY, USA
| | - M Linenberger
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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45
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Bruce HA, Kochunov P, Paciga SA, Hyde CL, Chen X, Xie Z, Zhang B, Xi HS, O'Donnell P, Whelan C, Schubert CR, Bellon A, Ament SA, Shukla DK, Du X, Rowland LM, O'Neill H, Hong LE. Potassium channel gene associations with joint processing speed and white matter impairments in schizophrenia. Genes Brain Behav 2017; 16:515-521. [PMID: 28188958 DOI: 10.1111/gbb.12372] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 01/14/2017] [Accepted: 02/07/2017] [Indexed: 12/17/2022]
Abstract
Patients with schizophrenia show decreased processing speed on neuropsychological testing and decreased white matter integrity as measured by diffusion tensor imaging, two traits shown to be both heritable and genetically associated indicating that there may be genes that influence both traits as well as schizophrenia disease risk. The potassium channel gene family is a reasonable candidate to harbor such a gene given the prominent role potassium channels play in the central nervous system in signal transduction, particularly in myelinated axons. We genotyped members of the large potassium channel gene family focusing on putatively functional single nucleotide polymorphisms (SNPs) in a population of 363 controls, 194 patients with schizophrenia spectrum disorder (SSD) and 28 patients with affective disorders with psychotic features who completed imaging and neuropsychological testing. We then performed three association analyses using three phenotypes - processing speed, whole-brain white matter fractional anisotropy (FA) and schizophrenia spectrum diagnosis. We extracted SNPs showing an association at a nominal P value of <0.05 with all three phenotypes in the expected direction: decreased processing speed, decreased FA and increased risk of SSD. A single SNP, rs8234, in the 3' untranslated region of voltage-gated potassium channel subfamily Q member 1 (KCNQ1) was identified. Rs8234 has been shown to affect KCNQ1 expression levels, and KCNQ1 levels have been shown to affect neuronal action potentials. This exploratory analysis provides preliminary data suggesting that KCNQ1 may contribute to the shared risk for diminished processing speed, diminished white mater integrity and increased risk of schizophrenia.
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Affiliation(s)
- H A Bruce
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - P Kochunov
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - S A Paciga
- Pfizer Inc., Worldwide Research and Development, Cambridge, MA
| | - C L Hyde
- Pfizer Inc., Worldwide Research and Development, Cambridge, MA
| | - X Chen
- Pfizer Inc., Worldwide Research and Development, Cambridge, MA
| | - Z Xie
- Pfizer Inc., Worldwide Research and Development, Cambridge, MA
| | - B Zhang
- Pfizer Inc., Worldwide Research and Development, Cambridge, MA
| | - H S Xi
- Pfizer Inc., Worldwide Research and Development, Cambridge, MA
| | - P O'Donnell
- Pfizer Inc., Worldwide Research and Development, Cambridge, MA
| | - C Whelan
- Pfizer Inc., Worldwide Research and Development, Cambridge, MA
| | | | - A Bellon
- Department of Psychiatry, Penn State Hershey Medical Center, Hershey, PA, USA
| | - S A Ament
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - D K Shukla
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - X Du
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - L M Rowland
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - H O'Neill
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - L E Hong
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
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Steullet P, Cabungcal JH, Monin A, Dwir D, O'Donnell P, Cuenod M, Do KQ. Redox dysregulation, neuroinflammation, and NMDA receptor hypofunction: A "central hub" in schizophrenia pathophysiology? Schizophr Res 2016; 176:41-51. [PMID: 25000913 PMCID: PMC4282982 DOI: 10.1016/j.schres.2014.06.021] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/06/2014] [Accepted: 06/08/2014] [Indexed: 12/18/2022]
Abstract
Accumulating evidence points to altered GABAergic parvalbumin-expressing interneurons and impaired myelin/axonal integrity in schizophrenia. Both findings could be due to abnormal neurodevelopmental trajectories, affecting local neuronal networks and long-range synchrony and leading to cognitive deficits. In this review, we present data from animal models demonstrating that redox dysregulation, neuroinflammation and/or NMDAR hypofunction (as observed in patients) impairs the normal development of both parvalbumin interneurons and oligodendrocytes. These observations suggest that a dysregulation of the redox, neuroimmune, and glutamatergic systems due to genetic and early-life environmental risk factors could contribute to the anomalies of parvalbumin interneurons and white matter in schizophrenia, ultimately impacting cognition, social competence, and affective behavior via abnormal function of micro- and macrocircuits. Moreover, we propose that the redox, neuroimmune, and glutamatergic systems form a "central hub" where an imbalance within any of these "hub" systems leads to similar anomalies of parvalbumin interneurons and oligodendrocytes due to the tight and reciprocal interactions that exist among these systems. A combination of vulnerabilities for a dysregulation within more than one of these systems may be particularly deleterious. For these reasons, molecules, such as N-acetylcysteine, that possess antioxidant and anti-inflammatory properties and can also regulate glutamatergic transmission are promising tools for prevention in ultra-high risk patients or for early intervention therapy during the first stages of the disease.
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Affiliation(s)
- P Steullet
- Center for Psychiatric Neuroscience, Department of Psychiatry, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Site de Cery, 1008 Prilly-Lausanne, Switzerland
| | - J H Cabungcal
- Center for Psychiatric Neuroscience, Department of Psychiatry, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Site de Cery, 1008 Prilly-Lausanne, Switzerland
| | - A Monin
- Center for Psychiatric Neuroscience, Department of Psychiatry, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Site de Cery, 1008 Prilly-Lausanne, Switzerland
| | - D Dwir
- Center for Psychiatric Neuroscience, Department of Psychiatry, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Site de Cery, 1008 Prilly-Lausanne, Switzerland
| | - P O'Donnell
- Neuroscience Research Unit, Pfizer, Inc., 700 Main Street, Cambridge, MA 02139, USA
| | - M Cuenod
- Center for Psychiatric Neuroscience, Department of Psychiatry, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Site de Cery, 1008 Prilly-Lausanne, Switzerland
| | - K Q Do
- Center for Psychiatric Neuroscience, Department of Psychiatry, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Site de Cery, 1008 Prilly-Lausanne, Switzerland.
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Chetty UJ, O'Donnell P, Blane D, Willems S. The role of primary care in improving health equity: report of a workshop held by the WONCA Health Equity Special Interest Group at the 2015 WONCA Europe Conference in Istanbul, Turkey. Int J Equity Health 2016; 15:128. [PMID: 27496027 PMCID: PMC4975904 DOI: 10.1186/s12939-016-0415-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/28/2016] [Indexed: 11/10/2022] Open
Abstract
The WONCA Special Interest Group on Health Equity was established in 2014 to provide a focus of support, education, research and policy on issues relating to promotion of health equity in primary care settings. In keeping with this remit, the group hosted a workshop at the WONCA Europe conference held in Istanbul in October 2015. The aim of the session was to engage practitioners from across Europe in discussion of the barriers and facilitators to addressing the social determinants of health at practice level and in the training of doctors. This commentary reflects on the main findings from this workshop and how these compare with existing work in this field.
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Affiliation(s)
- Ula Jan Chetty
- General Practice and Primary Care, University of Glasgow, Scotland, UK
| | - Patrick O'Donnell
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| | - David Blane
- General Practice and Primary Care, University of Glasgow, Scotland, UK
| | - Sara Willems
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
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48
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Espina C, Jenkins I, Taylor L, Farah R, Cho E, Epworth J, Coleman K, Pinelli J, Mentzer S, Jarrett L, Gooley T, O'Donnell P, Hirsch IB, Bar M. Blood glucose control using a computer-guided glucose management system in allogeneic hematopoietic cell transplant recipients. Bone Marrow Transplant 2016; 51:973-9. [PMID: 27042836 DOI: 10.1038/bmt.2016.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/24/2015] [Revised: 02/13/2016] [Accepted: 02/19/2016] [Indexed: 12/18/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative treatment for patients with hematological malignancies. However, is associated with substantial rates of morbidity and mortality. We and others have shown that malglycemia is associated with adverse transplant outcome. Therefore, improving glycemic control may improve transplant outcome. In this prospective study we evaluated the feasibility of using Glucommander (a Computer-Guided Glucose Management System; CGGM) in order to achieve improved glucose control in hospitalized HCT patients. Nineteen adult patients contributed 21 separate instances on CGGM. Patients were on CGGM for a median of 43 h. Median initial blood glucose (BG) on CGGM was 244 mg/dL, and patients on 20 study instances reached the study BG target of 100-140 mg/dL after a median of 6 h. After BG reached the target range, the median average BG level per patient was 124 mg/dL. Six patients had a total of 10 events of BG <70 mg/dL (0.9% of BG measurements), and no patients experienced BG level <40 mg/dL. The total estimated duration of BG <70 mg/dL was 3 h (0.2% of the total CGGM time). In conclusion, our study demonstrates that stringent BG control in HCT patients using CGGM is feasible.
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Affiliation(s)
- C Espina
- Internal Medicine, University of Washington, Seattle, WA, USA
| | - I Jenkins
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - L Taylor
- Internal Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - R Farah
- UPMC Cancer Center, Pittsburgh, PA, USA
| | - E Cho
- Internal Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - J Epworth
- Internal Medicine, University of Washington, Seattle, WA, USA
| | - K Coleman
- Internal Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - J Pinelli
- Internal Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - S Mentzer
- Internal Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - L Jarrett
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - T Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - P O'Donnell
- Internal Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - I B Hirsch
- Internal Medicine, University of Washington, Seattle, WA, USA
| | - M Bar
- Internal Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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49
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Chu Y, Roettger D, Trentin C, Hinton M, Kubassova O, Hargunani R, Boesen M, O'Donnell P. SAT0260 A Novel MRI-Based Analysis Workflow for Chronic Recurrent Multifocal Osteomyelitis (CRMO). Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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50
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O'Donnell P, Shyu J, Ferguson J, Demartin K, May T, Jensen D, Celeri M, Rehage T, Corona L, Current R, Joshi S, Wu Y, Floren M, Soviero S. A Real-time PCR Assay for the Detection of EGFR Mutations in FFPE Tissue and Plasma Samples of NSCLC Patients. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e23251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Johnny Shyu
- Roche Molecular Systems, Inc, Pleasanton, CA
| | | | | | - Theresa May
- Roche Molecular Systems, Inc, Pleasanton, CA
| | | | | | | | | | | | | | - Yiqiao Wu
- Roche Molecular Systems, Inc, Pleasanton, CA
| | - Muskan Floren
- Formerly (Roche Molecular Systems, Inc.), Albuquerque, NM
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