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Durrand J, Livingston R, Tew G, Gillis C, Yates D, Gray J, Greaves C, Moore J, O’Doherty AF, Doherty P, Danjoux G, Avery L. Systematic development and feasibility testing of a multibehavioural digital prehabilitation intervention for patients approaching major surgery (iPREPWELL): A study protocol. PLoS One 2022; 17:e0277143. [PMID: 36574417 PMCID: PMC9794053 DOI: 10.1371/journal.pone.0277143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/25/2022] [Indexed: 12/28/2022] Open
Abstract
Improving outcomes for people undergoing major surgery, specifically reducing perioperative morbidity and mortality remains a global health challenge. Prehabilitation involves the active preparation of patients prior to surgery, including support to tackle risk behaviours that mediate and undermine physical and mental health and wellbeing. The majority of prehabilitation interventions are delivered in person, however many patients express a preference for remotely-delivered interventions that provide them with tailored support and the flexibility. Digital prehabilitation interventions offer scalability and have the potential to benefit perioperative healthcare systems, however there is a lack of robustly developed and evaluated digital programmes for use in routine clinical care. We aim to systematically develop and test the feasibility of an evidence and theory-informed multibehavioural digital prehabilitation intervention 'iPREPWELL' designed to prepare patients for major surgery. The intervention will be developed with reference to the Behaviour Change Wheel, COM-B model, and the Theoretical Domains Framework. Codesign methodology will be used to develop a patient intervention and accompanying training intervention for healthcare professionals. Training will be designed to enable healthcare professionals to promote, support and facilitate delivery of the intervention as part of routine clinical care. Patients preparing for major surgery and healthcare professionals involved with their clinical care from two UK National Health Service centres will be recruited to stage 1 (systematic development) and stage 2 (feasibility testing of the intervention). Participants recruited at stage 1 will be asked to complete a COM-B questionnaire and to take part in a qualitative interview study and co-design workshops. Participants recruited at stage 2 (up to twenty healthcare professionals and forty participants) will be asked to take part in a single group intervention study where the primary outcomes will include feasibility, acceptability, and fidelity of intervention delivery, receipt, and enactment. Healthcare professionals will be trained to promote and support use of the intervention by patients, and the training intervention will be evaluated qualitatively and quantitatively. The multifaceted and systematically developed intervention will be the first of its kind and will provide a foundation for further refinement prior to formal efficacy testing.
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Affiliation(s)
- J. Durrand
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-Upon-Tyne, United Kingdom
- Department of Anaesthesia and Perioperative Medicine, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
- * E-mail: (JD); (LA)
| | - R. Livingston
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - G. Tew
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-Upon-Tyne, United Kingdom
| | - C. Gillis
- School of Human Nutrition, McGill University, Montreal, Canada
| | - D. Yates
- Department of Anaesthesia and Critical Care, York & Scarborough Teaching Hospitals NHS Foundation Trust, York, United Kingdom
- North Yorkshire Academic Alliance of Perioperative Medicine, England
| | - J. Gray
- School of Nursing Midwifery and Health, Northumbria University, Upon-Tyne, United Kingdom
| | - C. Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - J. Moore
- Department of Anaesthesia and Critical Care, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - A. F. O’Doherty
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-Upon-Tyne, United Kingdom
| | - P. Doherty
- Department of Health Sciences, University of York, York, United Kingdom
| | - G. Danjoux
- Department of Anaesthesia and Perioperative Medicine, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
- North Yorkshire Academic Alliance of Perioperative Medicine, England
| | - L. Avery
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
- * E-mail: (JD); (LA)
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2
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Alotaibi J, Doherty P. The association between fitness measurement and cardiac rehabilitation completion. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Assessing functional capacity for patients entering a CR programme is strongly recommended by various organisations. Based on the result of this assessment, the intensity of exercise is prescribed, the risk is stratified and by the end of the programme, the effectiveness of the exercise intervention is evaluated [1]. However, despite the recommendations relating to assessing patients' level of functional capacity prior to the programme and following it, less than one -third of CR patients undertook this test [2].
Aims
The aim of this study was to examine the association between whether the patient's fitness is measured at bseline assessment and the completion of their Cardiac Rehabilitation (CR) programme.
Method
A retrospective observational study using data from 102 CR centres from January 2015 to April 2016 was conducted to address this aim. Logistic regression was used to investigate the association and taken into account some factors including age, gender, Body Mass Index (BMI), employment status, total number of comorbidities
Results
Data relating to 31,433 patients (mean age of 65.20±11.80 years, 73% of whom were male) was analysed. Out of the total number of patients, 9,785 (31%) undertook a fitness assessment at baseline. Patients whose fitness was measured were 48% more likely to complete their CR programme compared to those whose fitness was not measured.
Conclusion
Patients are more likely to complete CR if their fitness is measured at baseline which represents one the largest modifiable service-level characteristics reported in CR
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Alotaibi
- King Fahad Military Medical Complex , Dhahran , Saudi Arabia
| | - P Doherty
- University of York, Health Sciences , York , United Kingdom
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3
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Kinney MV, Day LT, Palestra F, Biswas A, Jackson D, Roos N, de Jonge A, Doherty P, Manu AA, Moran AC, George AS. Overcoming blame culture: key strategies to catalyse maternal and perinatal death surveillance and response. BJOG 2021; 129:839-844. [PMID: 34709701 PMCID: PMC9298870 DOI: 10.1111/1471-0528.16989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 11/29/2022]
Affiliation(s)
- M V Kinney
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - L T Day
- Maternal Newborn Health Group, Maternal Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK.,Maternal Newborn Health Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - F Palestra
- World Health Organization, Geneva, Switzerland
| | | | - D Jackson
- School of Public Health, University of the Western Cape, Bellville, South Africa.,Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - N Roos
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | - A de Jonge
- Midwifery Science, AVAG (Academy Midwifery Amsterdam and Groningen), Amsterdam Public Health Research Institute, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands
| | - P Doherty
- Options Consultancy Services Ltd, St Magnus House, London, UK
| | - A A Manu
- Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - A C Moran
- Department of Maternal, Newborn, Child, Adolescent Health & Ageing, World Health Organization, Geneva, Switzerland
| | - A S George
- School of Public Health, University of the Western Cape, Bellville, South Africa
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Lawless M, Harrison AS, Doherty P. Multiple interventions following an acute coronary syndrome event increase uptake into cardiac rehabilitation. Int J Cardiol 2020; 326:1-5. [PMID: 33181160 DOI: 10.1016/j.ijcard.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 10/29/2020] [Accepted: 11/04/2020] [Indexed: 12/01/2022]
Abstract
AIMS Cardiac rehabilitation (CR) improves morbidity and mortality. Uptake varies for patients following acute coronary syndrome (ACS). Entry into CR is often dependent on the management strategy received, lower following percutaneous coronary intervention (PCI), higher following coronary artery bypass grafting (CABG). This study sought to investigate differences in CR uptake following an ACS event for those patients receiving multiple treatments. METHODS Data was from the National Audit of CR between 2016 and 2019. Patients with ACS were categorised as: no intervention; one treatment (such as any PCI, CABG, any valve surgery and any device therapy); two treatments; or three or more treatments. Baseline demographics and logistic regression were used to analyse the effect of multiple treatment intervention on uptake into CR. RESULTS A total of 6833 ACS patients were included in the analysis (0 treatments 2014, 1 treatment 3104, ≥2 treatments 2799). Patients who received ≥2 therapeutic interventions were more likely to be male, partnered and >2 comorbidities. Logistic regression showed a positive relationship between uptake total intervention. Similar associations were seen: being younger, male, partnered and having any comorbidity. The hospital stay, history of angina, diabetes and stroke was negatively correlated with an uptake. CONCLUSION This study showed for the first time that multiple interventions following ACS is a significant predictor of uptake into CR. The findings align with recent trends with medically managed myocardial infarction uptake. Our findings identify factors associated with poor uptake to CR which should be considered as part of strategy to increase participation.
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Affiliation(s)
- M Lawless
- Department of Health Sciences, University of York, York, UK
| | - A S Harrison
- Department of Health Sciences, University of York, York, UK.
| | - P Doherty
- Department of Health Sciences, University of York, York, UK
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Alotaibi J, Doherty P, Doherty P. Determinants of achieving the minimum clinically important difference for the Incremental Shuttle Walk Test in a cardiac rehabilitation population. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The primary aim of this study was to identify the determinants of achieving the minimum clinically important difference (MCID) for the Incremental Shuttle Walk Test (ISWT) in the CR population. The secondary aim was to examine whether achieving MCID in ISWT at the end of the CR programme is associated with the likelihood of patients meeting the physical activity recommendation or whether it is associated with the patients' self-reported physical fitness (Dartmouth COOP tool) at the end of the CR programmme.
Method
Routine clinical data related to patients who undertook ISWT as a pre- and post-CR functional capacity assessment were taken from National Audit of Cardiac Rehabilitation (NACR) during the 2013 to 2016 and retrospectively analysed. A sub-analysis was conducted to address the secondary aim. Logistic regression approaches, taking account of potential confounders were constructed.
Results
For the main study, data from 9,786 patients (mean age of 63.9±10.7), 77.5% of whom were male, were analysed. Sixteen determinants for achieving the MCID for ISWT in CR patients were identified. A sub-analysis was also conducted on 7,950 to address the secondary aim. Patients who achieved the MCID were 30% more likely to meet the physical activity recommendation and 60% more likely to rate themselves positively on the self-reported physical fitness Dartmouth COOP scale.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - P Doherty
- University of York, Health Sciences, York, United Kingdom
| | - P Doherty
- University of York, Health Sciences, York, United Kingdom
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6
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Driscoll A, Hinde S, Harrison A, Bojke L, Doherty P. Estimating the health loss due to poor engagement with cardiac rehabilitation in Australia. Int J Cardiol 2020; 317:7-12. [PMID: 32376418 DOI: 10.1016/j.ijcard.2020.04.088] [Citation(s) in RCA: 8] [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: 01/14/2020] [Revised: 04/07/2020] [Accepted: 04/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) programs are effective in reducing cardiovascular mortality and readmissions. However, most patients are denied the benefits of CR due to low referral rates. Of those patients referred, commencement rates vary from 28.4% to 60%. This paper quantifies the scale of health loss in Australia due to poor engagement with the program, and estimates how much public funding can be justifiably reallocated to address the problem. METHODS Economic decision modelling was undertaken to estimate the expected lifetime health loss and costs to Medicare. Key parameters were derived from Australian databases, CR registries and meta-analyses. Population health gains associated with uptake rates of 60%, and 85% were calculated. RESULTS CR was associated with a 99.9% probability of being cost-effective, even at a cost-effectiveness threshold lower than conventionally applied. Importantly, an average of 0.52 years of life expectancy are lost due to national uptake being below 60% achieved in some best performing programs in Australia, equivalent to 0.28 quality adjusted life years. The analysis indicates that $12.9 million/year could be justifiably reallocated from public funds to achieve a national uptake rate of 60%, while maintaining cost-effectiveness of CR due to the large health gains that would be expected. CONCLUSION CR is a cost-effective service for patients with coronary heart disease. In Australia, less than a third of patients commence CR, potentially resulting in avoidable patient harm. Additional investment in CR is vital and should be a national priority as the health gains for patients far outweigh the costs.
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Affiliation(s)
- A Driscoll
- Deakin University, School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, VIC 3220, Australia.; Austin Health, Dept of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia.
| | - S Hinde
- University of York, Centrefor Health Economics, Alcuin A Block, Heslington, York, YO105DD, UK
| | - A Harrison
- University of York, Department of Health Sciences, Seebohm Rowntree Building, Heslington, York YO105DD, UK
| | - L Bojke
- University of York, Centrefor Health Economics, Alcuin A Block, Heslington, York, YO105DD, UK
| | - P Doherty
- University of York, Department of Health Sciences, Seebohm Rowntree Building, Heslington, York YO105DD, UK
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7
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Patton V, Balakrishnan V, Pieri C, Doherty P, Phan-Thien KC, King DW, Lubowski DZ. Subtotal colectomy and ileorectal anastomosis for slow transit constipation: clinical follow-up at median of 15 years. Tech Coloproctol 2020; 24:173-179. [PMID: 31907721 DOI: 10.1007/s10151-019-02140-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/13/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Slow transit constipation is characterised by prolonged colonic transit and reliance on laxatives. The pathophysiology is poorly understood and in its most severe form, total colectomy with ileorectal anastomosis is the final treatment option. We present a follow-up study of the long-term function in patients who had surgery for laxative-resistant slow transit constipation. METHODS A postal survey was sent to assess bowel frequency, abdominal pain, St Mark's continence score, satisfaction with procedure, likelihood to choose the procedure again, and long-term rates of small bowel obstruction and ileostomy. Longitudinal data from a subgroup studied 23 years previously are reported. RESULTS Forty-two patients (male = 2) were available for follow-up out of an initial cohort of 102. Mean time since surgery was 15.9 years (range 1.7-29.7) years. Fifty percent had < 4 bowel motions per day, most commonly Bristol stool 6, mean St Mark's score 7.45. Twenty-one percent had severe incontinence. Satisfaction and likelihood to choose surgery were high (median 10/10). There was a high rate of small bowel obstruction, suggesting pan-intestinal dysmotility in some cases. Conversion to ileostomy occurred in 8 patients. In the longitudinal follow-up in 15 subjects, continence deteriorated (p < 0.01), stool consistency softened (p < 0.01), and stool frequency fell (p < 0.01). CONCLUSIONS Satisfactory stool frequency was achieved in the long term, and although 21% had incontinence scores > 12, patient satisfaction was high. This is the longest reported follow-up of colectomy for slow transit constipation, with longitudinal outcomes reported. There was considerable attrition of patients, so larger, longitudinal studies are required to better ascertain the functional outcomes of these patients.
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Affiliation(s)
- V Patton
- Department Colorectal Surgery, St George Clinical School, St George Hospital, University of New South Wales, Kogarah, NSW, Sydney, 2217, Australia. .,School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia.
| | - V Balakrishnan
- Department Colorectal Surgery, St George Clinical School, St George Hospital, University of New South Wales, Kogarah, NSW, Sydney, 2217, Australia
| | - C Pieri
- Department Colorectal Surgery, St George Clinical School, St George Hospital, University of New South Wales, Kogarah, NSW, Sydney, 2217, Australia
| | - P Doherty
- Department Colorectal Surgery, St George Clinical School, St George Hospital, University of New South Wales, Kogarah, NSW, Sydney, 2217, Australia
| | - K C Phan-Thien
- Department Colorectal Surgery, St George Clinical School, St George Hospital, University of New South Wales, Kogarah, NSW, Sydney, 2217, Australia
| | - D W King
- Department Colorectal Surgery, St George Clinical School, St George Hospital, University of New South Wales, Kogarah, NSW, Sydney, 2217, Australia
| | - D Z Lubowski
- Department Colorectal Surgery, St George Clinical School, St George Hospital, University of New South Wales, Kogarah, NSW, Sydney, 2217, Australia
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8
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Ray M, Milston A, Doherty P, Crean S. In their own words: investigating the preparedness of final year dental students in the UK for independent general dental practice. Br Dent J 2018; 225:340-349. [PMID: 30117498 DOI: 10.1038/sj.bdj.2018.646] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2018] [Indexed: 11/09/2022]
Abstract
Introduction There is relatively little data on the preparedness of UK dental graduates for independent general dental practice. Two recent studies have indicated that graduates appear well prepared, but although quantifying the level of preparedness, they provide limited understanding of the underlying factors contributing to preparedness. This study aims to more deeply understand the contributing factors leading to assertions of graduate preparedness using focus groups of final year dental students, and semi-structured interviews of senior faculty members. Materials and methods Three UK dental schools were visited in order to conduct both study elements. Focus groups and semi-structured interviews were audio recorded and fully transcribed. Thematic analysis of the transcripts resulted in the production of a thematic matrix. Results The major categories of the thematic matrix were classified as extrinsic; including the role of educators and features of the course, and intrinsic; relating to fear of the unknown, the development of adult learning abilities and less easily identifiable attributes in the development of competence, which became known as 'bricks and mortar'. Discussion Students felt that the most important factor affecting their preparation was clinical exposure. Outreach placements were felt to be particularly useful, the simulation of general dental practice being highly valued by final year students. The interaction with educators was also felt to be a key influence on preparedness, with the involvement of general practitioners in dental school teaching felt to be helpful, perhaps giving students an extended exposure to general practice. Conclusion It is hoped that the rich data derived from this study may allow an invaluable insight into factors contributing to preparedness of new dental graduates, which may then be considered in the light of any proposed changes in the curricula or syllabi.
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Affiliation(s)
- M Ray
- Ravat and Ray Dental Care, Head Office, Rumworth House, 512 Wigan Road, Bolton, BL3 4QW
| | - A Milston
- College of Clinical and Biomedical Sciences, University of Central Lancashire, Preston, PR1 2HE
| | - P Doherty
- Centre for Excellence in Learning and Teaching, University of Central Lancashire, Preston, PR1 2HE
| | - S Crean
- University of Central Lancashire, School of Postgraduate Medical and Dental Education, Greenbank 303, Preston, PR1 2HE
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10
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Alotaibi J, Doherty P. P4909Gender differences in achieving the minimum clinically important difference in the incremental shuttle walk test in coronary artery bypass graft patients. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p4909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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11
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Salman A, Doherty P. P2498Do the demographic characteristics and baseline health state of patients vary in different cardiac rehabilitation performance programmes? Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Hailey P, Oakley A, Doherty P, Pettman A, Sharp D, Barnes D. Applications of near Infrared Spectroscopy in the Pharmaceutical Industry. ACTA ACUST UNITED AC 2017. [DOI: 10.1255/nirn.251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- P.A. Hailey
- Pfizer Central Research, Sandwich, Kent, CT13 9NJ, UK
| | - A.C.E. Oakley
- Pfizer Central Research, Sandwich, Kent, CT13 9NJ, UK
| | - P. Doherty
- Pfizer Central Research, Sandwich, Kent, CT13 9NJ, UK
| | - A.J. Pettman
- Pfizer Central Research, Sandwich, Kent, CT13 9NJ, UK
| | - D.C.A. Sharp
- Pfizer Central Research, Sandwich, Kent, CT13 9NJ, UK
| | - D.M.H. Barnes
- Pfizer Central Research, Sandwich, Kent, CT13 9NJ, UK
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13
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Eyre V, Lang CC, Smith K, Jolly K, Davis R, Hayward C, Wingham J, Abraham C, Green C, Warren FC, Britten N, Greaves CJ, Doherty P, Austin J, Van Lingen R, Singh S, Buckingham S, Paul K, Taylor RS, Dalal HM. Rehabilitation Enablement in Chronic Heart Failure-a facilitated self-care rehabilitation intervention in patients with heart failure with preserved ejection fraction (REACH-HFpEF) and their caregivers: rationale and protocol for a single-centre pilot randomised controlled trial. BMJ Open 2016; 6:e012853. [PMID: 27798024 PMCID: PMC5093626 DOI: 10.1136/bmjopen-2016-012853] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The Rehabilitation EnAblement in CHronic Heart Failure in patients with Heart Failure (HF) with preserved ejection fraction (REACH-HFpEF) pilot trial is part of a research programme designed to develop and evaluate a facilitated, home-based, self-help rehabilitation intervention to improve self-care and quality of life (QoL) in heart failure patients and their caregivers. We will assess the feasibility of a definitive trial of the REACH-HF intervention in patients with HFpEF and their caregivers. The impact of the REACH-HF intervention on echocardiographic outcomes and bloodborne biomarkers will also be assessed. METHODS AND ANALYSIS A single-centre parallel two-group randomised controlled trial (RCT) with 1:1 individual allocation to the REACH-HF intervention plus usual care (intervention) or usual care alone (control) in 50 HFpEF patients and their caregivers. The REACH-HF intervention comprises a REACH-HF manual with supplementary tools, delivered by trained facilitators over 12 weeks. A mixed methods approach will be used to assess estimation of recruitment and retention rates; fidelity of REACH-HF manual delivery; identification of barriers to participation and adherence to the intervention and study protocol; feasibility of data collection and outcome burden. We will assess the variance in study outcomes to inform a definitive study sample size and assess methods for the collection of resource use and intervention delivery cost data to develop the cost-effectiveness analyses framework for any future trial. Patient outcomes collected at baseline, 4 and 6 months include QoL, psychological well-being, exercise capacity, physical activity and HF-related hospitalisation. Caregiver outcomes will also be assessed, and a substudy will evaluate impact of the REACH-HF manual on resting global cardiovascular function and bloodborne biomarkers in HFpEF patients. ETHICS AND DISSEMINATION The study is approved by the East of Scotland Research Ethics Service (Ref: 15/ES/0036). Findings will be disseminated via journals and presentations to clinicians, commissioners and service users. TRIAL REGISTRATION NUMBER ISRCTN78539530; Pre-results .
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Affiliation(s)
- V Eyre
- Peninsula Clinical Trials Unit, Plymouth University, Plymouth, UK
| | - C C Lang
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - K Smith
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- School of Nursing & Midwifery, Dundee University, Dundee, UK
| | - K Jolly
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - R Davis
- Cardiology Department, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - C Hayward
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - J Wingham
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
- Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - C Abraham
- Psychology Applied to Health Group, University of Exeter Medical School, Exeter, UK
| | - C Green
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - F C Warren
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - N Britten
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - C J Greaves
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - P Doherty
- Department of Health Sciences, University of York, York, UK
| | - J Austin
- Heart Failure Services and Cardiac Rehabilitation, Aneurin Bevan University Health Board, Nevill Hall Hospital, Abergavenny, UK
| | - R Van Lingen
- Cardiology Department, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - S Singh
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - S Buckingham
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - K Paul
- REACH-HF Patient and Public Involvement Group, c/o Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - R S Taylor
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - H M Dalal
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
- Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Truro, UK
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Sivakumar S, Taccone FS, Desai KA, Lazaridis C, Skarzynski M, Sekhon M, Henderson W, Griesdale D, Chapple L, Deane A, Williams L, Strickland R, Lange K, Heyland D, Chapman M, Rowland MJ, Garry P, Westbrook J, Corkill R, Antoniades CA, Pattinson KT, Fatania G, Strong AJ, Myers RB, Lazaridis C, Jermaine CM, Robertson CS, Rusin CG, Hofmeijer J, Sondag L, Tjepkema-Cloostermans MC, Beishuizen A, Bosch FH, van Putten MJAM, Carteron L, Patet C, Solari D, Oddo M, Ali MA, Dias C, Almeida R, Vaz-Ferreira A, Silva J, Monteiro E, Cerejo A, Rocha AP, Elsayed AA, Abougabal AM, Beshey BN, Alzahaby KM, Pozzebon S, Ortiz AB, Cristallini S, Lheureux O, Brasseur A, Vincent JL, Creteur J, Taccone FS, Hravnak M, Yousef K, Chang Y, Crago E, Friedlander RM, Abdelmonem SA, Tahon SA, Helmy TA, Meligy HS, Puig F, Dunn-Siegrist I, Pugin J, Gupta S, Govil D, Srinivasan S, Patel SJ, N JK, Gupta A, Tomar DS, Shafi M, Harne R, Arora DP, Talwar N, Mazumdar S, Papakrivou EE, Makris D, Manoulakas E, Tsolaki B, 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ESICM LIVES 2016: part two. Intensive Care Med Exp 2016. [PMCID: PMC5042923 DOI: 10.1186/s40635-016-0099-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Anzueto A, Aliberti S, Restrepo MI, Larsson JS, Redfors B, Ricksten SE, Haines R, Powell-Tuck J, Leonard H, Ostermann M, Berthelsen RE, Itenov TS, Perner A, Jensen JU, Ibsen M, Jensen AEK, Bestle MH, Bucknall T, Dixon J, Boa F, MacPhee I, Philips BJ, Doyle J, Saadat F, Samuels T, Huddart S, McCormick B, DeBrunnar R, Preece J, Swart M, Peden C, Richardson S, Forni L, Kalfon P, Baumstarck K, Estagnasie P, Geantot MA, Berric A, Simon G, Floccard B, Signouret T, Boucekine M, Fromentin M, Nyunga M, Sossou A, Venot M, Robert R, Follin A, Renault A, Garrouste M, Collange O, Levrat Q, Villard I, Thévenin D, Pottecher J, Patrigeon RG, Revel N, Vigne C, Mimoz O, Auquier P, Pawar S, Jacques T, Deshpande K, Pusapati R, Wood B, Pulham RA, Wray J, Brown K, Pierce C, Nadel S, Ramnarayan P, Azevedo JR, Montenegro WS, Rodrigues DP, Sousa SC, Araujo VF, Leitao AL, Prazeres PH, Mendonca AV, Paula MP, Das Neves A, Loudet CI, Busico M, Vazquez D, Villalba D, Lischinsky A, Veronesi M, Emmerich M, Descotte E, Juliarena A, Bisso MC, Grando M, Tapia A, Camargo M, Ulla DV, Corzo L, dos Santos HP, Ramos A, Doglia JA, Estenssoro E, Carbonara M, Magnoni S, Donald CLM, Shimony JS, Conte V, Triulzi F, Stretti F, Macrì M, Snyder AZ, Stocchetti N, Brody DL, Podlepich V, Shimanskiy V, Savin I, Lapteva K, Chumaev A, Tjepkema-Cloostermans MC, Hofmeijer J, Beishuizen A, Hom H, Blans MJ, van Putten MJAM, Longhi L, Frigeni B, Curinga M, Mingone D, Beretta S, Patruno A, Gandini L, Vargiolu A, Ferri F, Ceriani R, Rottoli MR, Lorini L, Citerio G, Pifferi S, Battistini M, Cordolcini V, Agarossi A, Di Rosso R, Ortolano F, Stocchetti N, Lourido CM, Cabrera JLS, Santana JDM, Alzola LM, del Rosario CG, Pérez HR, Torrent RL, Eslami S, Dalhuisen A, Fiks T, Schultz MJ, Hanna AA, Spronk PE, Wood M, Maslove D. ESICM LIVES 2016: part three. Intensive Care Med Exp 2016. [PMCID: PMC5042925 DOI: 10.1186/s40635-016-0100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bos L, Schouten L, van Vught L, Wiewel M, Ong D, Cremer O, Artigas A, Martin-Loeches I, Hoogendijk A, van der Poll T, Horn J, Juffermans N, Schultz M, de Prost N, Pham T, Carteaux G, Dessap AM, Brun-Buisson C, Fan E, Bellani G, Laffey J, Mercat A, Brochard L, Maitre B, Howells PA, Thickett DR, Knox C, Park DP, Gao F, Tucker O, Whitehouse T, McAuley DF, Perkins GD, Pham T, Laffey J, Bellani G, Fan E, Pisani L, Roozeman JP, Simonis FD, Giangregorio A, Schouten LR, Van der Hoeven SM, Horn J, Neto AS, Festic E, Dondorp AM, Grasso S, Bos LD, Schultz MJ, Koster-Brouwer M, Verboom D, Scicluna B, van de Groep K, Frencken J, Schultz M, van der Poll T, Bonten M, Cremer O, Ko JI, Kim KS, Suh GJ, Kwon WY, Kim K, Shin JH, Ranzani OT, Prina E, Menendez R, Ceccato A, Mendez R, Cilloniz C, Gabarrus A, Ferrer M, Torres A, Urbano A, Zhang LA, Swigon D, Pike F, Parker RS, Clermont G, Scheer C, Kuhn SO, Modler A, Vollmer M, Fuchs C, Hahnenkamp K, Rehberg S, Gründling M, Taggu A, Darang N, Öveges N, László 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Zöllner C, Morton B, Mitsi E, Pennington SH, Reine J, Wright AD, Parker R, Welters ID, Blakey JD, Rajam G, Ades EW, Ferreira DM, Wang D, Kadioglu A, Gordon SB, Koch R, Kox M, Rahamat-Langedoen J, Schloesser J, de Jonge M, Pickkers P, Bringue J, Guillamat-Prats R, Torrents E, Martinez ML, Camprubí-Rimblas M, Artigas A, Blanch L, Park SY, Park YB, Song DK, Shrestha S, Park SH, Koh Y, Park MJ, Hong CW, Lesur O, Coquerel D, Sainsily X, Cote J, Söllradl T, Murza A, Dumont L, Dumaine R, Grandbois M, Sarret P, Marsault E, Salvail D, Auger-Messier M, Chagnon F, Lauretta MP, Greco E, Dyson A, Singer M, Preau S, Ambler M, Sigurta A, Saeed S, Singer M, Sarıca LT, Zibandeh N, Genc D, Gul F, Akkoc T, Kombak E, Cinel L, Akkoc T, Cinel I, Pollen SJ, Arulkumaran N, Singer M, Torrance HD, Longbottom ER, Warnes G, Hinds CJ, Pennington DJ, Brohi K, O’Dwyer MJ, Kim HY, Na S, Kim J, Chang YF, Chao A, Shih PY, Lee CT, Yeh YC, Chen LW, Adriaanse M, Trogrlic Z, Ista E, Lingsma H, Rietdijk W, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, Duran S, Gommers DAMPJ, van der Jagt M, Funcke S, Sauerlaender S, Saugel B, Pinnschmidt H, Reuter DA, Nitzschke R, Perbet S, Biboulet C, Lenoire A, Bourdeaux D, Pereira B, Plaud B, Bazin JE, Sautou V, Mebazaa A, Constantin JM, Legrand M, Boyko Y, Jennum P, Nikolic M. ESICM LIVES 2016: part one. Intensive Care Med Exp 2016. [PMCID: PMC5042924 DOI: 10.1186/s40635-016-0098-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Taylor RS, Hayward C, Eyre V, Austin J, Davies R, Doherty P, Jolly K, Wingham J, Van Lingen R, Abraham C, Green C, Warren FC, Britten N, Greaves CJ, Singh S, Buckingham S, Paul K, Dalal H. Clinical effectiveness and cost-effectiveness of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) facilitated self-care rehabilitation intervention in heart failure patients and caregivers: rationale and protocol for a multicentre randomised controlled trial. BMJ Open 2015; 5:e009994. [PMID: 26700291 PMCID: PMC4691763 DOI: 10.1136/bmjopen-2015-009994] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 09/30/2015] [Accepted: 10/05/2015] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) trial is part of a research programme designed to develop and evaluate a health professional facilitated, home-based, self-help rehabilitation intervention to improve self-care and health-related quality of life in people with heart failure and their caregivers. The trial will assess the clinical effectiveness and cost-effectiveness of the REACH-HF intervention in patients with systolic heart failure and impact on the outcomes of their caregivers. METHODS AND ANALYSIS A parallel two group randomised controlled trial with 1:1 individual allocation to the REACH-HF intervention plus usual care (intervention group) or usual care alone (control group) in 216 patients with systolic heart failure (ejection fraction <45%) and their caregivers. The intervention comprises a self-help manual delivered by specially trained facilitators over a 12-week period. The primary outcome measure is patients' disease-specific health-related quality of life measured using the Minnesota Living with Heart Failure questionnaire at 12 months' follow-up. Secondary outcomes include survival and heart failure related hospitalisation, blood biomarkers, psychological well-being, exercise capacity, physical activity, other measures of quality of life, patient safety and the quality of life, psychological well-being and perceived burden of caregivers at 4, 6 and 12 months' follow-up. A process evaluation will assess fidelity of intervention delivery and explore potential mediators and moderators of changes in health-related quality of life in intervention and control group patients. Qualitative studies will describe patient and caregiver experiences of the intervention. An economic evaluation will estimate the cost-effectiveness of the REACH-HF intervention plus usual care versus usual care alone in patients with systolic heart failure. ETHICS AND DISSEMINATION The study is approved by the North West-Lancaster Research Ethics Committee (ref 14/NW/1351). Findings will be disseminated via journals and presentations to publicise the research to clinicians, commissioners and service users. TRIAL REGISTRATION NUMBER ISRCTN86234930; Pre-results.
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Affiliation(s)
- R S Taylor
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - C Hayward
- Peninsula Clinical Trials Unit, Plymouth University, Plymouth, Devon, UK
| | - V Eyre
- Peninsula Clinical Trials Unit, Plymouth University, Plymouth, Devon, UK
| | - J Austin
- Heart Failure Services and Cardiac Rehabilitation, Aneurin Bevan University Health Board, Nevill Hall Hospital, Abergavenny, UK
| | - R Davies
- Cardiology Department, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - P Doherty
- Department of Health Sciences, University of York, York, UK
| | - K Jolly
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - J Wingham
- Institute of Health Research, University of Exeter Medical School, Exeter, UK Department of Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - R Van Lingen
- Cardiology Department, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - C Abraham
- Psychology Applied to Health Group, University of Exeter Medical School, Exeter, UK
| | - C Green
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - F C Warren
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - N Britten
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - C J Greaves
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - S Singh
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - S Buckingham
- Department of Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - K Paul
- REACH-HF Patient and Public Involvement Group, c/o Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - H Dalal
- Institute of Health Research, University of Exeter Medical School, Exeter, UK Department of Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Truro, UK
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Hansen TB, Zwisler AD, Berg SK, Sibilitz KL, Thygesen LC, Doherty P, Søgaard R. Exercise-based cardiac rehabilitation after heart valve surgery: cost analysis of healthcare use and sick leave. Open Heart 2015; 2:e000288. [PMID: 26301099 PMCID: PMC4538388 DOI: 10.1136/openhrt-2015-000288] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/16/2015] [Accepted: 06/22/2015] [Indexed: 01/05/2023] Open
Abstract
Background Owing to a lack of evidence, patients undergoing heart valve surgery have been offered exercise-based cardiac rehabilitation (CR) since 2009 based on recommendations for patients with ischaemic heart disease in Denmark. The aim of this study was to investigate the impact of CR on the costs of healthcare use and sick leave among heart valve surgery patients over 12 months post surgery. Methods We conducted a nationwide survey on the CR participation of all patients having undergone valve surgery between 1 January 2011 and 30 June 2011 (n=667). Among the responders (n=500, 75%), the resource use categories of primary and secondary healthcare, prescription medication and sick leave were analysed for CR participants (n=277) and non-participants (n=223) over 12 months. A difference-in-difference analysis was undertaken. All estimates were presented as the means per patient (95% CI) based on non-parametric bootstrapping of SEs. Results Total costs during the 12 months following surgery were €16 065 per patient (95% CI 13 730 to 18 399) in the CR group and €15 182 (12 695 to 17 670) in the non-CR group. CR led to 5.6 (2.9 to 8.3, p<0.01) more outpatient visits per patient. No statistically significant differences in other cost categories or total costs €1330 (−4427 to 7086, p=0.65) were found between the groups. Conclusions CR, as provided in Denmark, can be considered cost neutral. CR is associated with more outpatient visits, but CR participation potentially offsets more expensive outpatient visits. Further studies should investigate the benefits of CR to heart valve surgery patients as part of a formal cost-utility analysis.
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Affiliation(s)
- T B Hansen
- Department of Cardiology , Roskilde Hospital , Roskilde , Denmark ; Centre for Applied Health Services Research, University of Southern Denmark , Odense , Denmark ; Department of Cardiology , The Heart Centre, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - A D Zwisler
- Department of Cardiology , The Heart Centre, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark . ; National Institute of Public Health, University of Southern Denmark , Copenhagen , Denmark ; National Centre of Rehabilitation and Palliation, University of Southern Denmark and University Hospital of Odense , Odense , Denmark
| | - S K Berg
- Department of Cardiology , The Heart Centre, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - K L Sibilitz
- Department of Cardiology , The Heart Centre, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - L C Thygesen
- National Institute of Public Health, University of Southern Denmark , Copenhagen , Denmark
| | - P Doherty
- Department of Health Sciences , University of York , York , UK
| | - R Søgaard
- Department of Public Health , Aarhus University , Aarhus , Denmark ; Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
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Vanhees L, Rauch B, Piepoli M, van Buuren F, Takken T, Börjesson M, Bjarnason-Wehrens B, Doherty P, Dugmore D, Halle M. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular disease (Part III). Eur J Prev Cardiol 2012; 19:1333-56. [DOI: 10.1177/2047487312437063] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [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: 11/15/2022]
Affiliation(s)
| | - B Rauch
- Centre for Ambulatory Cardiac and Angiologic Rehabilitation, Ludwigshafen, Germany
| | - M Piepoli
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - T Takken
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Börjesson
- Sahlgrenska University Hospital/Ostra, Goteborg, Sweden
| | | | | | - D Dugmore
- Wellness International Medical Centre, Stockport, UK
| | - M Halle
- University Hospital ‘Klinikum rechts der Isar’, Technische Universitaet Muenchen, Munich, Germany
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Vanhees L, De Sutter J, Geladas N, Doyle F, Prescott E, Cornelissen V, Kouidi E, Dugmore D, Vanuzzo D, Börjesson M, Doherty P. Importance of characteristics and modalities of physical activity and exercise in defining the benefits to cardiovascular health within the general population: recommendations from the EACPR (Part I). Eur J Prev Cardiol 2012; 19:670-86. [DOI: 10.1177/2047487312437059] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Over the last decades, more and more evidence is accumulated that physical activity (PA) and exercise interventions are essential components in primary and secondary prevention for cardiovascular disease. However, it is less clear whether and which type of PA and exercise intervention (aerobic exercise, dynamic resistive exercise, or both) or characteristic of exercise (frequency, intensity, time or duration, and volume) would yield more benefit in achieving cardiovascular health. The present paper, as the first of a series of three, will make specific recommendations on the importance of these characteristics for cardiovascular health in the population at large. The guidance offered in this series of papers is aimed at medical doctors, health practitioners, kinesiologists, physiotherapists and exercise physiologists, politicians, public health policy makers, and the individual member of the public. Based on previous and the current literature, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding type, volume, and intensity of PA and exercise.
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Affiliation(s)
| | | | - N Geladas
- University of Athens, Athens, Greece
| | - F Doyle
- Royal College of Surgeons, Dublin, Ireland
| | - E Prescott
- Bispebjerg University Hospital, Copenhagen, Denmark
| | | | - E Kouidi
- Aristotle University, Thessaloniki, Greece
| | - D Dugmore
- Wellness International Medical Centre, Stockport, UK
| | - D Vanuzzo
- Cardiovascular Prevention Centre, Udine, Italy
| | - M Börjesson
- Sahlgrenska University Hospital/Ostra, Goteborg, Sweden
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Dalal HM, Wingham J, Lewin R, Doherty P, Taylor RS. Involving primary care and cardiac rehabilitation in a reorganised service could improve outcomes. Heart 2011; 97:1191; discussion 1191. [DOI: 10.1136/heartjnl-2011-300326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Khan E, O'Brien B, Breatnach C, Mannion D, Doherty P. Recovery after paediatric day case surgery: a prospective observational audit. Ir Med J 2010; 103:252. [PMID: 21046872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Abstract
A long-term, large-scale empirical test of the recruitment limitation hypothesis was done by sampling fish populations from the southern Great Barrier Reef after having monitored their recruitment histories for 9 years. After adjustment for demographic differences, recruitment patterns explained over 90 percent of the spatial variation in abundance of a common damselfish among seven coral reefs. The age structures from individual reefs also preserved major temporal variations in the recruitment signal over at least 10 years. Abundance and demography of this small fish at these spatial and temporal scales can be explained almost entirely as variable recruitment interacting with density-independent mortality.
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Doodnath R, Gillick J, Doherty P. Anaesthetic implications of laparoscopic splenectomy in patients with sickle cell anaemia. Ir Med J 2010; 103:121-122. [PMID: 20486319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
With the increasing immigrant population in the Republic of Ireland, the number of patients with sickle cell disease (SCD) seen in the paediatric hospitals is climbing. In this case report, we review the anaesthetic implications and outcome of the first two paediatric patients with SCD to have a laparoscopic splenectomy due to repeated splenic infarcts in the Republic of Ireland.
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Affiliation(s)
- R Doodnath
- Our Lady's Children's Hospital, Crumlin, Dublin 12.
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Walthall H, Doherty P. 89 Poster is there Sufficient Evidence for the Effectiveness of Exercise in Improving Outcomes for NYHA Class IV Heart Failure Patients? Eur J Cardiovasc Nurs 2010. [DOI: 10.1016/s1474-5151(10)60071-0] [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: 10/19/2022]
Affiliation(s)
| | - P. Doherty
- York St John University, York, United Kingdom
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Mackay A, Erskine J, Doherty P, McMillan E. Referral to intensive care: who and when? Crit Care 2010. [PMCID: PMC2934484 DOI: 10.1186/cc8649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Rajabi R, Doherty P, Goodarzi M, Hemayattalab R. Comparison of thoracic kyphosis in two groups of elite Greco-Roman and freestyle wrestlers and a group of non-athletic participants. Br J Sports Med 2008; 42:229-32; discussion 232. [PMID: 17615172 DOI: 10.1136/bjsm.2006.033639] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [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: 11/04/2022]
Abstract
BACKGROUND Freestyle and Greco-Roman are two types of wrestling that place the spine of athletes in different positions. Theoretically, it can be argued that this can lead to adverse effects on the spine and might be an important factor associated with changes in the degree of kyphosis. OBJECTIVES The aim of this study was to investigate whether the extent of thoracic kyphosis differs in two groups of elite wrestlers and a group of non-athletic participants. METHODS Sixty elite Iranian male wrestlers including 30 freestyle (mean (SD) age 23.5 (2.8) years, height 176 (7.1) cm and weight 77.8 (16.1) kg) and 30 Greco-Roman (age 23.9 (2.9) years, height 176 (4) cm and weight 80.1 (11.1) kg) wrestlers and 30 male non-athletes (age 23.3 (2.1) years, height 175 (8) cm and weight 75.2 (6.7) kg) were recruited. All wrestlers competed at international level with the Iranian national team or Iranian student national team. Each selected wrestler had to meet a minimum criterion of 5 years' wrestling. The degree of kyphosis was measured using a modified electrogoniometer. RESULTS Mean (SD) kyphosis was 30 degrees (3.8), 24.3 degrees (3.7) and 27.4 degrees (3.2) for the freestyle, Greco-Roman style and non-athlete groups, respectively. A significant difference was found in mean kyphosis between all groups (p<0.05) with freestyle being the highest and Greco-Roman the lowest. CONCLUSIONS The degree of kyphosis was highest in freestyle wrestling, followed by non-athletes and then Greco-Roman wrestlers. The extent of kyphosis was not influenced by years of training or age of starting wrestling.
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Affiliation(s)
- R Rajabi
- Department of Physical Education and Sport Sciences, Sport Medicine Division, University of Tehran, Engelab SQ, Tehran, Iran.
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Barnett S, Luempert L, Schuele G, Quezada A, Strehlau G, Doherty P. Efficacy of pyriprole topical solution against the cat flea, Ctenocephalides felis, on dogs. Vet Ther 2008; 9:4-14. [PMID: 18415942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Three studies evaluating various aspects of the performance of pyriprole against the cat flea, Ctenocephalides felis, on dogs demonstrated that 12.5% pyriprole applied as a spot-on provides rapid, long-lasting efficacy against adult cat fleas, even under severe flea challenge. Speed of kill data indicate treatment with this product can interrupt an already established adult flea infestation, whereas monthly treatment can prevent reinfestation. Pyriprole disrupts the flea life cycle by killing adult fleas before they lay eggs for at least 30 days after treatment. The residual effect of pyriprole on debris from treated dogs (dander, hair, scales, and flea feces) resulted in a decreased ability of cat flea larvae to complete development to the adult stage for 2 weeks after application. Based on the results of these studies, 12.5% pyriprole represents a valuable new tool in the control of the cat flea, C. felis, on dogs.
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Carlson RF, Doherty P, Margaziotis DJ, Slaus I, Tin SY, van Oers WTH. Proton-deuteron total reaction cross-sections in the energy range (20÷50) MeV. ACTA ACUST UNITED AC 2007. [DOI: 10.1007/bf02724711] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Davis LM, Harris C, Tang L, Doherty P, Hraber P, Sakai Y, Bocklage T, Doeden K, Hall B, Alsobrook J, Rabinowitz I, Williams TM, Hozier J. Amplification patterns of three genomic regions predict distant recurrence in breast carcinoma. J Mol Diagn 2007; 9:327-36. [PMID: 17591932 PMCID: PMC1899419 DOI: 10.2353/jmoldx.2007.060079] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [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: 11/20/2022] Open
Abstract
Currently used clinical and histopathological parameters imprecisely define the risk of distant recurrence in breast cancer, underscoring the need for more informative prognostic markers. In the present fluorescence in situ hybridization study of archived surgical specimens, we derived an algorithm for computing a prognostic index (PI) from DNA copy numbers of three genomic regions (CYP24, PDCD6IP, and BIRC5) for estrogen/progesterone receptor-positive (ER/PR+) cancers and a distinct PI (based on NR1D1, SMARCE1, and BIRC5) for estrogen/progesterone receptor-negative (ER/PR-) cancers. Among independent test cases stratified by PI, recurrence rates were significantly higher among high-risk patients than low-risk patients for both ER/PR+ (odds ratio = 9.52, 95% confidence interval >2.12, P = 0.0024) and ER/PR- (odds ratio = 12.3, 95% confidence interval >1.45, P = 0.0188) cancers. Among the entire population, recurrences were significantly more prevalent for cases with PI above the medians for both ER/PR+ (Fisher's exact, P = 1.19 x 10(-5)) and ER/PR- (P = 0.0025) patients and for the node-negative subsets (ER/PR+ node-negative, P = 0.042 and ER/PR- node-negative, P = 0.039). In conclusion, these markers perform well in comparison with other criteria for recurrence risk assessment and can be used with routinely formalin-fixed, paraffin-embedded surgical specimens.
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MESH Headings
- Biomarkers, Tumor/genetics
- Breast Neoplasms/diagnosis
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Disease-Free Survival
- Female
- Follow-Up Studies
- Gene Amplification
- Gene Dosage
- Genome, Human
- Humans
- In Situ Hybridization, Fluorescence
- Lymphatic Metastasis
- Middle Aged
- Prognosis
- Receptors, Estrogen/genetics
- Receptors, Progesterone/genetics
- Recurrence
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Abstract
OBJECTIVE To investigate the prevalence and predictors of early drop-out from a cardiac rehabilitation programme and also whether completers and drop-out patients differed in relation to their illness cognitions, gender and psychological distress and quality of life. DESIGN A six-week outpatient cardiac rehabilitation programme. SETTING A university teaching hospital. SUBJECTS One hundred and eighty-nine patients were recruited from a consecutive series of outpatient referrals prior to a six-week comprehensive cardiac rehabilitation programme. OUTCOME MEASURES The revised Illness Perception Questionnaire, Quality of Life after Myocardial Infarction Questionnaire and the Hospital Anxiety and Depression Scale. RESULTS One hundred and forty-seven cardiac patients completed the cardiac rehabilitation programme. Forty-two (22%) patients dropped out in the first two weeks. Factors predicting early drop-out were female gender, younger age, higher Hospital Anxiety Depression Scale score, lower illness perception consequences and higher illness perception personal control and lower illness perception treatment control (all P < 0.05). CONCLUSION Over a fifth of the patients did not complete this typical cardiac rehabilitation programme. Female patients are more likely to drop out from cardiac rehabilitation than men. Psychological distress, younger age and lower perceptions of consequences, higher perception personal control and lower illness perception of treatment control were predictors of early drop-out from a cardiac rehabilitation programme.
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Affiliation(s)
- A M Yohannes
- Manchester Metropolitan University, Manchester, UK.
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Doherty P, Digby B. Analysis of critical incidents during the interhospital transport of critically ill patients. Crit Care 2007. [PMCID: PMC4095555 DOI: 10.1186/cc5662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Watson S, Doherty P, Graham A. [P173]: Endocannabinoid signalling during early neuronal development. Int J Dev Neurosci 2006. [DOI: 10.1016/j.ijdevneu.2006.09.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Alsobrook J, Hraber P, Davis L, Harris C, Doherty P, Hall B, Williams T, Hozier J. HER2 comparison with novel 3-gene marker sets for risk prediction of distant recurrence of breast carcinoma. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.20009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
20009 Background: The risk of distant recurrence in patients with invasive breast carcinoma (BrCa) is predicted imperfectly by currently used factors (e.g. nuclear grade, hormone receptor status), complicating adjuvant therapy decisions. In an effort to discover biomarkers for recurrence, we retrospectively analyzed BrCa recurrence and tumor gene amplification. Multi-gene marker sets were evaluated for predictive significance and accuracy. Because studies of HER2 as a suitable biomarker report positive and negative results, we compared our marker sets with HER2. Methods: 229 of 723 BrCa patients met inclusion criteria: invasive ductal carcinoma, no isolated local recurrence, minimum 4 years follow-up, and archived specimens adequate for fluorescent in situ hybridization (FISH) assay. Study endpoint was recurrence, or non-recurrence throughout follow-up. FISH was performed on formalin-fixed paraffin sections with probes for previously identified genomic regions. Signals were counted with a Metasystems workstation, and used in a “Prognostic Index” (PI) to categorize recurrence risk. One-sided Fisher’s exact test was used to assess increased incidence of distant recurrence in relation to PI and HER2, and increased incidence of HER2 amplification in relation to PI. Results: Two separate 3-gene marker sets were obtained that predict clinical outcome for hormone receptor + (HR+) and hormone receptor − (HR−) tumors. In HR+ samples a PI based upon regions surrounding CYP24, PDCP6IP, and BIRC5 was the best predictor of recurrence, while for HR- specimens the PI was based on the NR1D1, SMARCE1, and BIRC5 regions. The PIs are significantly associated with recurrence of HR+ and HR− tumors (OR = 9.52, 95% CI > 2.12, p = 0.0024; and OR = 12.3, 95% CI > 1.45, p = 0.0188, respectively). However, tumor HER2 amplification was not prognostic for recurrence (OR = 1.76, 95% CI > 0.77, p = 0.1395). Furthermore, there was no significant association of PI with HER2 status (OR = 1.56, CI > 0.57, p = 0.862). Conclusions: Prognostic Indices based on copy numbers of two 3-gene marker sets significantly predict clinical outcome of stage I-III invasive ductal carcinoma. HER2 amplification, included in our previous whole genome survey but not present in our final marker sets, had no prognostic value. [Table: see text]
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Affiliation(s)
- J. Alsobrook
- Exagen Diagnostics, Inc., Albuquerque, NM; University of New Mexico School of Medicine, Albuquerque, NM
| | - P. Hraber
- Exagen Diagnostics, Inc., Albuquerque, NM; University of New Mexico School of Medicine, Albuquerque, NM
| | - L. Davis
- Exagen Diagnostics, Inc., Albuquerque, NM; University of New Mexico School of Medicine, Albuquerque, NM
| | - C. Harris
- Exagen Diagnostics, Inc., Albuquerque, NM; University of New Mexico School of Medicine, Albuquerque, NM
| | - P. Doherty
- Exagen Diagnostics, Inc., Albuquerque, NM; University of New Mexico School of Medicine, Albuquerque, NM
| | - B. Hall
- Exagen Diagnostics, Inc., Albuquerque, NM; University of New Mexico School of Medicine, Albuquerque, NM
| | - T. Williams
- Exagen Diagnostics, Inc., Albuquerque, NM; University of New Mexico School of Medicine, Albuquerque, NM
| | - J. Hozier
- Exagen Diagnostics, Inc., Albuquerque, NM; University of New Mexico School of Medicine, Albuquerque, NM
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Barker R, Biddulph P, Bly D, Boysen R, Brown A, Clementson C, Crofts M, Culverhouse T, Czeres J, Dace R, D'Alessandro R, Doherty P, Duffett-Smith P, Duggan K, Ely J, Felvus M, Flynn W, Geisbusch J, Grainge K, Grainger W, Hammet D, Hills R, Hobson M, Holler C, Jilley R, Jones ME, Kaneko T, Kneissl R, Lancaster K, Lasenby A, Marshall P, Newton F, Norris O, Northrop I, Pooley G, Quy V, Saunders RDE, Scaife A, Schofield J, Scott P, Shaw C, Taylor AC, Titterington D, Veli M, Waldram E, West S, Wood B, Yassin G, Zwart J. High-significance Sunyaev-Zel'dovich measurement: Abell 1914 seen with the Arcminute Microkelvin Imager. ACTA ACUST UNITED AC 2006. [DOI: 10.1111/j.1745-3933.2006.00151.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Samuel MC, Bulterys M, Jenison S, Doherty P. Tattoos, incarceration and hepatitis B and C among street-recruited injection drug users in New Mexico, USA: update. Epidemiol Infect 2006; 133:1146-8. [PMID: 16274514 PMCID: PMC2870351 DOI: 10.1017/s0950268805225517] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
To the Editor:In a previous report [1], we described significant risks for hepatitis B (HBV) and hepatitis C (HCV) positivity associated with receipt of tattoos, particularly while incarcerated, among a street-recruited population of injection drug users (IDUs) in New Mexico, United States from 1995 to 1997. Another recent report in this Journal, based on a study conducted on prisoners in Australia, found tattooing in prison to be an independent risk for HCV [2]. Another report also described a strong association between tattoos and HCV, but found the strongest association to be with commercial tattooing venues [3]. That study found the risk associated with receipt of tattoos in prison elevated, but not statistically significant. That same report reviewed other articles and found a significant risk for HCV infection associated with tattoos in six out of eight studies that had data available. Further, a recent U.S. Centers for Disease Control and Prevention (CDC) document summarized the literature on risks for hepatitis infections in correctional settings and developed extensive control guidelines [4].
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Abstract
BACKGROUND/AIM The law on consent has changed in Scotland with the introduction of the Adults with Incapacity (Scotland) Act 2000. This Act introduces the concept of proxy consent in Scotland. Many patients in intensive care are unable to participate in the decision making process because of their illness and its treatment. It is normal practice to provide relatives with information on the patient's condition, treatment, and prognosis as a substitute for discussion directly with the patient. The relatives of intensive care patients appeared to believe that they already had the right to consent on behalf of an incapacitated adult. The authors' aim was to assess the level of knowledge among relatives of intensive care patients of both the old and new law using a structured questionnaire. METHODS The next of kin of 100 consecutive patients completed a structured questionnaire. Each participant had the questions read to them and their answers recorded. Patients were not involved in the study. RESULTS Few (10%) were aware of the changes. Most (88%) thought that they previously could give consent on behalf of an incapacitated adult. Only 13% have ever discussed the preferences for life sustaining treatment with the patient but 84% felt that they could accurately represent the patient's wishes. CONCLUSIONS There appeared to be a lack of public awareness of the impending changes. The effectiveness of the Act at improving the care of the mentally incapacitated adult will depend largely on how successful it is at encouraging communication and decision making in advance of incapacity occurring.
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Affiliation(s)
- M G Booth
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK.
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Campbell L, Imrie G, Doherty P, Porteous C, Millar K, Kenny GNC, Fletcher G. Patient maintained sedation for colonoscopy using a target controlled infusion of propofol. Anaesthesia 2004; 59:127-32. [PMID: 14725514 DOI: 10.1111/j.1365-2044.2004.03580.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [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: 12/19/2022]
Abstract
In this study, we evaluated safety and recovery using a patient maintained, target controlled infusion of propofol for sedation in 20 patients undergoing colonoscopy. Using a handset with a two-minute lockout interval, patients could make 0.2 micro g.ml(-1) increments to an initial target plasma concentration of 1 micro g.ml(-1) up to a maximum 4.5 micro g.ml(-1). Four patients became oversedated but required no airway or circulatory interventions. Subjects had a significant reduction in mean (SD) heart rate: 78.7 (15) vs. 69.8 (13.5) (p < 0.001) and in systolic blood pressure 121.1 (13.2) mmHg vs. 96.5 (8.6) mmHg (p < 0.001). Choice reaction time testing 15 min after colonoscopy showed a significant median (IQR [range]) rise of 162 (- 16, 383.3 [-199-859]) ms (p < 0.05). Six patients had faster reaction times postcolonoscopy. All patients denied unpleasant recall and were satisfied with the system. Although oversedation was a problem in this model, we conclude that patient maintained propofol sedation could be possible for colonoscopy.
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Affiliation(s)
- L Campbell
- Department of Anaesthetics, The Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK.
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40
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Doherty P, O'Leary D, Brennan PC. Do CEC guidelines under-utilise the full potential of increasing kVp as a dose-reducing tool? Eur Radiol 2003; 13:1992-9. [PMID: 12942300 DOI: 10.1007/s00330-002-1810-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2002] [Accepted: 12/06/2002] [Indexed: 10/26/2022]
Abstract
Increasing beam energies are well established as a radiation dose-reducing tool in diagnostic radiology. This has led to useful recommendations by the Commission of European Communities (CEC) for appropriate kVp values to be employed for a variety of examinations. The current work tests the hypothesis that kVp levels above those recommended by the CEC will result in reduced patient dose while still producing images of acceptable quality. This study explored the effect of a range of kVp levels within and above CEC recommendations for lumbar spine radiology. A phantom investigation facilitated selection of appropriate kVp levels for a patient study ( n=59): 81 kVp (CEC) and 96 kVp (non-CEC) for the AP projection and 90 kVp (CEC) and 102 kVp (non-CEC) for the lateral projection. Entrance surface and effective dose were calculated and image quality quantified using CEC image criteria and images of a detail contrast test tool. Data analysis demonstrated significant reduction in effective radiation dose for AP (29.9%) and lateral (24.6%) when a kVp value above the CEC range was employed compared with a kVp recommended by the CEC. Although significant reductions in total image quality of 18.3% and 10.1% for the antero-posterior and lateral projections, respectively, were noted, all patient images produced with all kVp values were considered acceptable by each member of the evaluative panel with all image criteria receiving a score of 2 (out of 3) or better. The psychophysical tests revealed minor non-significant reductions in visualisation scores. The current study demonstrated that kVp values outside the CEC recommended range offer reductions in dose while producing acceptable images. Practitioners should be guided, rather than constrained, by the CEC recommendations on good radiographic technique. The need for further work exploring the effect of higher energies on visualisation of subtle pathological lesions has been identified.
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Affiliation(s)
- P Doherty
- UCD School of Diagnostic Imaging, Herbert Avenue, Dublin 4, Ireland
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41
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Doherty P, Fitchet A, Bundy C, Bell W, Fitzpatrick A, Garratt C. Comprehensive Cardiac Rehabilitation for Patients with Implanted Cardiac Defibrillators. Physiotherapy 2002. [DOI: 10.1016/s0031-9406(05)60735-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Williams EJ, Williams G, Howell FV, Skaper SD, Walsh FS, Doherty P. Identification of an N-cadherin motif that can interact with the fibroblast growth factor receptor and is required for axonal growth. J Biol Chem 2001; 276:43879-86. [PMID: 11571292 DOI: 10.1074/jbc.m105876200] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.1] [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: 01/14/2023] Open
Abstract
In this study, we show that the neurite outgrowth response stimulated by N-cadherin is inhibited by a recently developed and highly specific fibroblast growth factor receptor (FGFR) antagonist. To test whether the N-cadherin response also requires FGF function, we developed peptide mimetics of the receptor binding sites on FGFs. Most mimetics inhibit the neurite outgrowth response stimulated by FGF in the absence of any effect on the N-cadherin response. The exceptions to this result were two mimetics of a short FGF1 sequence, which has been shown to interact with the region of the FGFR containing the histidine-alanine-valine motif. These peptides inhibited FGF and N-cadherin responses with similar efficacy. The histidine-alanine-valine region of the FGFR has previously been implicated in the N-cadherin response, and a candidate interaction site has been identified in extracellular domain 4 of N-cadherin. We now show that antibodies directed to this site on N-cadherin inhibit the neurite outgrowth response stimulated by N-cadherin, and peptide mimetics of the site inhibit N-cadherin and FGF responses. Thus, we can conclude that N-cadherin contains a novel motility motif in extracellular domain 4, and that peptide mimetics of this motif can interact with the FGFR.
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Affiliation(s)
- E J Williams
- Molecular Neurobiology Group, MRC Center for Developmental Neurobiology, King's College London, London SE1 1UL, United Kingdom
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Hatton WJ, Mason HS, Carl A, Doherty P, Latten MJ, Kenyon JL, Sanders KM, Horowitz B. Functional and molecular expression of a voltage-dependent K(+) channel (Kv1.1) in interstitial cells of Cajal. J Physiol 2001; 533:315-27. [PMID: 11389194 PMCID: PMC2278641 DOI: 10.1111/j.1469-7793.2001.0315a.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [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] [Indexed: 11/30/2022] Open
Abstract
1. Located within the gastrointestinal (GI) musculature are networks of cells known as interstitial cells of Cajal (ICC). ICC are associated with several functions including pacemaker activity that generates electrical slow waves and neurotransmission regulating GI motility. In this study we identified a voltage-dependent K(+) channel (Kv1.1) expressed in ICC and neurons but not in smooth muscle cells. 2. Transcriptional analyses demonstrated that Kv1.1 was expressed in whole tissue but not in isolated smooth muscle cells. Immunohistochemical co-localization of Kv1.1 with c-kit (a specific marker for ICC) and vimentin (a specific marker of neurons and ICC) indicated that Kv1.1-like immunoreactivity (Kv1.1-LI) was present in ICC and neurons of GI tissues of the dog, guinea-pig and mouse. Kv1.1-LI was not observed in smooth muscle cells of the circular and longitudinal muscle layers. 3. Kv1.1 was cloned from a canine colonic cDNA library and expressed in Xenopus oocytes. Pharmacological investigation of the electrophysiological properties of Kv1.1 demonstrated that the mamba snake toxin dendrotoxin-K (DTX-K) blocked the Kv1.1 outward current when expressed as a homotetrameric complex (EC(50) = 0.34 nM). Other Kv channels were insensitive to DTX-K. When Kv1.1 was expressed as a heterotetrameric complex with Kv1.5, block by DTX-K dominated, indicating that one or more subunits of Kv1.1 rendered the heterotetrameric channel sensitive to DTX-K. 4. In patch-clamp experiments on cultured murine fundus ICC, DTX-K blocked a component of the delayed rectifier outward current. The remaining, DTX-insensitive current (i.e. current in the presence of 10(-8) M DTX-K) was outwardly rectifying, rapidly activating, non-inactivating during 500 ms step depolarizations, and could be blocked by both tetraethylammonium (TEA) and 4-aminopyridine (4-AP). 5. In conclusion, Kv1.1 is expressed by ICC of several species. DTX-K is a specific blocker of Kv1.1 and heterotetrameric channels containing Kv1.1. This information is useful as a means of identifying ICC and in studies of the role of delayed rectifier K(+) currents in ICC functions.
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Affiliation(s)
- W J Hatton
- Department of Physiology and Cell Biology, University of Nevada, School of Medicine, Reno, NV 89557, USA
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44
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Dunican DJ, Williams EJ, Howell FV, Doherty P. Selective inhibition of fibroblast growth factor (FGF)-stimulated mitogenesis by a FGF receptor-1-derived phosphopeptide. Cell Growth Differ 2001; 12:255-64. [PMID: 11373272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
The activated fibroblast growth factor receptor (FGFR)-1 is phosphorylated on five tyrosine residues outside the catalytic site. Although one such residue, Tyr730, is flanked by potential binding sites for phosphotyrosine-interacting molecules, a physiological role for this region is still controversial. We report that a cell-permeant phosphopeptide mimic of this site, FGFR730(p)Y, inhibits FGF-mediated mitogenesis in cells with no effect on responses stimulated by other growth factors. A similar phosphopeptide corresponding to the phospholipase Cgamma binding site on the receptor had no effect on the mitogenic response. The FGFR730(p)Y peptide did not inhibit phosphorylation of p90/FRS2 or Erk, suggesting that it does not act by inhibiting the Erk-kinase cascade. However, the FGFR730(p)Y peptide bound Shc in a manner requiring both phosphorylated tyrosine and a putative PTB domain binding determinant. These data suggest that the peptide might inhibit mitogenesis by competing with the corresponding site on the FGFR for the ability to bind SHC.
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Affiliation(s)
- D J Dunican
- Molecular Neurobiology Group, MRC Centre for Developmental Neurobiology, Kings College London, London Bridge, London SE1 1UL, United Kingdom
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45
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Utton MA, Eickholt B, Howell FV, Wallis J, Doherty P. Soluble N-cadherin stimulates fibroblast growth factor receptor dependent neurite outgrowth and N-cadherin and the fibroblast growth factor receptor co-cluster in cells. J Neurochem 2001; 76:1421-30. [PMID: 11238727 DOI: 10.1046/j.1471-4159.2001.00140.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.8] [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: 11/20/2022]
Abstract
A chimeric molecule consisting of the extracellular domain of the adhesion molecule, N-cadherin, fused to the Fc region of human IgG (NCAD-Fc) supports calcium-dependent cell adhesion and promotes neurite outgrowth following affinity-capture to a tissue culture substrate. When presented to cerebellar neurons as a soluble molecule, the NCAD-Fc stimulated neurite outgrowth in a manner equivalent to that seen for N-cadherin expressed as a cell surface glycoprotein. Neurons expressing a dominant-negative version of the fibroblast growth factor (FGF) receptor did not respond to soluble NCAD-Fc. In cells transfected with full-length N-cadherin and the FGF receptor, antibody-clustering of N-cadherin resulted in a co-clustering of the FGF receptor to discrete patches in the cell membrane. The data demonstrate that the ability of N-cadherin to stimulate neurite outgrowth can be dissociated from its ability to function as a substrate associated adhesion molecule. The N-cadherin and the FGF receptor co-clustering in cells provides a basis for the neurite outgrowth response stimulated by N-cadherin being dependent on FGF receptor function.
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Affiliation(s)
- M A Utton
- Molecular Neurobiology Group, GKT School of Medicine, London, UK.
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46
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Franceschini I, Angata K, Ong E, Hong A, Doherty P, Fukuda M. Polysialyltransferase ST8Sia II (STX) polysialylates all of the major isoforms of NCAM and facilitates neurite outgrowth. Glycobiology 2001; 11:231-9. [PMID: 11320061 DOI: 10.1093/glycob/11.3.231] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [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] [Indexed: 01/28/2023] Open
Abstract
The neural cell adhesion molecule (NCAM) has different isoforms due to different sizes in its polypeptide and plays a significant role in neural development. In neural development, the function of NCAM is modified by polysialylation catalyzed by two polysialyltransferases, ST8Sia II and ST8Sia IV. Previously, it was reported by others that ST8Sia II polysialylates only transmembrane isoforms of the NCAM, such as NCAM-140 and NCAM-180, but not NCAM-120 and NCAM-125 anchored by a glycosylphosphotidylinositol. In the present study, we first discovered that ST8Sia II polysialylates all isoforms of the NCAM examined, and we demonstrated that polysialylation of NCAM expressed on 3T3 cells facilitates neurite outgrowth regardless of isoforms of NCAM, where polysialic acid is attached. We then show that neurite outgrowth is significantly facilitated only when polysialylated NCAM is present in cell membranes. Moreover, the soluble NCAM coated on plates did not have an effect on neurite outgrowth exerted by soluble L1 adhesion molecule coated on plates. These results, taken together, indicate that ST8Sia II plays critical roles in modulating the function of all major isoforms of NCAM. The results also support previous studies showing that a signal cascade initiated by NCAM differs from that initiated by L1 molecule.
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Affiliation(s)
- I Franceschini
- Glycobiology Program, Cancer Research Center, The Burnham Institute, 10901 North Torrey Pines Road, La Jolla, CA 92037, USA
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Callaghan MJ, McCarthy C, Oldham JA, Al-Zahrani E, Doherty P. Reliability of Surface EMG Recordings of the Quadriceps in a Healthy and a Patient Population. Physiotherapy 2001. [DOI: 10.1016/s0031-9406(05)60447-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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48
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Abstract
A central theme in intracellular signaling is the regulatable interaction of proteins via the binding of specialized domains on one protein to short linear sequences on other molecules. The capability of these short sequences to mediate the required specificity and affinity for signal transduction allows for the rational design of peptide-based modulators of specific protein-protein interactions. Such inhibitors are valuable tools for elucidating the role of these interactions in cellular physiology and in targeting such interactions for potential therapeutic intervention. This approach is exemplified by the study of the role of phosphorylation of specific sites on signaling proteins. However, the difficulty of introducing large hydrophilic molecules such as phosphopeptides into cells has been a major drawback in this area. This review describes the application of recently developed cell-permeant peptide vectors in the introduction of biologically active peptides into cells, with particular emphasis on the antennapedia/penetratin, TAT, and signal-peptide based sequences. In addition, the modification of such peptides to increase uptake efficiency and affinity for their targets is discussed. Finally, the use of cell-permeant phosphopeptides to both inhibit and stimulate intracellular signaling mechanisms is described, by reference to the PLCgamma, Grb2, and PI-3 kinase pathways.
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Affiliation(s)
- D J Dunican
- Molecular Neurobiology Group, New Hunts House, 4th Floor South Wing, Guy's Campus, Kings College London, London Bridge, London SE1 9RT, UK
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49
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Abstract
Calcium has long been recognized as a key player in the control of axonal growth and guidance. Recent studies lend support to this pivotal role by showing that local changes in calcium can directly induce the formation of filopodia in vivo and turn a growth cone in vitro. Under normal growth conditions, the L1 adhesion molecule has now been shown to induce local rather than global changes in calcium in growth cones, and this suggests that cell adhesion molecules (CAMs) use localized calcium transients to stimulate axonal growth and guidance. A number of recent reports have demonstrated that the neurite outgrowth response stimulated by L1 and other adhesion molecules (NCAM, N-cadherin, laminin) also depends in part upon the integrity of the MAPK cascade in cells. In this review we consider the recent data and suggest that calcium and the MAPK cascade might be required for very distinct growth cone functions. Finally, we will consider the contentious issue of how the above CAMs activate signaling cascades in growth cones and review the recently available data that support the hypothesis that at least one of these CAMs (N-cadherin) might promote growth cone motility by directly interacting with the FGFR in growth cones.
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Affiliation(s)
- P Doherty
- Molecular Neurobiology Group, MRC Centre for Developmental Neurobiology, King's College London, United Kingdom.
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50
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Skaper SD, Kee WJ, Facci L, Macdonald G, Doherty P, Walsh FS. The FGFR1 inhibitor PD 173074 selectively and potently antagonizes FGF-2 neurotrophic and neurotropic effects. J Neurochem 2000; 75:1520-7. [PMID: 10987832 DOI: 10.1046/j.1471-4159.2000.0751520.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.3] [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: 12/21/2022]
Abstract
Basic fibroblast growth factor (FGF-2) promotes survival and/or neurite outgrowth from a variety of neurons in cell culture and regenerative processes in vivo. FGFs exert their effects by activating cell surface receptor tyrosine kinases. FGF receptor (FGFR) inhibitors have not been characterized on neuronal cell behaviors to date. In the present study, we show that the FGFR1 inhibitor PD 173074 potently and selectively antagonized the neurotrophic and neurotropic actions of FGF-2. Nanomolar concentrations of PD 173074 prevented FGF-2, but not insulin-like growth factor-1, support of cerebellar granule neuron survival under conditions of serum/K(+) deprivation; another FGF-2 inhibitor, SU 5402, was effective only at a 1,000-fold greater concentration. Neither PD 173074 nor SU 5402, at 100 times their IC(50) values, interfered with the survival of dorsal root ganglion neurons promoted by nerve growth factor, ciliary neurotrophic factor, or glial cell line-derived neurotrophic factor. PD 173074 and SU 5402 displayed 1,000-fold differential IC(50) values for inhibition of FGF-2-stimulated neurite outgrowth in PC12 cells and in granule neurons, and FGF-2-induced mitogen-activated protein kinase (p44/42) phosphorylation. The two inhibitors failed to disturb downstream signalling stimuli of FGF-2. PD 173074 represents a valuable tool for dissecting the role of FGF-2 in normal and pathological nervous system function without compromising the actions of other neurotrophic factors.
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Affiliation(s)
- S D Skaper
- Department of Neuroscience Research, SmithKline Beecham Pharmaceuticals, Essex, England.
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