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Forde R, Collin J, Brackenridge A, Chamley M, Hunt K, Forbes A. A qualitative study exploring the factors that influence the uptake of pre-pregnancy care among women with Type 2 diabetes. Diabet Med 2020; 37:1038-1048. [PMID: 31127872 DOI: 10.1111/dme.14040] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 01/19/2023]
Abstract
AIM To elicit the views and experiences of women with Type 2 diabetes and healthcare professionals relating to the pregnancy and pre-pregnancy care they have received or provided. METHODS A qualitative study using in-depth semi-structured interviews with women with Type 2 diabetes (n=30) and healthcare professionals (n=22) from primary and specialist care. Women were purposively sampled to include different experiences of pregnancy and pre-pregnancy care. Data were transcribed verbatim and analysed thematically using Framework Analysis. RESULTS The median age of the women was 37 years, and most were obese (median BMI 34.9 kg/m2 ), of black or Asian ethnicity (n=24, 80%) and from areas of high deprivation (n=21, 70%). Participating healthcare professionals were from primary (n=14), intermediate (n=4) and secondary (n=4) care. Seven themes expressing factors that mediate reproductive behaviour and care in women with Type 2 diabetes were identified at the patient, professional and system levels. Type 2 diabetes was generally perceived negatively by the women and the healthcare professionals. There was a lack of awareness about the pre-pregnancy care needs for this population, and communication between both groups was unhelpful in eliciting the reproductive intentions of these women. The themes also reveal a lack of systemic processes to incorporate pre-pregnancy care into the care of women with Type 2 diabetes, and consequently, health professionals in primary care have limited capacity to provide such support. CONCLUSION If the current high levels of unprepared pregnancies in women with Type 2 diabetes are to be reduced, the reproductive healthcare needs of this group need to be embedded into their mainstream diabetes management.
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Affiliation(s)
- R Forde
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London, UK
| | - J Collin
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London, UK
| | | | - M Chamley
- North Wood Group Practice, London, UK
| | - K Hunt
- King's College Hospital NHS Foundation Trust, London, UK
| | - A Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London, UK
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Forde R, Peters S, Wittkowski A. Psychological interventions for managing postpartum psychosis: a qualitative analysis of women's and family members' experiences and preferences. BMC Psychiatry 2019; 19:411. [PMID: 31856785 PMCID: PMC6923990 DOI: 10.1186/s12888-019-2378-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/27/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Postpartum psychosis is a rare, yet severe disorder, in which early identification and immediate intervention are crucial. Despite recommendations for psychological input, little is known about the types of psychological intervention reported to be helpful. The aim of this study was to explore the experiences, needs and preferences for psychological intervention from the perspective of women with postpartum psychosis and from the perspective of family members. METHODS Thirteen women and eight family members, including partners were interviewed. The data from these semi-structured interviews were audio-recorded, transcribed and inductively analysed using thematic analysis. RESULTS Twelve subthemes were identified and then organised around three main themes: 1) Seeking safety and containment, 2) Recognising and responding to the psychological impact and 3) Planning for the future. These themes highlight the temporal element of recovery from postpartum psychosis, because women's psychological needs and preferences changed over time. Emphasis was initially placed on ensuring safety, followed by a need to connect, process and adjust to their experiences. Additional needs were reported by women and family when planning for the future, including managing the fear of relapse and help to reach a decision about future pregnancies. CONCLUSION The results illustrate a range of areas in which psychological intervention could be delivered to facilitate and enhance recovery. Further research is needed to develop meaningful and effective psychological interventions and to investigate the most appropriate timing for this to be offered.
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Affiliation(s)
- R Forde
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - S Peters
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
| | - A Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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Bird CB, Hoerner RJ, Restaino L, Anderson G, Birbari W, Bodra L, Brookman D, Bryant D, Campbell C, Degraft-Hanson J, Fetviet D, Forde R, Goins D, Hajkowski S, Haley E, Holland R, Jones J, Joseph JM, Kallewaard N, Keckeissen J, Kirkbride T, Kusch S, Noel D, Nutsch A, Okolo C, Parks K, Raines D, Remes A, Roach V, Robbins R, Rodrick G, Shelef L, Theissen H, Vasavada PC, Wang T. Comparison of the Reveal 20-Hour Method and the BAM Culture Method for the Detection of Escherichia coli O157:H7 in Selected Foods and Environmental Swabs: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/84.3.737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Four different food types along with environmental swabs were analyzed by the Reveal for E. coli O157:H7 test (Reveal) and the Bacteriological Analytical Manual (BAM) culture method for the presence of Escherichia coli O157:H7. Twenty-seven laboratories representing academia and private industry in the United States and Canada participated. Sample types were inoculated with E. coli O157:H7 at 2 different levels. Of the 1095 samples and controls analyzed and confirmed, 459 were positive and 557 were negative by both methods. No statistical differences (p <0.05) were observed between the Reveal and BAM methods.
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Affiliation(s)
| | | | - Lawrence Restaino
- R&F Laboratories, 245 W. Roosevelt Rd, Bldg 3, Unit 17, West Chicago, IL 60185
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Bird CB, Hoerner RJ, Restaino L, Anderson G, Birbari W, Bodra L, Brookman D, Bryant D, Campbell C, Degraft-Hanson J, Fetviet D, Forde R, Goins D, Hajkowski S, Haley E, Holland R, Jones J, Joseph JM, Kallewaard N, Keckeissen J, Kirkbride T, Kusch S, Noel D, Nutsch A, Okolo C, Parks K, Raines D, Remes A, Roach V, Robbins R, Rodrick G, Shelef L, Theissen H, Vasavada PC, Wang T. Reveal 8-Hour Test System for Detection of Escherichia coli O157:H7 in Raw Ground Beef, Raw Beef Cubes, and Iceberg Lettuce Rinse: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/84.3.719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Five different food types were analyzed by the Reveal for E. coli O157:H7 8-Hour Test System (Reveal 8) and either the U.S. Food and Drug Administration's Bacteriological Analytical Manual (BAM) culture method or the U.S. Department of Agriculture Food Safety Inspection Service (FSIS) culture method for the presence of E. coli O157:H7. A total of 27 laboratories representing academia and private industry in the United States and Canada participated. Food types were inoculated with E. coli O157:H7 at 2 different levels: a high level where predominantly positive results were expected, and a low level where fractional recovery was anticipated. During this study, 1110 samples and controls were analyzed by both the Reveal 8 and by BAM or FSIS by each of the collaborators (2220 samples in total). For each set of samples, 740 were artificially inoculated with E. coli O157:H7, and 370 were uninoculated controls. The Reveal 8 detected 528 presumptive positives of which 487 were confirmed positive by the BAM culture method. In comparison, BAM and FSIS detected 489 of the 740 artificially contaminated samples as positive. In an additional in-house study performed only on chilled and frozen raw ground beef, 240 artificially inoculated samples were analyzed by both the Reveal 8 and by FSIS. The Reveal 8 detected and confirmed 104 samples as positive compared to 79 confirmed positive by FSIS.
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Affiliation(s)
| | | | - Lawrence Restaino
- R&F Laboratories, 245 W. Roosevelt Rd, Bldg 3, Unit 17, West Chicago, IL 60185
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Murphy HR, Bell R, Dornhorst A, Forde R, Lewis-Barned N. Pregnancy in Diabetes: challenges and opportunities for improving pregnancy outcomes. Diabet Med 2018; 35:292-299. [PMID: 29337383 DOI: 10.1111/dme.13579] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2018] [Indexed: 01/02/2023]
Abstract
Our aim was to review the data from the National Pregnancy in Diabetes (NPID) audit, and to identify the challenges and opportunities for improving pregnancy outcomes in women with diabetes. We reviewed three years of NPID data and relevant diabetes and obstetric literature, and found that there has been little change in pregnancy preparation or outcomes over the past 3 years, with substantial clinic-to clinic variations in care. Women with Type 2 diabetes remain less likely to take 5 mg preconception folic acid (22.8% vs. 41.8%; P < 0.05), and more likely to take potentially harmful medications (statin and/or ACE inhibitor 13.0% vs. 1.8%; P < 0.05) than women with Type 1 diabetes. However, women with Type 1 diabetes are less likely to achieve the recommended glucose control target of HbA1c < 48 mmol/mol (6.5%) (14.9% vs. 38.1%; P < 0.05). The following opportunities for improvement were identified. First, the need to integrate reproductive health into the diabetes care plans of all women with diabetes aged 15-50 years. Second, to develop more innovative approaches to improve uptake of pre-pregnancy care in women with Type 2 diabetes in primary care settings. Third, to integrate insulin pump, continuous glucose monitoring and automated insulin delivery technologies into the pre-pregnancy and antenatal care of women with Type 1 diabetes. Fourth, to improve postnatal care with personalized approaches targeting women with previous pregnancy loss, congenital anomaly and perinatal mortality. A nationwide commitment to delivering integrated reproductive and diabetes healthcare interventions is needed to improve the health outcomes of women with diabetes.
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Affiliation(s)
- H R Murphy
- Norwich Medical School, University of East Anglia, Norwich
- Division of Women's & Children's Health, Kings College London
| | - R Bell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne
| | - A Dornhorst
- Department of Medicine, Imperial College London
| | - R Forde
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
| | - N Lewis-Barned
- Northumbria Diabetes and Endocrinology Service, Wansbeck Hospital, Ashington, UK
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Forde R, Mitchell A, Duncan K, Gibson TN. Parathyroid Carcinoma: A Case Report and Review of the Literature. W INDIAN MED J 2015; 64:305-8. [PMID: 26426192 PMCID: PMC4763914 DOI: 10.7727/wimj.2014.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/05/2015] [Indexed: 11/18/2022]
Affiliation(s)
- R Forde
- Ear, Nose and Throat Division, Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Kingston, Jamaica, West Indies. ;
| | - A Mitchell
- Ear, Nose and Throat Division, Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Kingston, Jamaica, West Indies
| | - K Duncan
- Ear, Nose and Throat Division, Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Kingston, Jamaica, West Indies
| | - T N Gibson
- Department of Pathology, The University of the West Indies, Kingston 7, Jamaica, West Indies
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Neff KJ, Forde R, Gavin C, Byrne MM, Firth RGR, Daly S, McAuliffe FM, Foley M, Coffey M, Coulter-Smith S, Kinsley BT. Pre-pregnancy care and pregnancy outcomes in type 1 diabetes mellitus: a comparison of continuous subcutaneous insulin infusion and multiple daily injection therapy. Ir J Med Sci 2013; 183:397-403. [DOI: 10.1007/s11845-013-1027-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
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Forde R, Ashman H, Williams EW, Williams-Johnson J. Idiopathic nasal septal abscess--a case report. W INDIAN MED J 2012; 61:832-833. [PMID: 23757906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- R Forde
- Department of Surgery, Radiology, Anaesthesia and Intensive Care Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica.
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Dreyer A, Forde R, Nortvedt P. Autonomy at the end of life: life-prolonging treatment in nursing homes--relatives' role in the decision-making process. J Med Ethics 2009; 35:672-677. [PMID: 19880703 DOI: 10.1136/jme.2009.030668] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The increasing number of elderly people in nursing homes with failing competence to give consent represents a great challenge to healthcare staff's protection of patient autonomy in the issues of life-prolonging treatment, hydration, nutrition and hospitalisation. The lack of national guidelines and internal routines can threaten the protection of patient autonomy. OBJECTIVES To place focus on protecting patient autonomy in the decision-making process by studying how relatives experience their role as substitute decision-makers. DESIGN A qualitative descriptive design with analysis of the contents of transcribed in-depth interviews with relatives. PARTICIPANTS Fifteen relatives of 20 patients in 10 nursing homes in Norway. RESULTS AND INTERPRETATIONS The main findings reveal deficient procedures for including relatives in decision-making processes. Relatives have poor knowledge about the end of life, and there is little discussion about their role as substitute decision-makers for patients who are not competent to give consent. Few relatives understand the concept of patient autonomy. In Norway the treating physician is responsible for patient treatment. When relatives are included in discussions on treatment, they perceive themselves as responsible for the decision, which is a burden for them afterwards. This qualitative study describes relatives' experiences, thus providing important information on the improvement potential with the main objective of safeguarding patient autonomy and caring for relatives. CONCLUSION The study reveals failing procedures and thus a great potential for improvement. Both ethical and legal aspects must be addressed when considering patient autonomy.
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Affiliation(s)
- A Dreyer
- Aalesund University College, University of Oslo, Oslo, Norway.
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Hurst SA, Reiter-Theil S, Slowther AM, Pegoraro R, Forde R, Danis M. Should ethics consultants help clinicians face scarcity in their practice? J Med Ethics 2008; 34:241-246. [PMID: 18375673 DOI: 10.1136/jme.2006.019828] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In an international survey of rationing we have found that European physicians encounter scarcity-related ethical difficulties, and are dissatified with the resolution of many of these cases. Here we further examine survey results to explore whether ethics support services would be potentially useful in addressing scarcity related ethical dilemmas. Results indicate that while the type of help offered by ethics support services was considered helpful by physicians, they rarely referred difficulties regarding scarcity to ethics consultation. We propose that ethics consultants could assist physicians by making the process less difficult, and by contributing to decisions being more ethically justifiable. Expertise in bringing considerations of justice to bear on real cases could also be useful in recognising an unjust limit, as opposed to a merely frustrating limit. Though these situations are unlikely to be among the most frequently referred to ethics support services, ethics consultants should be prepared to address them.
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Affiliation(s)
- S A Hurst
- Institute for Biomedical Ethics, University of Geneva MedicalSchool, Geneva, Switzerland
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Hurst SA, Perrier A, Pegoraro R, Reiter-Theil S, Forde R, Slowther AM, Garrett-Mayer E, Danis M. Ethical difficulties in clinical practice: experiences of European doctors. J Med Ethics 2007; 33:51-7. [PMID: 17209113 PMCID: PMC2598078 DOI: 10.1136/jme.2005.014266] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services. METHODS A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK. RESULTS Survey respondents (n=656, response rate 43%) ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority (17.6%) reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity (94.8%), disagreement among caregivers (81.2%) and limitation of treatment at the end of life (79.3%). The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct (47.5%), someone capable of providing specific advice (41.1%), help in weighing outcomes (36%) and clarification of the issues (35.9%). Few of the types of help expected to be useful varied among countries. CONCLUSION Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries.
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Affiliation(s)
- S A Hurst
- Institute for Biomedical Ethic, Medical Faculty, University of Geneva, and General Internal Medicine Service, Geneva University Hospital, Switzerland
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Abstract
In protein engineering, the tasks of generating and testing a large number of variants of a molecule and of optimizing expression conditions for one distinct molecule create the need for purification methods that can handle a large number of samples simultaneously. We describe the development and some application results of a simple affinity chromatography system that can be used for the parallel purification of 24 protein samples, yielding sufficient quantities for biochemical and functional analysis. Advantages of this system over existing systems are as follows. Compared with commercially available complete chromatography systems, the costs of this system are minimal. In comparison with vacuum systems with various outlets, and with batch purification systems where centrifugation is necessary, this system allows gentler processing of the samples. This could be important for proteins that are easily damaged.
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Affiliation(s)
- C Gottstein
- Department of Internal Medicine I, University of Cologne, 50924 Cologne and Aqua Research, 50974 Cologne, Germany
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Gottstein C, Forde R. In vivo measurement of biodistribution kinetics of radiolabeled compounds in laboratory animals. Biotechniques 1999; 27:934-6, 938. [PMID: 10572640 DOI: 10.2144/99275bm12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- C Gottstein
- University of Texas, Southwestern Medical Center at Dallas, USA.
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