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Bankar A, Siriwardena TP, Rizoska B, Rydergård C, Kylefjord H, Rraklli V, Eneroth A, Pinho P, Norin S, Bylund J, Moses S, Bethell R, Kavanagh S, Maclean N, Gronda M, Wang X, Hurren R, Minden MD, Targett-Adams P, Schimmer AD, Albertella M. Novel L-nucleoside analogue, 5-fluorotroxacitabine, displays potent efficacy against acute myeloid leukemia. Haematologica 2021; 106:574-579. [PMID: 31857370 PMCID: PMC7849559 DOI: 10.3324/haematol.2019.226795] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 12/18/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Aniket Bankar
- Princess Margaret Cancer Center, University Health Network, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | | - Simon Kavanagh
- Princess Margaret Cancer Center, University Health Network, Ontario, Canada
| | - Neil Maclean
- Princess Margaret Cancer Center, University Health Network, Ontario, Canada
| | - Marcela Gronda
- Princess Margaret Cancer Center, University Health Network, Ontario, Canada
| | - Xiaoming Wang
- Princess Margaret Cancer Center, University Health Network, Ontario, Canada
| | - Rose Hurren
- Princess Margaret Cancer Center, University Health Network, Ontario, Canada
| | - Mark D Minden
- Princess Margaret Cancer Center, University Health Network, Ontario, Canada
| | | | - Aaron D Schimmer
- Princess Margaret Cancer Center, University Health Network, Ontario, Canada
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2
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Song SH, McMurray C, Thomas C, Kavanagh S, Stephenson J. Improving pre-pregnancy care for women with diabetes: a community-focused strategy. Diabet Med 2020; 37:2171-2172. [PMID: 32617999 DOI: 10.1111/dme.14355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2020] [Indexed: 12/01/2022]
Affiliation(s)
- S H Song
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - C McMurray
- Sheffield Clinical Commissioning Group, Sheffield, UK
| | - C Thomas
- Sheffield Local Pharmaceutical Committee, Sheffield, UK
| | - S Kavanagh
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - J Stephenson
- Sheffield Clinical Commissioning Group, Sheffield, UK
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3
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Bain A, Hasan SS, Kavanagh S, Babar ZUD. Use and validation of a survey tool to measure the perceived effectiveness of insulin prescribing safety interventions in UK hospitals. Diabet Med 2020; 37:2027-2034. [PMID: 32592220 DOI: 10.1111/dme.14351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/26/2020] [Accepted: 06/18/2020] [Indexed: 11/28/2022]
Abstract
AIMS To describe the use and validation of a survey tool to elicit the opinion of hospital pharmacists and medicines safety officers in the UK regarding the perceived effectiveness of strategies to improve insulin prescribing safety in hospitals. METHODS One respondent from each participating organization completed the survey on behalf of the main acute hospital in their trust (n = 92). A five-point Likert scale was used to determine opinion on how effective 22 different interventions were at promoting insulin safety at the respondent's trust. The tool, the Perception of Effectiveness of Prescribing Safety Interventions for Insulin (PEPSII) questionnaire, underwent content validity testing. The reliability was estimated using Cronbach's alpha (α). RESULTS The PEPSII questionnaire demonstrated good reliability (α = 0.867). Outreach team review and mandatory insulin education were the highest-scoring interventions; the insulin passport was amongst the lowest scoring interventions. Most interventions were considered more effective by trusts using them compared to those who didn't, except for self-administration policies, electronic prescribing and the insulin passport. CONCLUSIONS The perceived effectiveness of a variety of insulin prescribing safety strategies in UK hospitals was described by leveraging a purposely developed survey tool. The results describe current levels of support for recommended interventions, and may facilitate the direction of both local and national insulin prescribing safety improvement efforts.
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Affiliation(s)
- A Bain
- School of Applied Sciences, University of Huddersfield, Huddersfield, UK
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S S Hasan
- School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - S Kavanagh
- School of Applied Sciences, University of Huddersfield, Huddersfield, UK
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Z-U-D Babar
- School of Applied Sciences, University of Huddersfield, Huddersfield, UK
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4
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Chand D, Finkel R, Day J, Darris B, Kuntz N, Connolly A, Zaidman C, Crawford T, Butterfield R, Shieh P, Tennekoon G, Brandesma J, Iannaccone S, Meriggioli M, Tauscher-Wisniewski S, Shoffner J, Ogrinc F, Kavanagh S, Feltner D, Mendell J. SMA – THERAPY. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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5
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Bain A, Hasan SS, Kavanagh S, Babar ZUD. Strategies to reduce insulin prescribing errors in UK hospitals: results from a national survey. Diabet Med 2020; 37:1176-1184. [PMID: 31845373 DOI: 10.1111/dme.14209] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2019] [Indexed: 02/01/2023]
Abstract
AIM To describe insulin prescribing practice in National Health Service hospitals in the UK and the current use of interventions and strategies to reduce insulin prescribing errors. METHODS We sent a cross-sectional questionnaire to chief pharmacists in all National Health Service hospital trusts in the UK in January 2019. Questions concerned the use and functionality of electronic and paper systems used to prescribe subcutaneous insulin, along with features and interventions designed to reduce insulin prescribing errors. RESULTS Ninety-five hospital trusts responded (54%). Electronic prescribing of insulin was reported in 40% of hospitals, most of which were teaching hospitals in England. We found a wide variation in the functionality of both electronic prescribing and paper-based systems to enable the safe prescribing of insulin for inpatients. The availability of specialist diabetes pharmacists to support the safe prescribing of insulin was low (29%), but was positively associated with the use of a greater number of insulin prescribing error reduction strategies (P=0.002). The use of specific interventions to improve insulin prescribing quality (e.g. self-administration policies) varied greatly between respondent hospitals. CONCLUSIONS There is potential to optimize the functionality of both electronic and paper-based prescribing systems to improve the safe prescribing of insulin in hospitals in the UK. The wide variation in the use of insulin error reduction strategies may be improved by the availability of specialist diabetes pharmacists who can support the implementation of insulin-prescribing interventions.
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Affiliation(s)
- A Bain
- School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S S Hasan
- School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
| | - S Kavanagh
- School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Z-U-D Babar
- School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
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6
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Khemis A, Lebwohl M, Piguet V, Sofen H, Blauvelt A, Arendt C, Kavanagh S, Boehnlein M, Augustin M. Efficacité du certolizumab pegol en retraitement du psoriasis en plaques après une période en aveugle d’interruption du traitement : résultats de l’essai CIMPACT. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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7
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Pasquereau Y, Gordon K, Reich K, Blauvelt A, Thaçi D, Leonardi C, Poulin Y, Boehnlein M, Kavanagh S, Arendt C, Gottlieb A. Le certolizumab pegol dans le traitement du psoriasis en plaques : résultats d’efficacité sur 2 ans provenant de deux essais de phase 3 (CIMPASI-1 et CIMPASI-2). Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Gordon K, Warren R, Gottlieb A, Blauvelt A, Thaci D, Leonardi C, Poulin Y, Boehnlein M, Kavanagh S, Arendt C, Reich K. Certolizumab Pegol for Treatment of Plaque Psoriasis: Pooled Three-Year Efficacy Outcomes from Two Phase 3 Trials (CIMPASI-1 and CIMPASI-2). ACTA ACUST UNITED AC 2019. [DOI: 10.25251/skin.3.supp.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Abstract not available.
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Gottlieb A, Thaci D, Leonardi C, Poulin Y, Kavanagh S, Boehnlein M, Reich K. Nail Outcome Improvements with Certolizumab Pegol in Moderate to Severe Plaque Psoriasis: Results from Phase 3 Trials. ACTA ACUST UNITED AC 2019. [DOI: 10.25251/skin.3.supp.38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Abstract not available.
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10
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Hiatt W, Hopley CW, Kavanagh S, Patel MR, Baumgartner I, Berger JS, Blomster JI, Fowkes FGR, Jones WS, Katona BG, Mahaffey KW, Norgren L. P935Effect of hypertension and systolic blood pressure on cardiovascular and limb outcomes in patients with symptomatic peripheral artery disease: the EUCLID trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hypertension is a risk factor for major adverse cardiac events (MACE) in patients with symptomatic peripheral artery disease (PAD).
Purpose
The effects of a history of hypertension and baseline systolic blood pressure (SBP) on MACE and major adverse limb events (MALE), including acute limb ischemia and major amputation, were evaluated in the Examining Use of tiCagreLor In paD (EUCLID) trial.
Methods
EUCLID randomized 13,885 patients with PAD and found no benefit of ticagrelor compared with clopidogrel on risk of MACE or MALE. The median duration of follow up was approximately 30 months. This post hoc, subgroup analysis evaluated the effects of hypertension history at baseline on the hazard for MACE and MALE. An adjusted restricted cubic spline regression analysis evaluated the association of SBP with MACE and MALE.
Results
A clinical history of hypertension was present in 10,857 (78%) patients at baseline and these patients were more likely to be older, female, white or African American, and reside in North America compared with the 3026 without hypertension. Hypertension was associated with a higher prevalence of concomitant cardiovascular diseases, polyvascular disease, diabetes, and prior coronary interventions. MACE occurred at a rate of 4.63 events/100 pt-yrs in participants with hypertension and 3.64 events/100 pt-yrs in participants without hypertension, (adjusted hazard ratio [aHR] 0.94, 95% CI 0.82–1.08; p=0.38). MALE occurred at a rate of 1.11 events/100 pt-yrs in those with hypertension and 1.38 events/100 pt-yrs in those without hypertension (p=0.054) (aHR 0.93 (95% CI 0.73, 1.18) p=0.55. The adjusted spline model for MACE and SBP demonstrated a significantly non-linear relationship with a HR 1.08 (95% CI 1.01, 1.15), p=0.0275 for every 10-unit decrease <135 mmHg SBP and HR 1.11 (1.06, 1.16), p<0.0001 for every 10-unit increase >135 mmHg (figure). There was no association between baseline SBP and MALE events.
Conclusions
A history of hypertension was not associated with a higher adjusted hazard for MACE or MALE in participants with PAD. In contrast, SBP at baseline was associated with increased risk of MACE at values both above and below 135 mmHg.
Acknowledgement/Funding
EUCLID was sponsored by AstraZeneca
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Affiliation(s)
- W Hiatt
- CPC Clinical Research, University of Colorado School of Medicine, Aurora, United States of America
| | - C W Hopley
- Geisel School of Medicine, Dartmouth College, Department of Medicine, Section of Nephrology and Hypertension, Hanover, United States of America
| | - S Kavanagh
- CPC Clinical Research, Aurora, United States of America
| | - M R Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, United States of America
| | - I Baumgartner
- Swiss Cardiovascular Center, University of Bern, Bern, Switzerland
| | - J S Berger
- New York University School of Medicine, Departments of Medicine and Surgery, New York, United States of America
| | | | - F G R Fowkes
- University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh, United Kingdom
| | - W S Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, United States of America
| | - B G Katona
- AstraZeneca Gaithersburg, Gaithersburg, United States of America
| | - K W Mahaffey
- Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, United States of America
| | - L Norgren
- Orebro University, Faculty of Medicine and Health, Orebro, Sweden
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11
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Schultz M, Swoboda K, Farrar M, McMillan H, Parsons J, Kernbauer E, Farrow M, Ogrinc F, Kavanagh S, Feltner D, McGill B, Spector S, L'Italien J, Sproule D, Strauss K. P.350Onasemnogene abeparvovec gene-replacement therapy (GRT) in pre-symptomatic spinal muscular atrophy (SMA). Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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12
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Finkel R, Day J, Darras B, Kuntz N, Connolly A, Crawford T, Butterfield R, Shieh P, Tennekoon G, Iannaccone S, Ogrinc F, Kavanagh S, Kernbauer E, Whittle J, L'Italien J, Kaspar B, Sproule D, Spector S, Feltner D, Mendell J. O.40Intrathecal administration of onasemnogene abeparvovec gene-replacement therapy (GRT) for spinal muscular atrophy type 2 (SMA2): phase 1/2a study (STRONG). Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.594] [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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13
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Strauss K, Swoboda K, Farrar M, McMillan H, Parsons J, Krueger J, Iannaccone S, Chiriboga C, Kwon J, Saito K, Scoto M, Baldinetti F, Schultz M, Kernbauer E, Farrow M, Ogrinc F, Kavanagh S, Feltner D, McGill B, Spector S, L’Italien J, Sproule D, Muntoni F. Onasemnogene abeparvovec gene-replacement therapy (GRT) in presymptomatic spinal muscular atrophy (SMA): SPR1NT study update. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Kavanagh S, Ribeiro LR, Noeske T, Sharma P. Application of PBPK modelling of enterocyte exposure aids in vitro to in vivo translational risk assessment of μ-opioid-induced clinical constipation. Toxicol Lett 2018. [DOI: 10.1016/j.toxlet.2018.06.1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Hopley CW, Kavanagh S, Patel M, Baumgartner I, Berger JS, Blomster JI, Fowkes FGR, Jones WS, Katona BG, Mahaffey KW, Norgren L, Held P, Rockhold FW, Hiatt WR. 4065Moderate to severe renal insufficiency and risk for cardiovascular and limb outcomes in patients with symptomatic peripheral artery disease: the EUCLID trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C W Hopley
- University of Colorado School of Medicine, CPC Clinical Research, Aurora, United States of America
| | - S Kavanagh
- CPC Clinical Research, Aurora, United States of America
| | - M Patel
- Duke University Medical Center, Duke Clinical Research Institute, Durham, United States of America
| | - I Baumgartner
- Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - J S Berger
- New York University School of Medicine, New York, United States of America
| | - J I Blomster
- Turku University Hospital, Heart Centre, Turku, Finland
| | - F G R Fowkes
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - W S Jones
- Duke University Medical Center, Duke Clinical Research Institute, Durham, United States of America
| | - B G Katona
- AstraZeneca Gaithersburg, Gaithersburg, United States of America
| | - K W Mahaffey
- Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, United States of America
| | - L Norgren
- Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - P Held
- AstraZeneca Gothenburg, Molndal, Sweden
| | - F W Rockhold
- Duke Clinical Research Institute, Durham, United States of America
| | - W R Hiatt
- CPC Clinical Research, University of Colorado School of Medicine, Aurora, United States of America
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16
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Kavanagh S, Bril V, Lipton JH. Peripheral neuropathy associated with imatinib therapy for chronic myeloid leukemia. Blood Res 2018; 53:172-174. [PMID: 29963528 PMCID: PMC6021569 DOI: 10.5045/br.2018.53.2.172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 12/28/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Simon Kavanagh
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Vera Bril
- The Prosserman Family Neurology Clinic, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Jeffrey H Lipton
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
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17
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Abstract
INTRODUCTION BCR-ABL-directed tyrosine kinase inhibitors (TKIs) have revolutionised therapy for chronic myeloid leukemia. However, despite the availability and efficacy of this class of agents, lifelong treatment is still required in a significant proportion of patients Areas covered: We give an overview of the currently available BCR-ABL-directed TKIs and other conventional therapies for CML. We proceed to review the current market and some of the scientific rationale for new drug development before outlining a number of novel therapies, considered broadly as immunotherapies and targeted agents. Published English-language literature was reviewed regarding currently available TKIs; clinical trials repositories were reviewed to identify novel agents recently investigated or under active study. Expert opinion: We recommend discussion with patients and enrolment on an appropriate clinical trial where feasible. In situations where no trials are available, or if patients decline enrolment, we recommend use of an appropriate BCR-ABL directed TKI, selected on the basis of an evaluation of patient risk factors and side effect profile. Allogeneic stem cell transplant continues to have a role though this is generally limited to cases with advanced phases of disease or in cases with resistance-conferring mutations.
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Affiliation(s)
- Simon Kavanagh
- a Princess Margaret Cancer Centre , University Health Network , Toronto , ON , Canada
| | - Aisling Nee
- a Princess Margaret Cancer Centre , University Health Network , Toronto , ON , Canada
| | - Jeffrey H Lipton
- a Princess Margaret Cancer Centre , University Health Network , Toronto , ON , Canada
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18
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Kavanagh S, Murphy T, Law A, Yehudai D, Ho JM, Chan S, Schimmer AD. Emerging therapies for acute myeloid leukemia: translating biology into the clinic. JCI Insight 2017; 2:95679. [PMID: 28931762 PMCID: PMC5621868 DOI: 10.1172/jci.insight.95679] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Acute myeloid leukemia (AML) is an aggressive hematological malignancy with a poor outcome; overall survival is approximately 35% at two years and some subgroups have a less than 5% two-year survival. Recently, significant improvements have been made in our understanding of AML biology and genetics. These fundamental discoveries are now being translated into new therapies for this disease. This review will discuss recent advances in AML biology and the emerging treatments that are arising from biological studies. Specifically, we will consider new therapies that target molecular mutations in AML and dysregulated pathways such as apoptosis and mitochondrial metabolism. We will also discuss recent advances in immune and cellular therapy for AML.
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19
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Kavanagh S, Lipton JH. How I Diagnose Hypereosinophilic Syndromes. EMJ 2017. [DOI: 10.33590/emj/10313450] [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: 11/18/2022] Open
Abstract
Hypereosinophilic syndromes are a group of disorders characterised by significant eosinophilia and organ damage. They have proven challenging to define, diagnose, and study for many years, due in part to their variable clinical presentations, the overlap between neoplastic and reactive eosinophilia, and the lack of a universal marker of eosinophil clonality. Herein, we give an overview of the term and discuss aetiology and our approach to diagnosis.
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Affiliation(s)
- Simon Kavanagh
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey H. Lipton
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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20
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McGillicuddy E, Murray I, Kavanagh S, Morrison L, Fogarty A, Cormican M, Dockery P, Prendergast M, Rowan N, Morris D. Silver nanoparticles in the environment: Sources, detection and ecotoxicology. Sci Total Environ 2017; 575:231-246. [PMID: 27744152 DOI: 10.1016/j.scitotenv.2016.10.041] [Citation(s) in RCA: 258] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/05/2016] [Accepted: 10/05/2016] [Indexed: 05/25/2023]
Abstract
The environmental impact of silver nanoparticles (AgNP) has become a topic of interest recently, this is due to the fact that AgNPs have been included in numerous consumer products including textiles, medical products, domestic appliances, food containers, cosmetics, paints and nano-functionalised plastics. The production, use and disposal of these AgNP containing products are potential routes for environmental exposure. These concerns have led to a number of studies investigating the release of particles from nano-functionalised products, the detection of the particles in the aquatic environment and the potential environmental toxicology of these AgNPs to aquatic organisms. The overall aim of this review is to examine methods for the capture and detection of AgNPs, potential toxicity and transmission routes in the aquatic environment.
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Affiliation(s)
- E McGillicuddy
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Galway, Ireland; Centre for Health from Environment, Ryan Institute, National University of Ireland Galway, Galway, Ireland.
| | - I Murray
- Bioscience Research Institute, Athlone Institute of Technology, Dublin Road, Athlone, Co. Westmeath, Ireland
| | - S Kavanagh
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Galway, Ireland; Centre for Health from Environment, Ryan Institute, National University of Ireland Galway, Galway, Ireland
| | - L Morrison
- Earth and Ocean Sciences, National University of Ireland Galway, Galway, Ireland
| | - A Fogarty
- Bioscience Research Institute, Athlone Institute of Technology, Dublin Road, Athlone, Co. Westmeath, Ireland; Department of Life & Physical Science, Athlone Institute of Technology, Dublin Road, Athlone, Co. Westmeath, Ireland
| | - M Cormican
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Galway, Ireland; Centre for Health from Environment, Ryan Institute, National University of Ireland Galway, Galway, Ireland
| | - P Dockery
- Discipline of Anatomy, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - M Prendergast
- Centre for Health from Environment, Ryan Institute, National University of Ireland Galway, Galway, Ireland
| | - N Rowan
- Bioscience Research Institute, Athlone Institute of Technology, Dublin Road, Athlone, Co. Westmeath, Ireland; Department of Life & Physical Science, Athlone Institute of Technology, Dublin Road, Athlone, Co. Westmeath, Ireland
| | - D Morris
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Galway, Ireland; Centre for Health from Environment, Ryan Institute, National University of Ireland Galway, Galway, Ireland
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21
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Malherbe JAJ, Fuller KA, Mirzai B, Kavanagh S, So CC, Ip HW, Guo BB, Forsyth C, Howman R, Erber WN. Dysregulation of the intrinsic apoptotic pathway mediates megakaryocytic hyperplasia in myeloproliferative neoplasms. J Clin Pathol 2016; 69:jclinpath-2016-203625. [PMID: 27060176 PMCID: PMC5136711 DOI: 10.1136/jclinpath-2016-203625] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 12/24/2022]
Abstract
AIMS Megakaryocyte expansion in myeloproliferative neoplasms (MPNs) is due to uncontrolled proliferation accompanied by dysregulation of proapoptotic and antiapoptotic mechanisms. Here we have investigated the intrinsic and extrinsic apoptotic pathways of megakaryocytes in human MPNs to further define the mechanisms involved. METHODS The megakaryocytic expression of proapoptotic caspase-8, caspase-9, Diablo, p53 and antiapoptotic survivin proteins was investigated in bone marrow specimens of the MPNs (n=145) and controls (n=15) using immunohistochemistry. The megakaryocyte percentage positivity was assessed by light microscopy and correlated with the MPN entity, JAK2V617F/CALR mutation status and platelet count. RESULTS The proportion of megakaryocytes in the MPNs expressing caspase-8, caspase-9, Diablo, survivin and p53 was significantly greater than controls. A greater proportion of myeloproliferative megakaryocytes expressed survivin relative to its reciprocal inhibitor, Diablo. Differences were seen between myelofibrosis, polycythaemia vera and essential thrombocythaemia for caspase-9 and p53. CALR-mutated cases had greater megakaryocyte p53 positivity compared to those with the JAK2V617F mutation. Proapoptotic caspase-9 expression showed a positive correlation with platelet count, which was most marked in myelofibrosis and CALR-mutated cases. CONCLUSIONS Disruptions targeting the intrinsic apoptotic cascade promote megakaryocyte hyperplasia and thrombocytosis in the MPNs. There is progressive dysfunction of apoptosis as evidenced by the marked reduction in proapoptotic caspase-9 and accumulation of p53 in myelofibrosis. The dysfunction of caspase-9, which is necessary for proplatelet formation, may be the mechanism for the excess thrombocytosis associated with CALR mutations. Survivin seems to be the key protein mediating the megakaryocyte survival signature in the MPNs and is a potential therapeutic target.
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Affiliation(s)
- Jacques A J Malherbe
- Schoolof Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Kathryn A Fuller
- Schoolof Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
- PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Bob Mirzai
- Schoolof Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
- PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Simon Kavanagh
- Schoolof Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
- PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Chi-Chiu So
- Department of Pathology, Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Ho-Wan Ip
- Department of Pathology & Clinical Biochemistry, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Belinda B Guo
- Schoolof Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Cecily Forsyth
- Jarrett Street Specialist Centre, North Gosford, New South Wales, Australia
| | - Rebecca Howman
- PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Wendy N Erber
- Schoolof Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
- PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
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Abstract
Background Transforming growth factor α (TGFα) is a peptide growth factor known to be expressed in normal haemopoiesis. It is also expressed in a range of epithelial neoplasms but has not been assessed in haemopoietic malignancies. We have performed an immunohistochemical evaluation of TGFα in acute and chronic myeloid malignancies. Methods TGFα expression was semiquantitatively assessed in 69 normal bone marrow trephines and 157 cases of myeloid malignancy using an immunohistochemical approach. Results Blast cells of myeloid origin in acute myeloid leukaemia (AML), myelodysplasia and accelerated and blast phases of chronic myeloid leukaemia (CML) were TGFα positive. In acute promyelocytic leukaemia the neoplastic cells had significantly weaker TGFα expression than seen in other forms of AML. The blast cells in CML-accelerated and blast phases were positive with similar expression to AML. Conclusions TGFα is expressed in neoplastic myeloblasts and could, therefore, be used as blast cell biomarker in diagnostic haematopathology. In addition, TGFα immunohistochemistry may be of use in identifying a therapeutic target.
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Affiliation(s)
- Simon Kavanagh
- Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Western Australia, Australia PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Bob Mirzai
- Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Western Australia, Australia PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Kathy Fuller
- Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Western Australia, Australia
| | - Wendy N Erber
- Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Western Australia, Australia PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
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Lucas M, Jeelall Y, Kavanagh S, Bundell C, Hew M, Wood BA, Joske D, McLean-Tooke A. B-cell small lymphocytic lymphoma associated with extremely high total IgE and cutaneous vasculitis. J Allergy Clin Immunol Pract 2016; 4:552-4. [PMID: 26883544 DOI: 10.1016/j.jaip.2015.12.020] [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] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/24/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Michaela Lucas
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia; Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia.
| | - Yogesh Jeelall
- School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Simon Kavanagh
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Christine Bundell
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Meilyn Hew
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Benjamin A Wood
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - David Joske
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Andrew McLean-Tooke
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
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Kavanagh S, Gaudig M, Van Baelen B, Adami M, Delgado A, Guzman C, Jedenius E, Schäuble B. Galantamine and behavior in Alzheimer disease: analysis of four trials. Acta Neurol Scand 2011; 124:302-8. [PMID: 21615354 DOI: 10.1111/j.1600-0404.2011.01525.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [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: 01/01/2023]
Abstract
OBJECTIVES Many individuals with Alzheimer's disease (AD) experience behavioral and neuropsychiatric symptoms, which may cause caregiver distress and lead to the institutionalization of the patient. This analysis characterized behavioral symptoms and caregiver distress in trials of galantamine and their response to treatment. MATERIALS AND METHODS Data were pooled from four randomized, placebo-controlled clinical trials of galantamine in patients with mild to moderate AD (three studies) or AD plus cerebrovascular disease (one study) (n = 2177). Behavior and associated caregiver distress were assessed in each study using the Neuropsychiatric Inventory (NPI) and NPI distress (NPI-D), respectively. RESULTS After 5/6 months, but not after 3 months, NPI score was significantly improved with galantamine vs placebo (P = 0.013). The benefit was particularly pronounced in patients categorized as having advanced moderate AD. At 5/6 months, there was a numerical benefit of galantamine over placebo in terms of caregiver distress; the difference was statistically significant in patients with moderate or advanced moderate AD. CONCLUSIONS Galantamine reduces behavioral symptoms in patients with mild to moderate AD, leading to reduced caregiver burden. The reductions were greatest in patients with moderate or advanced moderate disease.
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Affiliation(s)
- S Kavanagh
- Johnson & Johnson Pharmaceutical Services, Beerse, Belgium
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25
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Lee L, Rianto J, Raykar V, Creasey H, Waite L, Berry A, Xu J, Chenoweth B, Kavanagh S, Naganathan V. Health and functional status of adults with intellectual disability referred to the specialist health care setting: a five-year experience. Int J Family Med 2011; 2011:312492. [PMID: 22295183 PMCID: PMC3263836 DOI: 10.1155/2011/312492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 06/16/2011] [Accepted: 08/09/2011] [Indexed: 05/23/2023]
Abstract
Aims and Method. The Developmental Disability Database in the Department of Rehabilitation Medicine at a metropolitan hospital was audited for observations on adults with Intellectual Disability living in the local region (total population 180,000) who were seen in an identified multidisciplinary specialist clinic, during 2006-2010. Results. There were 162 people (representing half the known number of adults with Intellectual Disability living in the region): 77 females, 85 males, age range 16-86 years. The most common complex disabilities referred to the specialists in this clinic were epilepsy (52%), challenging or changing behavior (42%) and movement disorders (34%). Early onset dementia was a feature of the group (7%). The prevalence of prescription of medications for gastro-oesophageal reflux was high (36%) and similar to the numbers of people taking psychotropic medications. The rates of chronic cardiovascular disease (2%), chronic respiratory disease (10%) and generalised arthritis (11%) were low overall, but did rise with increasing age. Conclusions. Complex neurological disabilities are common, and chronic medical illnesses are uncommon in adults with Intellectual Disability referred to specialist clinicians in this region. A combined, coordinated, multidisciplinary clinic model addresses some of the barriers experienced by adults with Intellectual Disability in the secondary health system.
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Affiliation(s)
- L. Lee
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
- Developmental Assessment Service, St. George Hospital, Kogarah, NSW 2217, Australia
| | - J. Rianto
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
- Developmental Assessment Service, St. George Hospital, Kogarah, NSW 2217, Australia
| | - V. Raykar
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
| | - H. Creasey
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
| | - L. Waite
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
| | - A. Berry
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
- Developmental Assessment Service, St. George Hospital, Kogarah, NSW 2217, Australia
| | - J. Xu
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
| | - B. Chenoweth
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
- Developmental Assessment Service, St. George Hospital, Kogarah, NSW 2217, Australia
| | - S. Kavanagh
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
- Developmental Assessment Service, St. George Hospital, Kogarah, NSW 2217, Australia
| | - V. Naganathan
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
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Kavanagh S, Howe I, Brashear HR, Wang D, van Baelen B, Todd M, Schwalen S. Long-term response to galantamine in relation to short-term efficacy data: pooled analysis in patients with mild to moderate Alzheimer's disease. Curr Alzheimer Res 2011; 8:175-86. [PMID: 21222607 PMCID: PMC3182415 DOI: 10.2174/156720511795256044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 08/30/2010] [Indexed: 11/22/2022]
Abstract
Background: This analysis aimed to identify an operational, clinically relevant definition of response achieved in short-term clinical trials to support the identification of patients with Alzheimer’s disease (AD) who would benefit most from long-term galantamine therapy. Methods: Data were analyzed from 6 randomized placebo-controlled trials of up to 6 months’ duration, which included patients with mild to moderate AD receiving maintenance doses of galantamine 16-24 mg/day, and from 12 open-label extensions (galantamine 24 mg/day maintenance therapy). Assessments included changes from baseline in the 11-item AD Assessment Scale-Cognitive subscale (ADAS-Cog 11). Results: Pooled analysis of the 5-6 month trial data showed that at the trial endpoint (2-5 months after reaching maintenance doses), the proportions of galantamine- (n=1,173) versus placebo-treated patients (n=801) with probable AD categorized according to “improved”, “stable” or “non-rapid decline” criteria, were 45.8% versus 27.2%, 59.5% versus 37.1%, and 87.6% versus 69.7%, respectively (observed cases analysis), whilst changes in ADAS-Cog 11 scores versus baseline were -4.9, -4.7 and -2.9 points, respectively, for “improved”, “stable” and “non-rapid decline” galantamine-treated patients (-1.5 points for galantamine recipients overall). “Improved” or “stable” galantamine-treated patients displayed mean improvement in ADAS-Cog 11 scores over baseline until 18 months after starting treatment, and attenuated deterioration thereafter; for galantamine-treated patients exhibiting “non-rapid decline”, mean ADAS-Cog 11 score returned to baseline after approximately 12 months. Conclusions: Patients who demonstrate improvement, stability, or limited cognitive decline 2-5 months after reaching maintenance doses of galantamine are more likely to experience continued benefit from long-term galantamine therapy.
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Affiliation(s)
- S Kavanagh
- Johnson & Johnson Pharmaceutical Services, 30 Turnhoutseweg, 2340 Beerse, Belgium.
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Mitchell B, Kavanagh S, Greenwood J, Mitchell A. The implementation of a ‘burns/intensive care link nurse’ to facilitate best practice burn management. Aust Crit Care 2010. [DOI: 10.1016/j.aucc.2009.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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28
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Kwong W, Gasik A, Voeller S, Kavanagh S, Gregorian R. Importance of opioid side effects in pain management from patient perspective. The Journal of Pain 2009. [DOI: 10.1016/j.jpain.2009.01.273] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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29
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Kavanagh S, Kwong W, Hammond G, Upmalis D, Okamoto A, Yang M. Bowel function following tapentadol and oxycodone immediate release (IR) Treatment in subjects with end stage joint disease: post-hoc analysis of data from a randomized, double-blind, active- and placebo-controlled study. The Journal of Pain 2009. [DOI: 10.1016/j.jpain.2009.01.180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Bonnet F, Eberhart L, Wennberg E, Dodds SJ, Van Bellinghen L, Annemans L, Kavanagh S, Choe Y. Fentanyl HCl iontophoretic transdermal system versus morphine IV-PCA for postoperative pain management: survey of healthcare provider opinion. Curr Med Res Opin 2009; 25:293-301. [PMID: 19192974 DOI: 10.1185/03007990802631321] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This survey estimated differences in staff time requirements between fentanyl HCl iontophoretic transdermal system (fentanyl ITS) and intravenous patient-controlled analgesia (IV-PCA) in post-operative pain management. RESEARCH DESIGN AND METHODS European Delphi panels of nurses and anaesthesiologists, who had practical experience with both fentanyl ITS and IV-PCA, were provided a task list, developed from a previous clinical trial, associated with each modality. The panellists were asked to estimate time spent on each task. Estimates were calculated by multiplying the estimated patient proportion for whom the task was performed by the expected frequency of task performance, by the estimated task time. RESULTS Data is presented as mean minutes (standard deviation). Fentanyl ITS use was estimated to save an average of 68.7 min total staff time per patient per treatment period compared to IV-PCA (86.5 (20.3)) vs. 156.4 (55.2); respectively; p < 0.001), the largest amount of savings being in the 'Setup' category (19.4 (6.7) vs. 47.8 (17.5), respectively; p < 0.001), and mostly due to IV-PCA task elimination. Significant time savings were estimated using fentanyl ITS over IV-PCA in the 'Discontinuation' category (4.8 (2.4) vs. 20.6 (3.3), respectively; p < 0.001). Panellists agreed that fentanyl ITS use would decrease staff assistance time required for helping patients during self-care routines and it may also decrease the patient's time to ambulation. Survey limitations included: possible recall bias due to the observational nature of the data; task list descriptions resulting in possible double-counting of data; no sensitivity analyses; and the declarative nature of the responses possibly leading to a dilution of survey findings. CONCLUSIONS Fentanyl ITS use was estimated, by expert opinion, to require 44% less staff time than IV-PCA use.
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Affiliation(s)
- F Bonnet
- Université Pierre & Marie Curie, Paris, France.
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31
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Feldman HH, Pirttila T, Dartigues JF, Everitt B, Van Baelen B, Brashear HR, Berlin JA, Battisti WP, Kavanagh S. Analyses of mortality risk in patients with dementia treated with galantamine. Acta Neurol Scand 2009; 119:22-31. [PMID: 18518863 DOI: 10.1111/j.1600-0404.2008.01047.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [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: 11/28/2022]
Abstract
OBJECTIVE To analyze mortality data from patients with Alzheimer's disease (AD), Alzheimer's plus cerebrovascular disease (AD + CVD) or vascular dementia (VaD). METHODS (1) Meta-analysis of mortality data from double-blind, placebo-controlled, randomized trials; and (2) recontact study to collect additional longer term mortality data from previous galantamine trial participants. RESULTS (META-ANALYSIS): Across 12 trials (< or =6 months duration), there was no increased risk of mortality associated with the use of galantamine (n = 4116) compared with that of placebo (n = 2386) (OR galantamine/placebo: 0.67, 95% CI 0.41-1.10). RESULTS (RECONTACT STUDY): Median survival was 79 months for patients with AD (n = 478) and 59 months for patients with AD + CVD (n = 180) or VaD (n = 145). Prolonged galantamine treatment (> vs < or =6 months) was not associated with decreased survival time (75 vs 61 months respectively; P = 0.02). Cox regression analyses were consistent with the Kaplan-Meier analyses. CONCLUSIONS We found no short-term or longer term evidence of increased risk of mortality associated with the use of galantamine in patients with AD, AD + CVD or VaD.
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Affiliation(s)
- H H Feldman
- University British Columbia Hospital, Vancouver, Canada.
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Burke F, Murphy JJ, O'Donovan MA, O'Mara FP, Kavanagh S, Mulligan FJ. Comparative Evaluation of Alternative Forages to Grass Silage in the Diet of Early Lactation Dairy Cows. J Dairy Sci 2007; 90:908-17. [PMID: 17235167 DOI: 10.3168/jds.s0022-0302(07)71574-6] [Citation(s) in RCA: 26] [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: 11/19/2022]
Abstract
Fifty-six autumn-calving Holstein-Friesian cows, blocked on the basis of days in milk (27.6 +/- 10.65 d), lactation number (3.1 +/- 2.21), and preexperimental milk yield (28.4 +/- 6.69 kg) were used to examine the effects of replacing 330 g/kg of dry matter (DM) of first-cut perennial ryegrass silage with either fermented whole-crop wheat (WCW), urea-treated processed WCW, or corn silage on subsequent feed intake, milk production, and efficiency of nitrogen utilization. The DM (g/kg), crude protein (CP, g/kg of DM) and in vitro DM digestibility (g/kg) of the forages were 204, 179, and 762 for grass silage; 389, 90, and 711 for fermented WCW; 795, 141, and 768 for urea-treated processed WCW; and 346, 93, and 783 for corn silage, respectively. Four forage treatments were evaluated as follows: 1) grass silage as the sole forage (GS); 2) a mixture of grass silage and fermented WCW silage, (F-WCW); 3) a mixture of grass silage and urea-treated processed WCW, (UP-WCW); and 4) a mixture of grass silage and corn silage (CS). In all cases, the alternative forages comprised 67% of the forage mix on a DM basis. Isonitrogenous diets were formulated by offering all cows 8 kg of concentrate as fed, formulated to different CP concentrations. Cows were offered these diets from 28 to 104 d in milk. Total DM intake and milk yield were greater on UP-WCW (20.0 and 30.2 kg/d) and CS (18.3 and 33.2 kg/d) than on GS (13.5 and 26.5 kg/d). Although DM intake was greater on F-WCW (17.1 kg/d) than on GS, milk yield was not significantly greater (+2.7 kg/d). Milk protein concentration was greater on F-WCW (30.5 g/kg), UP-WCW (31.3 g/kg), and CS (30.7 g/kg) than on GS (28.5 g/kg). However, there was no difference between treatments in milk fat or lactose concentrations. Body weight change was greater for cows offered GS (-0.27 kg/d) than for those offered UP-WCW (-0.01 kg/d) and CS (+0.05 kg/d) but not compared with those offered F-WCW (-0.06 kg/d). There was no effect of treatment on plasma glucose, nonesterified fatty acids, beta-hydroxybutyrate, urea, or total protein at d 64 +/- 17.4 and d 92 +/- 17.4 postpartum. Efficiency of N utilization was greatest for CS with 0.36 of N intake being recovered in milk compared with 0.28, 0.32, and 0.26 for GS, F-WCW, and UP-WCW, respectively. There was no effect of treatment on milk urea N concentration or the urinary allantoin N to creatinine N ratio. The results of this experiment indicate that corn silage is a more suitable supplementary forage to grass silage than fermented or urea-treated processed WCW, with advantages realized in milk production and more efficient N utilization.
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Affiliation(s)
- F Burke
- Teagasc Moorepark Dairy Production Research Centre, Fermoy, Co. Cork, Ireland
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33
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Grond S, Heisel O, Kavanagh S, Balshaw R, Hunsche E. 717 META-ANALYSIS OF THE EFFICACY OF THE FENTANYL HCL IONTOPHORETIC TRANSDERMAL SYSTEM (ITS) VERSUS IV PCA IN POST-OPERATIVE ACUTE PAIN MANAGEMENT. Eur J Pain 2006. [DOI: 10.1016/s1090-3801(06)60720-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Annemans L, Hunsche E, Spaepen E, Bellinghen LA, Choe Y, Kavanagh S. 712 ECONOMIC EVALUATION OF THE FENTANYL HCL PATIENT-ACTIVATED TRANSDERMAL SYSTEM (ITS) IN ACUTE POST-OPERATIVE PAIN MANAGEMENT (POPM) IN BELGIUM. Eur J Pain 2006. [DOI: 10.1016/s1090-3801(06)60715-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dubois D, Kosinski M, Hale M, Schein J, Kavanagh S. 672 SAFETY, EFFICACY, AND HEALTH-RELATED QUALITY-OF-LIFE OUTCOMES FOR PATIENTS WITH CHRONIC OSTEOARTHRITIS PAIN TREATED WITH OROS® HYDROMORPHONE VERSUS ER OXYCODONE. Eur J Pain 2006. [DOI: 10.1016/s1090-3801(06)60675-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Standl T, Bannister J, Capdevila X, Kavanagh S. 724 IMPACT OF INTRAVENOUS PATIENT-CONTROLLED ANALGESIA ON HOSPITAL LOGISTICS, RESOURCE UTILISATION, AND COSTS ASSOCIATED WITH POSTOPERATIVE PAIN MANAGEMENT IN EUROPE. Eur J Pain 2006. [DOI: 10.1016/s1090-3801(06)60727-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pereira J, Bruera E, Macmillan K, Kavanagh S. Palliative cancer patients and their families on the Internet: motivation and impact. J Palliat Care 2002; 16:13-9. [PMID: 11965929] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Increasingly, palliative patients and their families are going online. A series of cases are presented to explore the reasons they go online and the effects of their online activity, both harmful and beneficial. This paper highlights the need to take this growing phenomenon and its effects on patient care seriously, and identifies key areas that need to be explored further.
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Affiliation(s)
- J Pereira
- Palliative Care Program, Grey Nuns Community Hospital & Health Centre, Edmonton, Alberta
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Wilke HJ, Kavanagh S, Neller S, Claes L. [Effect of artificial disk nucleus implant on mobility and intervertebral disk high of an L4/5 segment after nucleotomy]. Orthopade 2002; 31:434-40. [PMID: 12089792 DOI: 10.1007/s00132-001-0286-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study investigated whether after a nucleotomy and implantation of a prosthetic disk nucleus (PDN) the original height and mobility of an L4/L5 disk can be restored. Compared to the intact state (100%), nucleotomy increased the median values of the normalized range of motion (ROM) in flexion/extension to 118%, lateral bending to 112%, and axial rotation to 121%. PDN implantation reduced ROM to 102%, 88%, and 90%. These differences were even more distinct when comparing the neutral zone (NZ) with 210%, 173%, and 107% after nucleotomy and 146%, 149%, and 44% after PDN implantation. With an axial preload of 200 N, disk height after nucleotomy was reduced by about 1.3 mm and could be restored with PDN implantation. PDN implantation can restore disk height and ROM after nucleotomy to normal values and reduce the strong NZ increase. Further biomechanical characterization of this therapy with PDN is necessary.
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Affiliation(s)
- H J Wilke
- Institut für Unfallchirurgische Forschung und Biomechanik, Universität Ulm, Helmholtzstrasse 14, 89081 Ulm.
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Abstract
The Rural and Remote Mental Health Service (RRMHS) has delivered telepsychiatry services through the use of videoconferencing to South Australian communities since May 1994. The survivability of the service results from a combination of factors that have seen the RRMHS expand to 48 centres and deliver an average of 100 clinical sessions a month. The key factors responsible for the success of the service lie in the model of service delivery, management support, and the implementation of a system for the scheduling and reporting of videoconference activity. The current model of service delivery has evolved over the past seven years and is fundamentally different to the infrastructure established at the implementation stage of the project. A retrospective analysis shows the shift in service delivery models necessary for the sustainability of telepsychiatry services in South Australia.
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Affiliation(s)
- S Kavanagh
- Rural and Remote Mental Health Service of South Australia, Flinders Medical Centre, SA 5063, Australia.
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Wilke HJ, Kavanagh S, Neller S, Haid C, Claes LE. Effect of a prosthetic disc nucleus on the mobility and disc height of the L4-5 intervertebral disc postnucleotomy. J Neurosurg 2001; 95:208-14. [PMID: 11599838 DOI: 10.3171/spi.2001.95.2.0208] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Current procedures for treatment of degenerative disc disease may not restore flexibility or disc height to the intervertebral disc. Recently, a prosthetic device, intended to replace the degenerated nucleus pulposus, was developed. In this biomechanical in vitro test the authors study the effect of implanting a prosthetic nucleus in cadaveric lumbar intervertebral discs postnucleotomy and determine if the flexibility and disc height of the L4-5 motion segment is restored. METHODS The prosthetic disc nucleus device consists of two hydrogel pellets, each enclosed in a woven polyethylene jacket. Six human cadaveric lumbar motion segments (obtained in individuals who, at the time of death, were a mean age of 56.7 years) were loaded with moments of +/- 7.5 Nm in flexion-extension, lateral bending, and axial rotation. The following states were investigated: intact, postnucleotomy, and after device implantation. Range of motion (ROM) and neutral zone (NZ) measurements were determined. Change in disc height from the intact state was measured after nucleotomy and device implantation, with and without a 200-N preload. CONCLUSIONS Compared with the intact state (100%), the nucleotomy increased the ROM in flexion-extension to 118%, lateral bending to 112%, and axial rotation to 121%; once the device was implanted the ROM was reduced to 102%, 88%, and 90%, respectively. The NZ increased the ROM to 210%, lateral bending to 173%, and axial rotation to 107% after nucleotomy, and 146%, 149%, 44%, respectively, after device implantation. A 200-N preload reduced the intact and postnucleotomy disc heights by approximately 1 mm and 2 mm, respectively. The original intact disc height was restored after implantation of the device. The results of the cadaveric L4-5 flexibility testing indicate that the device can potentially restore ROM, NZ, and disc height to the denucleated segment.
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Affiliation(s)
- H J Wilke
- Institute for Orthopedic Research and Biomechanics, University of Ulm, Germany.
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Kavanagh S, Lynch P, O’Mara F, Caffrey P. A comparison of total collection and marker technique for the measurement of apparent digestibility of diets for growing pigs. Anim Feed Sci Technol 2001. [DOI: 10.1016/s0377-8401(00)00237-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [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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Abstract
BACKGROUND The high costs of health and social care support for stroke survivors, and the development of new service arrangements, have concentrated growing attention on economic issues. However, there are few data on costs and their association with levels of disability. METHODS Secondary analyses of data from the OPCS (Office of Population Censuses and Surveys) Surveys of Disability conducted in the mid-1980s were used to examine service utilization and costs for more than 1000 people who have had a stroke. Costs were estimated for all health and social care services. Regression analyses examined the cost-disability association in the context of other covariates for people living in private households. RESULTS Disability problems were common among stroke survivors, particularly in relation to locomotion, self-care and holding. Among people living alone, the major contributors to costs were in-patient care (Pound Sterling 27 per week) and home help (Pound Sterling 30 per week). Among people living with others, in-patient hospital care was also a major cost (Pound Sterling 28 per week). Other services costing more than Pound Sterling 5 per week were general practitioner consultations, hospital out-patient care and day centre attendances. Resource use patterns varied considerably. Costs were associated with severity of disability, time since stroke and whether the person was living alone. Looking at the overall balance of care, a greater proportion of stroke survivors with severe disability were resident in communal establishments. CONCLUSION The analyses provide a baseline from which more recent local studies and evaluations can be compared. Key issues for economic studies of stroke are the inclusion of a broad range of services, a reasonable duration of follow-up and consideration of the impact of the substitution of informal for formal services.
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Affiliation(s)
- S Kavanagh
- Personal Social Services Research Unit, London School of Economics and Political Science
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43
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Abstract
Telemedicine has evolved to become an integral part of the South Australian Rural and Remote Mental Health Service. The resulting telemedicine service is one of only a few telepsychiatry services around the world that is firmly embedded in normal clinical practice and can be regarded as sustainable. The telepsychiatry service has been operational in Adelaide since January 1994 and more than 2000 clinical consultations have been performed since that time. In contrast to other telepsychiatry systems internationally, more than 80% of the usage of the South Australian system has been for clinical purposes. The benefits and limitations of telepsychiatry are reviewed, as are factors that have affected the success of the project.
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Affiliation(s)
- F Hawker
- Rural and Remote Mental Health Service of South Australia, Glenside Hospital, South Australia.
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44
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Abstract
BACKGROUND Population ageing and the high costs of care support for elderly people have concentrated attention on economic issues. Is there an association between costs and cognitive disability? AIMS To compare service utilisation and direct costs for elderly people with different degrees of cognitive disability, and between people living in households and in communal establishments. METHOD Secondary analysis of Office of Population Censuses and Surveys (OPCS) Disability Surveys data compared service utilisation and costs for 8736 elderly people with cognitive disability. Cost estimates were constructed for all health and social care services. RESULTS A much greater proportion of people at higher levels of cognitive disability lived in communal establishments, where their (direct) costs were much higher than when supported in households. Service utilisation patterns and costs varied with cognitive disability. CONCLUSIONS It is important to look at the full range of living arrangements and support services when examining costs. The potential cost implications of pharmacotherapies, other treatments or new care arrangements cannot be appreciated without such a broad perspective.
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Abstract
OBJECTIVES To describe utilisation of general practitioners by elderly people resident in communal establishments; to examine variations in general practitioner utilisation and estimate the likely impact of the "downsizing" of long stay provision in NHS hospitals. DESIGN Secondary analyses of the survey of disability among adults in communal establishments conducted by the Office of Population Censuses and Surveys in 1986, and projection to present day. SETTING Nationally representative sample of communal establishments in Great Britain. SUBJECTS Disabled residents aged 65 or more without mental handicap. RESULTS Residents with higher levels of disability, disorders of the digestive system, resident in smaller local authority homes or larger voluntary residential homes were more likely to consult a general practitioner. For those who consulted, higher levels of disability and morbidity and residence in a private nursing home or a larger private residential home were all associated with greater general practitioner utilisation. Overall, when residents' characteristics and size of home was controlled for, residents in nursing homes had greater predicted utilisation than those in residential care homes. People who would previously have been cared for in NHS hospitals and are now cared for in nursing homes have high predicted utilisation due to their greater morbidity and disability. CONCLUSION The "downsizing" of NHS provision for elderly people has increased demand on general practitioners by 160 whole time equivalents per year in Britain.
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Affiliation(s)
- S Kavanagh
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent CT2 7NF.
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Weaver T, Taylor F, Cunningham B, Kavanagh S, Maden A, Rees S, Renton A. Impact of a dedicated service for male mentally disordered remand prisoners in north west London: retrospective study. BMJ 1997; 314:1244-5. [PMID: 9154028 PMCID: PMC2126621 DOI: 10.1136/bmj.314.7089.1244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- T Weaver
- Department of Epidemiology and Public Health, Imperial College School of Medicine at St Mary's, London
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Beecham J, Knapp M, McGilloway S, Donnelly M, Kavanagh S, Fenyo A, Mays N. The cost-effectiveness of community care for adults with learning disabilities leaving long-stay hospital in Northern Ireland. J Intellect Disabil Res 1997; 41 ( Pt 1):30-41. [PMID: 9089457 DOI: 10.1111/j.1365-2788.1997.tb00674.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Among the many questions concerning the replacement of long-stay hospital services with community-based care are those of cost and cost-effectiveness. Is community care more expensive than hospital care? Are levels of expenditure associated with clients' needs and changes in their well-being? By following a cohort of people discharged from seven long-stay hospitals in Northern Ireland, this wide-ranging evaluation was able to address such cost-related questions. Although nearly three-quarters of the sample were living in private sector residential or nursing homes, a six-fold variation in the total costs of support was found. However, at the mean, community care was less expensive than hospital care. For only ten people in our sample of 192 clients did the costs of community care exceed the average cost of long-stay inpatient care. Multivariate analysis revealed that the costs of community care 'packages' were linked to some client needs, but higher spending was not unequivocally associated with better client outcomes. Care in the community is reasonably cost-effective in Northern Ireland when compared with long-term hospital care. However, there is a case for increasing expenditure on community care for people with learning difficulties, to increase use of services provided outside the accommodation and enhance staffing arrangements within the accommodation facilities. Distributing resources appropriately and targeting resources on priority needs through coordination will hep to continue to improve clients' quality of life.
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Affiliation(s)
- J Beecham
- Personal Social Services Research Unit (PSSRU), University of Kent at Canterbury, England
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Abstract
Schizophrenia is an expensive illness, with hospitalization representing a major cost of treatment. To evaluate new drugs and management strategies for schizophrenia, we must have reliable measures of outcomes and costs. Cost-outcome evaluations are particularly important because they allow comparisons of the potential costs and consequences of various strategies. The best estimates of outcome use batteries of instruments to score the well-being of patients and their caregivers. Dimensions of well-being include clinical status, functional status, access to resources and opportunities, subjective quality of life, family well-being, and patient satisfaction with services. The best overall outcome may involve trade-offs between different dimensions (eg, moving a patient from hospital-based care to community-based care may improve the patient's quality of life but increase family burden). Although measuring direct costs of schizophrenia is reasonably straightforward, indirect costs are more difficult to measure. The cost of pain and suffering (intangible costs) caused by schizophrenia for an individual patient or family is seldom assessed, although quality-of-life measures may provide some information. Increased costs of treatments in one area (eg, medication) may well be offset by reduced expenditures in another (eg, hospitalization), Trade-offs between different dimensions and different schizophrenia management agencies are only possible once the boundaries between these have been made clear by proper economic evaluations.
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Affiliation(s)
- M Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, United Kingdom
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Abstract
There has been considerable debate concerning the cost-effectiveness of selective serotonin re-uptake inhibitors (SSRIs) versus tricyclic antidepressants (TCAs) thus far using crude prescription price comparisons or reductionist decision-analytic models. This paper employs a retrospective quasi-experimental design where data on service utilisation, use of medication and informal care were collected for two groups of patients in general practice settings. The mean cost of treatment was marginally greater for those people receiving TCA medication due to greater use of psychiatric services. Factors such as age, previous depression and concomitant physical illness are all associated with greater treatment costs. Further analysis using a prospective design is recommended.
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Affiliation(s)
- J Forder
- Personal Social Services Research Unit (PSSRU), London School of Economics, UK
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