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Andrews NE, Ireland D, Vijayakumar P, Burvill L, Hay E, Westerman D, Rose T, Schlumpf M, Strong J, Claus A. Acceptability of a Pain History Assessment and Education Chatbot (Dolores) Across Age Groups in Populations With Chronic Pain: Development and Pilot Testing. JMIR Form Res 2023; 7:e47267. [PMID: 37801342 PMCID: PMC10589833 DOI: 10.2196/47267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The delivery of education on pain neuroscience and the evidence for different treatment approaches has become a key component of contemporary persistent pain management. Chatbots, or more formally conversation agents, are increasingly being used in health care settings due to their versatility in providing interactive and individualized approaches to both capture and deliver information. Research focused on the acceptability of diverse chatbot formats can assist in developing a better understanding of the educational needs of target populations. OBJECTIVE This study aims to detail the development and initial pilot testing of a multimodality pain education chatbot (Dolores) that can be used across different age groups and investigate whether acceptability and feedback were comparable across age groups following pilot testing. METHODS Following an initial design phase involving software engineers (n=2) and expert clinicians (n=6), a total of 60 individuals with chronic pain who attended an outpatient clinic at 1 of 2 pain centers in Australia were recruited for pilot testing. The 60 individuals consisted of 20 (33%) adolescents (aged 10-18 years), 20 (33%) young adults (aged 19-35 years), and 20 (33%) adults (aged >35 years) with persistent pain. Participants spent 20 to 30 minutes completing interactive chatbot activities that enabled the Dolores app to gather a pain history and provide education about pain and pain treatments. After the chatbot activities, participants completed a custom-made feedback questionnaire measuring the acceptability constructs pertaining to health education chatbots. To determine the effect of age group on the acceptability ratings and feedback provided, a series of binomial logistic regression models and cumulative odds ordinal logistic regression models with proportional odds were generated. RESULTS Overall, acceptability was high for the following constructs: engagement, perceived value, usability, accuracy, responsiveness, adoption intention, esthetics, and overall quality. The effect of age group on all acceptability ratings was small and not statistically significant. An analysis of open-ended question responses revealed that major frustrations with the app were related to Dolores' speech, which was explored further through a comparative analysis. With respect to providing negative feedback about Dolores' speech, a logistic regression model showed that the effect of age group was statistically significant (χ22=11.7; P=.003) and explained 27.1% of the variance (Nagelkerke R2). Adults and young adults were less likely to comment on Dolores' speech compared with adolescent participants (odds ratio 0.20, 95% CI 0.05-0.84 and odds ratio 0.05, 95% CI 0.01-0.43, respectively). Comments were related to both speech rate (too slow) and quality (unpleasant and robotic). CONCLUSIONS This study provides support for the acceptability of pain history and education chatbots across different age groups. Chatbot acceptability for adolescent cohorts may be improved by enabling the self-selection of speech characteristics such as rate and personable tone.
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Affiliation(s)
- Nicole Emma Andrews
- RECOVER Injury Research Centre, The University of Queensland, Herston, Australia
- Tess Cramond Pain and Research Centre, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- The Occupational Therapy Department, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Herston, Australia
| | - David Ireland
- Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation, Herston, Australia
| | - Pranavie Vijayakumar
- Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation, Herston, Australia
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Lyza Burvill
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Elizabeth Hay
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Daria Westerman
- Queensland Interdisciplinary Paediatric Persistent Pain Service, Queensland Children's Hospital, South Brisbane, Australia
| | - Tanya Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Mikaela Schlumpf
- Queensland Interdisciplinary Paediatric Persistent Pain Service, Queensland Children's Hospital, South Brisbane, Australia
| | - Jenny Strong
- Tess Cramond Pain and Research Centre, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- The Occupational Therapy Department, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Andrew Claus
- Tess Cramond Pain and Research Centre, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
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Bola R, Sutherland J, Murphy RA, Leeies M, Grant L, Hayward J, Archambault P, Graves L, Rose T, Hohl C. Patient-reported health outcomes of SARS-CoV-2-tested patients presenting to emergency departments: a propensity score-matched prospective cohort study. Public Health 2023; 215:1-11. [PMID: 36587446 PMCID: PMC9712064 DOI: 10.1016/j.puhe.2022.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE This study aimed to compare the long-term physical and mental health outcomes of matched severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive and SARS-CoV-2-negative patients controlling for seasonal effects. STUDY DESIGN This was a retrospective cohort study. METHODS This study enrolled patients presenting to emergency departments participating in the Canadian COVID-19 Emergency Department Rapid Response Network. We enrolled consecutive eligible consenting patients who presented between March 1, 2020, and July 14, 2021, and were tested for SARS-CoV-2. Research assistants randomly selected four site and date-matched SARS-CoV-2-negative controls for every SARS-CoV-2-positive patient and interviewed them at least 30 days after discharge. We used propensity scores to match patients by baseline characteristics and used linear regression to compare Veterans RAND 12-item physical health component score (PCS) and mental health component scores (MCS), with higher scores indicating better self-reported health. RESULTS We included 1170 SARS-CoV-2-positive patients and 3716 test-negative controls. The adjusted mean difference for PCS was 0.50 (95% confidence interval [CI]: -0.36, 1.36) and -1.01 (95% CI: -1.91, -0.11) for MCS. Severe disease was strongly associated with worse PCS (β = -7.4; 95% CI: -9.8, -5.1), whereas prior mental health illness was strongly associated with worse MCS (β = -5.4; 95% CI: -6.3, -4.5). CONCLUSION Physical health, assessed by PCS, was similar between matched SARS-CoV-2-positive and SARS-CoV-2-negative patients, whereas mental health, assessed by MCS, was worse during a time when the public experienced barriers to care. These results may inform the development and prioritization of support programs for patients.
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Affiliation(s)
- R Bola
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - J Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - R A Murphy
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - M Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada; Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - L Grant
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada; Emergency Department, Jewish General Hospital, Montreal, QC, Canada
| | - J Hayward
- Department of Emergency Medicine, University of Alberta, AB, Canada
| | - P Archambault
- Université Laval, Department of Family Medicine and Emergency Medicine, QC, Canada
| | - L Graves
- Patient Partner, Canadian COVID-19 Emergency Department Rapid Response Network Patient Engagement Committee, Canada
| | - T Rose
- Patient Partner, Canadian COVID-19 Emergency Department Rapid Response Network Patient Engagement Committee, Canada
| | - C Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada; Emergency Department, Vancouver General Hospital, Vancouver, BC, Canada.
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Finch E, Ward EC, Brown B, Cornwell P, Hill AE, Hill A, Hobson T, Rose T, Scarinci N, Marshall J, Cameron A, Shrubsole K. Setting a prioritized agenda to drive speech-language therapy research in health. Int J Lang Commun Disord 2021; 56:768-783. [PMID: 34048119 DOI: 10.1111/1460-6984.12626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Prioritized research agendas are viewed internationally as an important method for ensuring that health research meets actual areas of clinical need. There is growing evidence for speech-language therapy-prioritized research agendas, particularly in disorder-specific areas. However, there are few general research priority agendas to guide speech-language therapy research. AIMS To collaboratively develop a prioritized research agenda for an Australian public health context with clinical speech-language therapists (SLTs), academic SLTs and consumers of speech-language therapy services. METHODS & PROCEDURES An initial stimulus list of potential research areas for prioritization was collected from SLTs via an online survey. Two categories (service delivery and expanded scope of practice) were selected from this list for prioritization due to their relevance across multiple health services. The Nominal Group Technique (NGT) was used to develop a prioritized research agenda for each of the two categories. One NGT session was conducted with each of the three participant groups (clinical SLTs, academic SLTs, consumers) for each category (total NGT sessions = six). The prioritization data for each group within each category were summed to give a single, ranked prioritized research agenda for each category. OUTCOMES & RESULTS Two prioritized research agendas were developed. Within each agenda, SLTs and consumers prioritized a need for more research in areas related to specific practice areas (e.g., Alternative and Augmentative Communication, Communication Partner Training), as well as broader professional issues (e.g., telehealth, working with culturally and linguistically diverse families). CONCLUSIONS & IMPLICATIONS The current findings support the need for funding proposals and targeted projects that address these identified areas of need. WHAT THIS PAPER ADDS What is already known on this subject Evidence-based practice is a critical component of SLT practice. There is often a disconnect between the research evidence generated and areas of clinical need, and in some areas a lack of evidence. Prioritized research agendas can help drive research in areas of clinical need. What this paper adds to existing knowledge A collaborative, prioritized SLT research agenda was developed using the NGT according to the views of clinical SLTs, academic SLTs and consumers of speech-language therapy services in a conglomerate of public health services. SLTs and consumers identified a need for further research in specific areas of SLT practice as well as broader emerging professional issues What are the potential or actual clinical implications of this work? Targeted research projects funded on a large scale are required to address these identified areas of need. Other health services around the world could replicate this prioritization process to drive research in areas of clinical need.
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Affiliation(s)
- Emma Finch
- Princess Alexandra Hospital, Brisbane, QLD, Australia
- The University of Queensland, Saint Lucia, QLD, Australia
- Centre for Functioning and Health Research, Brisbane, QLD, Australia
| | - Elizabeth C Ward
- The University of Queensland, Saint Lucia, QLD, Australia
- Centre for Functioning and Health Research, Brisbane, QLD, Australia
| | - Bena Brown
- Princess Alexandra Hospital, Brisbane, QLD, Australia
- The University of Queensland, Saint Lucia, QLD, Australia
| | | | - Anne E Hill
- The University of Queensland, Saint Lucia, QLD, Australia
| | - Annie Hill
- The University of Queensland, Saint Lucia, QLD, Australia
| | - Tania Hobson
- Children's Health Queensland, Brisbane, QLD, Australia
| | - Tanya Rose
- The University of Queensland, Saint Lucia, QLD, Australia
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Zorn-Pauly L, Von Stuckrad ASL, Klotsche J, Rose T, Kallinich T, Hiepe F, Enghard P, Ostendorf L, Dörner T, Meisel C, Schneider U, Unterwalder N, Burmester GR, Alexander T, Biesen R. POS0744 A NEGATIVE INTERFERON BIOMARKER CD169 / SIGLEC-1 RULES OUT SYSTEMIC LUPUS ERYTHEMATOSUS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:While there have been advances in the therapy of systemic lupus erythematosus (SLE) in recent years, there have been no major new findings in SLE biomarkers [1, 2]. Type I interferon (IFN) plays a pivotal role in the pathogenesis of SLE [3]. In 2008, we first described CD169 / SIGLEC-1 (sialic acid-binding immunoglobulin-like lectin-1), an interferon-induced adhesion molecule on monocytes in SLE patients [4]. For over five years SIGLEC-1 has been routinely assessed in our clinic.Objectives:To evaluate and compare the diagnostic utility of the type I IFN induced SIGLEC-1 with established biomarkers in the initial diagnosis of the disease.Methods:We analyzed retrospectively 232 patients who were on suspicion of SLE at Charité University Hospital Berlin between October 2015 and September 2020. Patients underwent full clinical characterization, and biomarkers were determined in the routine laboratory. Based on the final diagnosis, we divided patients into two groups: A) initial diagnosis of SLE and B) Non-SLE mimicking condition.Results:In 76 patients (32.3 %) SLE was confirmed by fulfilling the EULAR / ACR 2019 classification criteria [5]. SIGLEC-1 was dramatically increased in patients with an initial diagnosis of SLE compared to patients without SLE (p<0.0001). For a threshold of 2500 molecule per monocyte, a sensitivity of 98.7 %, a specificity of 82.1 %, a negative predictive value (NPV) of 99.2 %, and a positive predictive value (PPV) of 72.8 % were calculated for SIGLEC-1. Adjusted to the prevalence of SLE in Germany (36.7 per 100,000 inhabitants [6]) NPV and PPV turned out to > 99.9 % and 0.2 %. We further aimed to compare not only the performance of the tests at a given cutoff but also across all possible measured values. Therefore, we conducted ROC curves analyses (see figure 1). The area under the curve (AUC) of SIGLEC-1 test was significantly higher than that of ANA test (AUC=0.88, p=0.031), C3 (AUC = 0.83, p=0.001), C4 (AUC=0.83, p=0.002), but not than that of the Anti-dsDNA ELISA (AUC=0.90, p=0.163).Conclusion:Our study shows that IFN activity is a hallmark at the onset of the disease and that the interferon biomarker SIGLEC-1 is valuable to rule out SLE in suspected cases.References:[1]Ostendorf L, Burns M, Durek P, Heinz GA, Heinrich F, Garantziotis P, Enghard P, Richter U, Biesen R, Schneider U et al: Targeting CD38 with Daratumumab in Refractory Systemic Lupus Erythematosus. N Engl J Med 2020, 383(12):1149-1155.[2]Furie R, Rovin BH, Houssiau F, Malvar A, Teng YKO, Contreras G, Amoura Z, Yu X, Mok CC, Santiago MB et al: Two-Year, Randomized, Controlled Trial of Belimumab in Lupus Nephritis. N Engl J Med 2020, 383(12):1117-1128.[3]Ronnblom L, Leonard D: Interferon pathway in SLE: one key to unlocking the mystery of the disease. Lupus Sci Med 2019, 6(1):e000270.[4]Biesen R, Demir C, Barkhudarova F, Grun JR, Steinbrich-Zollner M, Backhaus M, Haupl T, Rudwaleit M, Riemekasten G, Radbruch A et al: Sialic acid-binding Ig-like lectin 1 expression in inflammatory and resident monocytes is a potential biomarker for monitoring disease activity and success of therapy in systemic lupus erythematosus. Arthritis Rheum 2008, 58(4):1136-1145.[5]Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey-Goldman R, Smolen JS, Wofsy D, Boumpas DT, Kamen DL et al: 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Annals of the Rheumatic Diseases 2019, 78(9):1151-1159.[6]Brinks R, Fischer-Betz R, Sander O, Richter JG, Chehab G, Schneider M: Age-specific prevalence of diagnosed systemic lupus erythematosus in Germany 2002 and projection to 2030. Lupus 2014, 23(13):1407-1411.Disclosure of Interests:None declared
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Graf M, Von Stuckrad ASL, Uruha A, Klotsche J, Zorn-Pauly L, Unterwalder N, Buttgereit T, Krusche M, Meisel C, Burmester GR, Hiepe F, Biesen R, Kallinich T, Stenzel W, Schneider U, Rose T. POS0183 SIGLEC1 AS A TYPE I INTERFERON BIOMARKER IN IDIOPATHIC INFLAMMATORY MYOPATHIES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Idiopathic inflammatory myopathies (IIM) are autoimmune diseases that mainly affect skeletal muscle, lung, skin and joints. IIM can be separated into dermatomyositis (DM), inclusion body myositis (IBM), antisynthetase syndrome (AS) and immune-mediated necrotizing myopathy (IMNM). Type I interferons (IFN) are known to play a crucial role in the etiopathogenesis of some of these entities such as DM.[1] Sialic acid binding Ig-like lectin 1 (SIGLEC1, CD169) is part of the type I IFN signature found in SLE and DM and is expressed on the cell surface of monocytes. Thus, analysis of SIGLEC1 expression by flow cytometry enables a straightforward assessment of the type I IFN signature. Its utility has been shown for juvenile and adult SLE and other rheumatic diseases but not in IIM.[2,3] The assessment of the type I IFN system in clinical practice is an unmet need and, in this context, SIGLEC1 might be useful.Objectives:To assess SIGLEC1 expression on monocytes by flow cytometry as a type I IFN biomarker in IIMMethods:Pediatric and adult patients with a clinical diagnosis of DM, AS, IMNM and IBM and at least one measurement of SIGLEC1 who have been treated at the Department of Rheumatology, Charité - Universitätsmedizin Berlin between 2015 and 2020 were included in this retrospective study. Control groups of healthy individuals (n=19) and SLE patients (n=30) were included. Disease activity was assessed by Physician Global Assessment (PGA) and Childhood Myositis Assessment Scale (CMAS). SIGLEC1 expression on monocytes was analyzed by flow cytometry. Cross-sectional analyses (n=74) were performed using Mann Whitney-U test (MWU) and two-level mixed-effects linear regression model was used for longitudinal analyses (n=26, 110 visits). This study was approved by the local ethics committee of the Charité - Universitätsmedizin Berlin.Results:74 patients (adult/juvenile DM: n=21/n=17; AS: n=19; IMNM: n=8; IBM: n=9) were included. In cross-sectional analysis, SIGLEC1 expression was significantly upregulated in adult and juvenile DM patients with moderate to severe disease activity (PGA≥5) compared with adult/juvenile DM patients with no to moderate disease activity (PGA<5) (both p<0.001). In longitudinal analyses, SIGLEC1 correlated with disease activity in juvenile DM (SIGLEC1 vs. CMAS: betaST=-0.65; p<0.001) and adult DM (SIGLEC1 vs. PGA: betaST=0.52; p<0.001), better than Creatine Kinase (CK) (juvenile DM, CK vs. CMAS: betaST=-0.50; p<0.001; adult DM, CK vs PGA: betaST=0.17; p=0.149). In AS 42,1% of the patients showed elevated SIGLEC1 expression, while it was not upregulated in IMNM and only in two patients with IBM, who were concurrently positive for autoantibodies that affect the type I IFN system (see Figure 1).Conclusion:SIGLEC1 is a useful biomarker to identify an activated type I IFN system in IIM. Flow cytometry is used widely in laboratory medicine, which could facilitate the implementation of SIGLEC1 into clinical routine.References:[1]Gallay L, Mouchiroud G, Chazaud B. Interferon-signature in idiopathic inflammatory myopathies: Current Opinion in Rheumatology 2019;31:634–42. doi:10.1097/BOR.0000000000000653[2]Rose T, Grutzkau A, Hirseland H, et al. IFNalpha and its response proteins, IP-10 and SIGLEC-1, are biomarkers of disease activity in systemic lupus erythematosus. Ann Rheum Dis 2013;72:1639–45. doi:10.1136/annrheumdis-2012-201586[3]Stuckrad SL von, Klotsche J, Biesen R, et al. SIGLEC1 (CD169) is a sensitive biomarker for the deterioration of the clinical course in childhood systemic lupus erythematosus. Lupus 2020;:961203320965699. doi:10.1177/0961203320965699Figure 1.SIGLEC1 expression on monocytes in IIM subgroups and control groups; in IIM subgroups, patients with low disease activity (PGA<5) are marked in blue, patients with high disease activity (PGA≥5) are marked in red; mAb/cell, monoclonal antibodies bound per cellDisclosure of Interests:None declared
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O'Malley A, Rich E, Shang L, Niedzwiecki M, Rose T, Ghosh A, Peikes D, Poznyak D. MEASURING SAFETY, QUALITY, AND VALUE. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - E. Rich
- Mathematica Washington DC USA
| | - L. Shang
- Mathematica Policy Researcher Princeton NJ USA
| | | | - T. Rose
- Mathematica Policy Research Ann Arbor MI USA
| | - A. Ghosh
- Mathematica Policy Research Princeton NJ USA
| | - D. Peikes
- Mathematica Policy Research Princeton NJ USA
| | - D. Poznyak
- Mathematica Policy Research Princeton NJ USA
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Aue A, Szelinski F, Weißenberg S, Wiedemann A, Rose T, Lino A, Dörner T. OP0005 ELEVATED STAT1 EXPRESSION BUT NOT PHOSPHORYLATION IN LUPUS B CELLS CORRELATES WITH DISEASE ACTIVITY AND INCREASED PLASMABLAST SUSCEPTIBILITY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Systemic lupus erythematosus (SLE) is characterized by two pathogenic key signatures, type I interferon (IFN) (1.) and B-cell abnormalities (2.). How these signatures are interrelated is not known. Type I-II IFN trigger activation of Janus kinase (JAK) – signal transducer and activator of transcription (STAT).Objectives:JAK-STAT inhibition is an attractive therapeutic possibility for SLE (3.). We assess STAT1 and STAT3 expression and phosphorylation at baseline and after IFN type I and II stimulation in B-cell subpopulations of SLE patients compared to other autoimmune diseases and healthy controls (HD) and related it to disease activity.Methods:Expression of STAT1, pSTAT1, STAT3 and pSTAT3 in B and T-cells of 21 HD, 10 rheumatoid arthritis (RA), 7 primary Sjögren’s (pSS) and 22 SLE patients was analyzed by flow cytometry. STAT1 and STAT3 expression and phosphorylation in PBMCs of SLE patients and HD after IFNα and IFNγ incubation were further investigated.Results:SLE patients showed substantially higher STAT1 but not pSTAT1 in B and T-cell subsets. Increased STAT1 expression in B cell subsets correlated significantly with SLEDAI and Siglec-1 on monocytes, a type I IFN marker (4.). STAT1 activation in plasmablasts was IFNα dependent while monocytes exhibited dependence on IFNγ.Figure 1.Significantly increased expression of STAT1 by SLE B cells(A) Representative histograms of baseline expression of STAT1, pSTAT1, STAT3 and pSTAT3 in CD19+ B cells of SLE patients (orange), HD (black) and isotype controls (grey). (B) Baseline expression of STAT1 and pSTAT1 or (C) STAT3 and pSTAT3 in CD20+CD27-, CD20+CD27+ and CD20lowCD27high B-lineage cells from SLE (orange) patients compared to those from HD (black). Mann Whitney test; ****p≤0.0001.Figure 2.Correlation of STAT1 expression by SLE B cells correlates with type I IFN signature (Siglec-1, CD169) and clinical activity (SLEDAI).Correlation of STAT1 expression in CD20+CD27- näive (p<0.0001, r=0.8766), CD20+CD27+ memory (p<0.0001, r=0.8556) and CD20lowCD27high (p<0.0001, r=0.9396) B cells from SLE patients with (A) Siglec-1 (CD169) expression on CD14+ cells as parameter of type I IFN signature and (B) lupus disease activity (SLEDAI score). Spearman rank coefficient (r) was calculated to identify correlations between these parameters. *p≤0.05, **p≤0.01. (C) STAT1 expression in B cell subsets of a previously undiagnosed, active SLE patient who was subsequently treated with two dosages of prednisolone and reanalyzed.Conclusion:Enhanced expression of STAT1 by B-cells candidates as key node of two immunopathogenic signatures (type I IFN and B-cells) related to important immunopathogenic pathways and lupus activity. We show that STAT1 is activated upon IFNα exposure in SLE plasmablasts. Thus, Jak inhibitors, targeting JAK-STAT pathways, hold promise to block STAT1 expression and control plasmablast induction in SLE.References:[1]Baechler EC, Batliwalla FM, Karypis G, Gaffney PM, Ortmann WA, Espe KJ, et al. Interferon-inducible gene expression signature in peripheral blood cells of patients with severe lupus. Proc Natl Acad Sci U S A. 2003;100(5):2610-5.[2]Lino AC, Dorner T, Bar-Or A, Fillatreau S. Cytokine-producing B cells: a translational view on their roles in human and mouse autoimmune diseases. Immunol Rev. 2016;269(1):130-44.[3]Dorner T, Lipsky PE. Beyond pan-B-cell-directed therapy - new avenues and insights into the pathogenesis of SLE. Nat Rev Rheumatol. 2016;12(11):645-57.[4]Biesen R, Demir C, Barkhudarova F, Grun JR, Steinbrich-Zollner M, Backhaus M, et al. Sialic acid-binding Ig-like lectin 1 expression in inflammatory and resident monocytes is a potential biomarker for monitoring disease activity and success of therapy in systemic lupus erythematosus. Arthritis Rheum. 2008;58(4):1136-45.Disclosure of Interests:Arman Aue: None declared, Franziska Szelinski: None declared, Sarah Weißenberg: None declared, Annika Wiedemann: None declared, Thomas Rose: None declared, Andreia Lino: None declared, Thomas Dörner Grant/research support from: Janssen, Novartis, Roche, UCB, Consultant of: Abbvie, Celgene, Eli Lilly, Roche, Janssen, EMD, Speakers bureau: Eli Lilly, Roche, Samsung, Janssen
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Finch E, Lethlean J, Rose T, Fleming J, Theodoros D, Cameron A, Coleman A, Copland D, McPhail SM. Conversations between people with aphasia and speech pathology students via telepractice: A Phase II feasibility study. Int J Lang Commun Disord 2020; 55:43-58. [PMID: 31553121 DOI: 10.1111/1460-6984.12501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/21/2019] [Accepted: 09/03/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Speech pathology students can experience low confidence when communicating with people with aphasia. Communication partner training (CPT) is one method to increase confidence and skills when communicating with people with aphasia. There is a paucity of research exploring the effects of delivering CPT to students via technology, such as telepractice. AIMS To explore the feasibility (acceptability, demand, implementation, practicality, limited efficacy) of a conversation with a person with aphasia via telepractice as part of a CPT programme with speech pathology students. A secondary aim was to explore the effects of feedback from the people with aphasia (i.e., patient feedback) on students' perceived confidence and proficiency in communicating with people with aphasia. METHODS & PROCEDURES A Phase II feasibility study design was used, where both quantitative and qualitative data were collected. A total of 33 speech pathology students attended a lecture about the strategies used to communicate effectively with people with aphasia. They then participated in a 10-min conversation via videoconferencing with a person with aphasia 1 week later. Students were randomly allocated to patient feedback or no patient feedback conditions. They completed a custom designed questionnaire pre- and post-conversation. OUTCOMES & RESULTS The study had a low recruitment rate but good retention. The programme was delivered as intended. Students reported that they found the conversations to be a positive but challenging experience. Post-conversation, statistically significant increases were found in students' self-rated confidence communicating with people with aphasia, proficiency at engaging in an everyday conversation and proficiency obtaining a case history (all p < 0.001). There were no significant differences for these ratings between the groups according to feedback condition (all p > 0.01). CONCLUSIONS & IMPLICATIONS CPT involving a conversation with a person with aphasia via telepractice is feasible and can provide a valuable learning experience for students. Further research is required.
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Affiliation(s)
- Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Queensland Health, Woolloongabba, QLD, Australia
- Centre for Functioning and Health Research, Metro South Health, Queensland Health, Buranda, QLD, Australia
| | - Jennifer Lethlean
- Speech Pathology Department, Princess Alexandra Hospital, Queensland Health, Woolloongabba, QLD, Australia
| | - Tanya Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Deborah Theodoros
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Ashley Cameron
- Speech Pathology Department, Princess Alexandra Hospital, Queensland Health, Woolloongabba, QLD, Australia
| | - Adele Coleman
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - David Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Steven M McPhail
- Centre for Functioning and Health Research, Metro South Health, Queensland Health, Buranda, QLD, Australia
- School of Public Health & Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
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Lee JJ, Finch E, Rose T. Exploring the outcomes and perceptions of people with aphasia who conversed with speech pathology students via telepractice: a pilot study. Speech, Language and Hearing 2019. [DOI: 10.1080/2050571x.2019.1702241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jeslyn J. Lee
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia
| | - Tanya Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
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Kim S, Khushalani N, Eroglu Z, Russell J, Wuthrick E, Caudell J, Harrison L, Aoki M, Shah H, Blakaj D, Markowitz J, Chen DT, Messina J, Rose T, Tsai K, Brohl A. A phase II, randomized study of nivolumab (NIVO) and Ipilimumab (IPI) versus NIVO, IPI and stereotactic body radiation therapy (SBRT) for metastatic Merkel cell carcinoma (MCC, NCT03071406): A preliminary report. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz255.010] [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: 11/12/2022] Open
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Rose T, Scarinci N, Meyer C, Harris S, Forsingdal S, Anger N, Webb K. The It Takes Two to Talk® – The Hanen Program® for Parents: impacts on child behaviour and social-emotional functioning. Speech, Language and Hearing 2019. [DOI: 10.1080/2050571x.2019.1622832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Tanya Rose
- Communication Disability Centre, School of Health and Rehabilitation Sciences, The University of Queensland, ST LUCIA, Australia
| | - Nerina Scarinci
- Communication Disability Centre, School of Health and Rehabilitation Sciences, The University of Queensland, ST LUCIA, Australia
| | - Carly Meyer
- Communication Disability Centre, School of Health and Rehabilitation Sciences, The University of Queensland, ST LUCIA, Australia
| | - Stephanie Harris
- Communication Disability Centre, School of Health and Rehabilitation Sciences, The University of Queensland, ST LUCIA, Australia
| | - Shareen Forsingdal
- Child and Youth Community Health Service, Children’s Health Queensland Hospital and Health Service, Queensland Health
| | - Narelle Anger
- Child and Youth Community Health Service, Children’s Health Queensland Hospital and Health Service, Queensland Health
| | - Kylie Webb
- West Moreton Hospital and Health Service, Queensland Health
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Rose T, Rose T, Flinchum D, Proctor McCollum J, Demons J. Fall Reduction Program in a Skilled Nursing Facility: a Multidisciplinary Approach. J Am Med Dir Assoc 2019. [DOI: 10.1016/j.jamda.2019.01.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rose T, Yu L, Jiang T, Zhang G, Zhang J, Chen H. TESTING AN EDUCATIONAL MESSAGE CAMPAIGN FOR PROFESSIONALS ON DIABETES AND COGNITIVE IMPAIRMENT. Innov Aging 2018. [DOI: 10.1093/geroni/igy031.3700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Rose
- University of Southern California
| | - L Yu
- Alzheimer’s Disease Research Center, University of Southern California, Los Angeles, California, USA
| | - T Jiang
- University of Southern California
| | - G Zhang
- Alzheimer’s Disease Research Center, University of Southern California, Los Angeles, California, 90033
| | - J Zhang
- University of Southern California
| | - H Chen
- University of Southern California
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Jiang T, Yu L, Zhang J, Zhang G, Rose T. SOCIAL MARKETING MESSAGES ON TYPE 2 DIABETES AND COGNITIVE IMPAIRMENT FOR HEALTH AND MENTAL HEALTH PROFESSIONALS. Innov Aging 2018. [DOI: 10.1093/geroni/igy031.3690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T Jiang
- University of Southern California
| | - L Yu
- Alzheimer’s Disease Research Center, University of Southern California, Los Angeles, California, USA
| | - J Zhang
- University of Southern California
| | - G Zhang
- Alzheimer’s Disease Research Center, University of Southern California, Los Angeles, California, 90033
| | - T Rose
- University of Southern California
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Wallace SJ, Worrall L, Rose T, Le Dorze G, Breitenstein C, Hilari K, Babbitt E, Bose A, Brady M, Cherney LR, Copland D, Cruice M, Enderby P, Hersh D, Howe T, Kelly H, Kiran S, Laska AC, Marshall J, Nicholas M, Patterson J, Pearl G, Rochon E, Rose M, Sage K, Small S, Webster J. A core outcome set for aphasia treatment research: The ROMA consensus statement. Int J Stroke 2018; 14:180-185. [DOI: 10.1177/1747493018806200] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background A core outcome set (COS; an agreed, minimum set of outcomes) was needed to address the heterogeneous measurement of outcomes in aphasia treatment research and to facilitate the production of transparent, meaningful, and efficient outcome data. Objective The Research Outcome Measurement in Aphasia (ROMA) consensus statement provides evidence-based recommendations for the measurement of outcomes for adults with post-stroke aphasia within phases I–IV aphasia treatment studies. Methods This statement was informed by a four-year program of research, which comprised investigation of stakeholder-important outcomes using consensus processes, a scoping review of aphasia outcome measurement instruments, and an international consensus meeting. This paper provides an overview of this process and presents the results and recommendations arising from the international consensus meeting. Results Five essential outcome constructs were identified: Language, communication, patient-reported satisfaction with treatment and impact of treatment, emotional wellbeing, and quality of life. Consensus was reached for the following measurement instruments: Language: The Western Aphasia Battery Revised (WAB-R) (74% consensus); emotional wellbeing: General Health Questionnaire (GHQ)-12 (83% consensus); quality of life: Stroke and Aphasia Quality of Life Scale (SAQOL-39) (96% consensus). Consensus was unable to be reached for measures of communication (where multiple measures exist) or patient-reported satisfaction with treatment or impact of treatment (where no measures exist). Discussion Harmonization of the ROMA COS with other core outcome initiatives in stroke rehabilitation is discussed. Ongoing research and consensus processes are outlined. Conclusion The WAB-R, GHQ-12, and SAQOL-39 are recommended to be routinely included within phases I–IV aphasia treatment studies. This consensus statement has been endorsed by the Collaboration of Aphasia Trialists, the British Aphasiology Society, the German Society for Aphasia Research and Therapy, and the Royal College of Speech Language Therapists.
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Affiliation(s)
- Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Tanya Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Guylaine Le Dorze
- School of Speech-Language Pathology and Audiology, University of Montreal, Montreal, Canada
| | - Caterina Breitenstein
- Department of General Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Katerina Hilari
- School of Health Sciences, City University of London, London, UK
| | - Edna Babbitt
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA & Shirley Ryan AbilityLab, Chicago, USA
| | - Arpita Bose
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Marian Brady
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Leora R. Cherney
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA & Shirley Ryan AbilityLab, Chicago, USA
| | - David Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Madeline Cruice
- School of Health Sciences, City University of London, London, UK
| | - Pam Enderby
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Deborah Hersh
- School of Psychology and Social Science, Edith Cowan University, Perth, Australia
| | - Tami Howe
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Helen Kelly
- School of Clinical Therapies, University College Cork, Cork, Republic of Ireland
| | - Swathi Kiran
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, USA
| | - Ann-Charlotte Laska
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Internal Medicine, Stockholm, Sweden
| | - Jane Marshall
- School of Health Sciences, City University of London, London, UK
| | - Marjorie Nicholas
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, USA
| | | | | | - Elizabeth Rochon
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
| | - Miranda Rose
- School of Allied Health, La Trobe University, Bundoora, Australia
| | - Karen Sage
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Steven Small
- Department of Neurology, University of California, Irvine, USA
| | - Janet Webster
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle Upon Tyne, UK
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Van Loey NE, Hofland HWC, Vlig M, Vandermeulen E, Rose T, Beelen RHJ, Ulrich MMW. Associations between traumatic stress symptoms, pain and bio-active components in burn wounds. Psychoneuroendocrinology 2018; 96:1-5. [PMID: 29864589 DOI: 10.1016/j.psyneuen.2018.05.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Pain and traumatic stress symptoms often co-occur. Evidence suggests that the neuropeptide oxytocine and pro-inflammatory cytokines are associated with both stress and pain. The aim of this pilot study was to explore relations between self-reported pain and traumatic stress, oxytocin and three cytokines in burn wounds. METHODS An observational study in three burn centres was performed. Patients were invited to participate in the study when deep dermal injury was suspected. Patients completed the Impact of Event Scale (IES), a self-report questionnaire assessing traumatic stress symptoms, and they rated their pain the day prior to surgery. During surgery, eschar (i.e., burned tissue) was collected and stored at -80 ° C until analysis. When the data collection was complete, oxytocin and cytokine levels were analysed. RESULTS Eschar from 53 patients was collected. Pain and stress scores were available from 42 and 36 patients respectively. Spearman correlational analyses showed an association between lower oxytocin levels at wound site and a higher total IES score (r = -0.37) and pain (r = -0.32). Mann-Whitney U tests comparing groups scoring high or low on pain or stress confirmed these associations. CONCLUSION These analyses lend support to a hormonal pathway that may explain how psychological distress affects pain at skin level in patients with traumatic stress symptoms.
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Affiliation(s)
- N E Van Loey
- Behavioral Research, Association of Dutch Burn Centers, P.O. Box 1015, Beverwijk, Netherlands; Clinical Psychology, Utrecht University, Utrecht, Netherlands.
| | - H W C Hofland
- Burn Center, Maasstad Hospital, Maasstadweg 21, 3079DZ Rotterdam, Netherlands.
| | - M Vlig
- Preclinical Research, Association of Dutch Burn Centers, P.O. Box 1015EA, Beverwijk, Netherlands.
| | - E Vandermeulen
- Burn Center, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Brussels, Belgium.
| | - T Rose
- Burn Center, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Brussels, Belgium.
| | - R H J Beelen
- Molecular Cell Biology and Immunology, VU University Medical Center, P.O. Box 7057, Amsterdam, Netherlands.
| | - M M W Ulrich
- Preclinical Research, Association of Dutch Burn Centers, P.O. Box 1015EA, Beverwijk, Netherlands; Plastic Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, Netherlands.
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Finch E, Lethlean J, Rose T, Fleming J, Theodoros D, Cameron A, Coleman A, Copland D, McPhail SM. How does feedback from patients impact upon healthcare student clinical skill development and learning? A systematic review. Med Teach 2018; 40:244-252. [PMID: 29172899 DOI: 10.1080/0142159x.2017.1401218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND A key feature of health professionals' training, irrespective of discipline, is the acquisition and application of clinical and communication skills. Despite this, little is known about the potential role of patient feedback on this process. This systematic review aimed to answer the question: How does feedback from patients impact upon healthcare student clinical skill development and learning? DESIGN Systematic review of published literature. METHODS Electronic databases were searched for studies that explored the effects of patient feedback on student learning and were published before March 2016. Eligible articles underwent methodological evaluation using the McMaster University Critical Evaluation Forms and data extraction. RESULTS A total of 237 articles were retrieved following searches of electronic databases and hand searches of reference lists. Twelve (7 quantitative, 2 qualitative, 3 mixed methods) studies met the inclusion criteria. Eleven studies reported that patient feedback improved students' clinical skills. CONCLUSION Minimal research has explored the impact of patient feedback on student learning. The research to date suggests that direct feedback from patients may be beneficial for the development of students' communication and clinical skills; however, the wide variety of evaluation methods and the lack of validated tools for patients to provide feedback suggest that further exploration is warranted.
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Affiliation(s)
- Emma Finch
- a School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Australia
- b Speech Pathology Department , Princess Alexandra Hospital , Brisbane , Australia
- c Centre for Functioning and Health Research , Metro South Health , Brisbane , Australia
| | - Jennifer Lethlean
- b Speech Pathology Department , Princess Alexandra Hospital , Brisbane , Australia
| | - Tanya Rose
- a School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Australia
| | - Jennifer Fleming
- a School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Australia
| | - Deborah Theodoros
- a School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Australia
| | - Ashley Cameron
- a School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Australia
- b Speech Pathology Department , Princess Alexandra Hospital , Brisbane , Australia
| | - Adele Coleman
- a School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Australia
| | - David Copland
- a School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Australia
| | - Steven M McPhail
- c Centre for Functioning and Health Research , Metro South Health , Brisbane , Australia
- d School of Public Health & Social Work and Institute of Health and Biomedical Innovation , Queensland University of Technology , Brisbane , Australia
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Abstract
Summary
Objectives: Self-directed and customized medical education programs are gaining importance in health care instruction. We prototypically implemented a repository-driven online computer system (CardioOP) for teleteaching in Heart Surgery. It supports authoring and multiple re-use of multimedia data for different user groups in different instructional applications and therefore requires a process of content management.
Methods: We defined objectives for a terminological system to support semantic, cross-media type annotation and retrieval of learning objects: domain completeness, German (natural) language processing, multi-user concepts, extensibility and maintenance, content based annotation and technical implementation. Existing terminologies (ICD10, READ V3, Snomed III, UMLS 1997, MESH) have been analysed according to these objectives.
Results: We found that the analysed terminologies did not meet our criteria sufficiently. Therefore, we developed a domain-specific thesaurus, the CardioOPDataClas (CDC). The application of the CDC within a database-driven authoring process using specifically developed tools is reported.
Conclusions: Metadata play an important role in the effective discovery and search, access, integration and management of educational multimedia data in medicine but so far, there is no terminology to support content management for instructional multimedia. We prototypically designed and applied a thesaurus for the CardioOP educational system. Additional work is needed to evaluate the system in terms of user-friendliness, concept coverage and information retrieval performance.
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Wallace SJ, Worrall L, Rose T, Le Dorze G. Using the International Classification of Functioning, Disability, and Health to identify outcome domains for a core outcome set for aphasia: a comparison of stakeholder perspectives. Disabil Rehabil 2017; 41:564-573. [DOI: 10.1080/09638288.2017.1400593] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sarah J. Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Tanya Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Guylaine Le Dorze
- School of Speech-Language Pathology and Audiology, University of Montreal, Montreal, Canada
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Tuffrey-Wijne I, Rose T. Investigating the factors that affect the communication of death-related bad news to people with intellectual disabilities by staff in residential and supported living services: An interview study. J Intellect Disabil Res 2017; 61:727-736. [PMID: 28386983 DOI: 10.1111/jir.12375] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 06/09/2016] [Revised: 02/16/2017] [Accepted: 03/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Most staff working in intellectual disability services will be confronted with people with intellectual disabilities who need support around death, dying and bereavement. Previous studies suggest that intellectual disability staff tend to protect clients from knowing about death and avoid communication about death. The aims of this study were to gain further insight into the individual, organisational and contextual factors that affect the communication of death-related bad news to people with intellectual disabilities by intellectual disability staff and to develop guidelines for services to enable appropriate communication with clients about death and dying. METHOD Semi-structured interviews were held with 20 social care staff working in intellectual disability residential or supported living services in London, who had supported a client affected by death-related bad news in the past 6 months. RESULTS Staff found supporting people with intellectual disabilities around death and dying extremely difficult and tended to avoid communication about death. The following factors had a particularly strong influence on staff practice around communicating death-related bad news: fear and distress around death; life and work experience; and organisational culture. Staff attitudes to death communication had a stronger influence than their client's level of cognitive or communicative abilities. Managers were important role models. CONCLUSIONS Service managers should ensure not only that all their staff receive training in death, loss and communication but also that staff are enabled to reflect on their practice, through emotional support, supervision and team discussions. Future work should focus on the development and testing of strategies to enable intellectual disability staff to support their clients in the areas of dying, death and bereavement.
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Affiliation(s)
- I Tuffrey-Wijne
- Faculty of Health, Social Care and Education, Kingston University & St George's, University of London, UK
| | - T Rose
- Faculty of Health, Social Care and Education, Kingston University & St George's, University of London, UK
- Kent Community Health NHS Foundation Trust, UK
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Francis N, Rose T, Parrott A, Birtles P, Archer J, Alexander H. 4DOES A WEEKLY COMMUNITY GERIATRIC CLINIC IN PEACEHAVEN REDUCE HOSPITAL ATTENDANCES? Age Ageing 2017. [DOI: 10.1093/ageing/afx115.4] [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: 11/14/2022] Open
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Scarinci N, Rose T, Cronan A, Lambertz K. Speech pathology student experiences and perceptions of working with parents in a Hanen It Takes Two to Talk family-centred clinical placement. Speech, Language and Hearing 2017. [DOI: 10.1080/2050571x.2017.1329890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nerina Scarinci
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Tanya Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Aryn Cronan
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Kathrin Lambertz
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
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Boucher LM, Marshall Z, Martin A, Larose-Hébert K, Flynn JV, Lalonde C, Pineau D, Bigelow J, Rose T, Chase R, Boyd R, Tyndall M, Kendall C. Expanding conceptualizations of harm reduction: results from a qualitative community-based participatory research study with people who inject drugs. Harm Reduct J 2017; 14:18. [PMID: 28494774 PMCID: PMC5427533 DOI: 10.1186/s12954-017-0145-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/30/2017] [Indexed: 12/04/2022] Open
Abstract
Background The perspectives of people who use drugs are critical in understanding why people choose to reduce harm in relation to drug use, what practices are considered or preferred in conceptualizations of harm reduction, and which environmental factors interfere with or support the use of harm reduction strategies. This study explores how people who inject drugs (PWID) think about harm reduction and considers the critical imperative of equity in health and social services delivery for this community. Methods This community-based participatory research study was conducted in a Canadian urban centre. Using a peer-based recruitment and interviewing strategy, semi-structured qualitative interviews were conducted by and with PWID. The Vidaview Life Story Board, an innovative tool where interviewers and participant co-construct a visual “life-scape” using a board, markers, and customized picture magnets, was used to facilitate the interviews. The topics explored included injection drug use and harm reduction histories, facilitators and barriers to using harm reduction strategies, and suggestions for improving services and supports. Results Twenty-three interviews with PWID (14 men and 9 women) were analysed, with a median age of 50. Results highlighted an expanded conceptualization of harm reduction from the perspectives of PWID, including motivations for adopting harm reduction strategies and a description of harm reduction practices that went beyond conventional health-focused concerns. The most common personal practices that PWID used included working toward moderation, employing various cognitive strategies, and engaging in community activities. The importance of social or peer support and improving self-efficacy was also evident. Further, there was a call for less rigid eligibility criteria and procedures in health and social services, and the need to more adequately address the stigmatization of drug users. Conclusions These findings demonstrated that PWID incorporate many personal harm reduction practices in their daily lives to improve their well-being, and these practices highlight the importance of agency, self-care, and community building. Health and social services are needed to better support these practices because the many socio-structural barriers this community faces often interfere with harm reduction efforts. Finally, “one size does not fit all” when it comes to harm reduction, and more personalized or de-medicalized conceptualizations are recommended.
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Affiliation(s)
- L M Boucher
- Élisabeth Bruyère Research Institute, 43 Bruyère Street, Annex E, Ottawa, Ontario, K1N 5C8, Canada.
| | - Z Marshall
- Social Development Studies & School of Social Work, Renison University College, University of Waterloo, 240 Westmount Road North, Waterloo, Ontario, N2L 3G4, Canada
| | - A Martin
- Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada
| | - K Larose-Hébert
- School of Social Work, Faculty of Social Sciences, Laval University, Charles de Koninck Hall, 1030, avenue des Sciences-Humaines, Quebec, G1V 0A6, Canada
| | - J V Flynn
- Department of Social Work, University of Gothenburg, Sprängkullsgatan 23, 405 30, Gothenburg, Sweden
| | - C Lalonde
- PROUD Community Advisory Committee, Ottawa, Ontario, Canada
| | - D Pineau
- PROUD Community Advisory Committee, Ottawa, Ontario, Canada
| | - J Bigelow
- PROUD Community Advisory Committee, Ottawa, Ontario, Canada
| | - T Rose
- PROUD Community Advisory Committee, Ottawa, Ontario, Canada
| | - R Chase
- Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, 750 Bannatyne Ave, Winnipeg, Manitoba, R3E 0W2, Canada
| | - R Boyd
- Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7, Canada
| | - M Tyndall
- BC Centre for Disease Control, 655 W 12th Avenue, Vancouver, British Columbia, V5Z 4R4, Canada
| | - C Kendall
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, 43 Bruyère Street, (375) Floor 3JB, Ottawa, Ontario, K1N 5C8, Canada
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Wallace S, Worrall L, Rose T, Le Dorze G, Rochon E. Results of an International Consensus Meeting to Develop a Core Outcome Set for Aphasia Treatment Research. Front Hum Neurosci 2017. [DOI: 10.3389/conf.fnhum.2017.223.00072] [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: 11/13/2022] Open
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25
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Wallace SJ, Worrall L, Rose T, Le Dorze G. Core Outcomes in Aphasia Treatment Research: An e-Delphi Consensus Study of International Aphasia Researchers. Am J Speech Lang Pathol 2016; 25:S729-S742. [PMID: 27997949 DOI: 10.1044/2016_ajslp-15-0150] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 04/07/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of this article is to identify outcome constructs that aphasia researchers consider essential to measure in all aphasia treatment research. METHOD Purposively sampled researchers were invited to participate in a 3-round e-Delphi exercise. In Round 1, an open-ended question was used to elicit important outcome constructs; responses were analyzed using inductive content analysis. In Rounds 2 and 3, participants rated the importance of each outcome using a 9-point rating scale. Outcomes reaching predefined consensus criteria were further analyzed using International Classification of Functioning, Disability and Health coding. RESULTS Eighty researchers commenced Round 1, with 72 completing the entire survey. High response rates (≥ 85%) were achieved in subsequent rounds. Consensus was reached on 6 outcomes: (a) language functioning in modalities relevant to study aims, (b) impact of treatment from the perspective of the person with aphasia (PWA), (c) communication-related quality of life, (d) satisfaction with intervention from the perspective of the PWA, (e) satisfaction with ability to communicate from the perspective of the PWA, and (f) satisfaction with participation in activities from the perspective of the PWA. CONCLUSIONS Consensus was reached that it is essential to measure language function and specific patient-reported outcomes in all aphasia treatment research. These results will contribute to the development of a core outcome set.
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Adams N, Rose T, Taylor-Robinson D, Barr B, O'Brien S, Violato M, Hawker J, Whitehead M. Does socioeconomic status influence risk of gastrointestinal infections in the community in the UK? Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw174.167] [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: 11/14/2022] Open
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Rose T, Adams N, Taylor-Robinson D, Barr B, Hawker J, O’Brien S, Violato M, Whitehead M. Relationship between socioeconomic status and measures of infectious intestinal disease severity. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw166.060] [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: 11/14/2022] Open
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Worrall L, Simmons-Mackie N, Wallace SJ, Rose T, Brady MC, Kong APH, Murray L, Hallowell B. Let’s call it “aphasia”: Rationales for eliminating the term “dysphasia”. Int J Stroke 2016; 11:848-851. [DOI: 10.1177/1747493016654487] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health professionals, researchers, and policy makers often consider the two terms aphasia and dysphasia to be synonymous. The aim of this article is to argue the merits of the exclusive use of the term aphasia and present a strategy for creating change through institutions such as the WHO-ICD. Our contention is that one term avoids confusion, speech-language pathologists prefer aphasia, scholarly publications indicate a preference for the term aphasia, stroke clinical guidelines indicate a preference for the term aphasia, consumer organizations use the title aphasia in their name and on their websites, and languages other than English use a term similar to aphasia. The use of the term dysphasia in the broader medical community may stem from the two terms being used interchangeably in the ICD10. Aphasia United http://www.shrs.uq.edu.au/aphasiaunited , an international movement for uniting the voice of all stakeholders in aphasia within an international context, will seek to eliminate the use of the term dysphasia.
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Affiliation(s)
- Linda Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Nina Simmons-Mackie
- Department of Health and Human Sciences, Southeastern Louisiana University, Hammond, USA
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Tanya Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Anthony Pak Hin Kong
- Communication Sciences and Disorders, University of Central Florida, Orlando, USA
| | - Laura Murray
- Department of Speech and Hearing Science, Indiana University, Bloomington, USA
| | - Brooke Hallowell
- Communication Sciences and Disorders, Ohio University, Athens, USA
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Wallace SJ, Worrall L, Rose T, Le Dorze G, Cruice M, Isaksen J, Kong APH, Simmons-Mackie N, Scarinci N, Gauvreau CA. Which outcomes are most important to people with aphasia and their families? an international nominal group technique study framed within the ICF. Disabil Rehabil 2016; 39:1364-1379. [DOI: 10.1080/09638288.2016.1194899] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Sarah J. Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Tanya Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Guylaine Le Dorze
- Centre for Interdisciplinary Research in Rehabilitation of Montreal, School of Speech-Language Pathology and Audiology, University of Montreal, Montreal, Canada
| | - Madeline Cruice
- School of Health Sciences, City University, London, United Kingdom
| | - Jytte Isaksen
- Department of Language and Communication, University of Southern Denmark, Odense, Denmark
| | - Anthony Pak Hin Kong
- Department of Communication Sciences and Disorders, The University of Central Florida, Orlando, FL, USA
| | - Nina Simmons-Mackie
- Department of Health and Human Sciences, Southeastern Louisiana University, Hammond, LA, USA
| | - Nerina Scarinci
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Christine Alary Gauvreau
- Centre for Interdisciplinary Research in Rehabilitation of Montreal, School of Speech-Language Pathology and Audiology, University of Montreal, Montreal, Canada
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Rose T, Jaepel J, Hubener M, Bonhoeffer T. Cell-specific restoration of stimulus preference after monocular deprivation in the visual cortex. Science 2016; 352:1319-22. [DOI: 10.1126/science.aad3358] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 05/12/2016] [Indexed: 12/24/2022]
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Rose T, Szelinski F, Burmester G, Hiepe F, Biesen R, Dörner T. FRI0350 The IFN Biomarker Siglec1 Indicates Extraglandular Manifestation in Primary Sjögren's Syndrome. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Barker M, Baird J, Lawrence W, Vogel C, Stömmer S, Rose T, Inskip H, Godfrey K, Cooper C. Preconception and pregnancy: opportunities to intervene to improve women's diets and lifestyles. J Dev Orig Health Dis 2016; 7:330-333. [PMID: 26924188 PMCID: PMC4958369 DOI: 10.1017/s2040174416000064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Recently, large-scale trials of behavioural interventions have failed to show improvements in pregnancy outcomes. They have, however, shown that lifestyle support improves maternal diet and physical activity during pregnancy, and can reduce weight gain. This suggests that pregnancy, and possibly the whole periconceptional period, represents a 'teachable moment' for changes in diet and lifestyle, an idea that was made much of in the recent report of the Chief Medical Officer for England. The greatest challenge with all trials of diet and lifestyle interventions is to engage people and to sustain this engagement. With this in mind, we propose a design of intervention that aims simultaneously to engage women through motivational conversations and to offer access to a digital platform that provides structured support for diet and lifestyle change. This intervention design therefore makes best use of learning from the trials described above and from recent advances in digital intervention design.
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Affiliation(s)
- M Barker
- 1MRC Lifecourse Epidemiology Unit,University of Southampton,Southampton General Hospital,Southampton,UK
| | - J Baird
- 1MRC Lifecourse Epidemiology Unit,University of Southampton,Southampton General Hospital,Southampton,UK
| | - W Lawrence
- 1MRC Lifecourse Epidemiology Unit,University of Southampton,Southampton General Hospital,Southampton,UK
| | - C Vogel
- 1MRC Lifecourse Epidemiology Unit,University of Southampton,Southampton General Hospital,Southampton,UK
| | - S Stömmer
- 1MRC Lifecourse Epidemiology Unit,University of Southampton,Southampton General Hospital,Southampton,UK
| | - T Rose
- 1MRC Lifecourse Epidemiology Unit,University of Southampton,Southampton General Hospital,Southampton,UK
| | - H Inskip
- 1MRC Lifecourse Epidemiology Unit,University of Southampton,Southampton General Hospital,Southampton,UK
| | - K Godfrey
- 1MRC Lifecourse Epidemiology Unit,University of Southampton,Southampton General Hospital,Southampton,UK
| | - C Cooper
- 1MRC Lifecourse Epidemiology Unit,University of Southampton,Southampton General Hospital,Southampton,UK
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Biesen R, Rose T, Hoyer BF, Alexander T, Hiepe F. Autoantibodies, complement and type I interferon as biomarkers for personalized medicine in SLE. Lupus 2016; 25:823-9. [DOI: 10.1177/0961203316640922] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Systemic lupus erythematosus (SLE) can be a mysterious disease, presenting with extremely divergent clinical phenotypes. Already, biomarkers are very helpful tools for diagnosis, assessment and monitoring of disease activity, differential diagnosis of clinical manifestations, prediction of the disease course and stratified therapy, and they hold the key to personalized medicine in SLE. We summarize the clinical information that can only be supplied by autoantibodies, complement components and interferon biomarkers in this diverse disease.
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Affiliation(s)
- R Biesen
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - T Rose
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - B F Hoyer
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - T Alexander
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - F Hiepe
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Jucaud V, Ravindranath MH, Terasaki PI, Morales‐Buenrostro LE, Hiepe F, Rose T, Biesen R. Serum antibodies to human leucocyte antigen (HLA)-E, HLA-F and HLA-G in patients with systemic lupus erythematosus (SLE) during disease flares: Clinical relevance of HLA-F autoantibodies. Clin Exp Immunol 2016; 183:326-40. [PMID: 26440212 PMCID: PMC4750595 DOI: 10.1111/cei.12724] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/28/2015] [Accepted: 10/02/2015] [Indexed: 12/31/2022] Open
Abstract
T lymphocyte hyperactivity and progressive inflammation in systemic lupus erythematosus (SLE) patients results in over-expression of human leucocyte antigen (HLA)-Ib on the surface of lymphocytes. These are shed into the circulation upon inflammation, and may augment production of antibodies promoting pathogenicity of the disease. The objective was to evaluate the association of HLA-Ib (HLA-E, HLA-F and HLA-G) antibodies to the disease activity of SLE. The immunoglobulin (Ig)G/IgM reactivity to HLA-Ib and β2m in the sera of 69 German, 29 Mexican female SLE patients and 17 German female controls was measured by multiplex Luminex(®)-based flow cytometry. The values were expressed as mean flourescence intensity (MFI). Only the German SLE cohort was analysed in relation to the clinical disease activity. In the controls, anti-HLA-G IgG predominated over other HLA-Ib antibodies, whereas SLE patients had a preponderance of anti-HLA-F IgG over the other HLA-Ib antibodies. The disease activity index, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2000, was reflected only in the levels of anti-HLA-F IgG. Anti-HLA-F IgG with MFI level of 500-1999 was associated with active SLE, whereas inactive SLE revealed higher MFI (>2000). When anti-HLA-F IgG were cross-reactive with other HLA-Ib alleles, their reactivity was reflected in the levels of anti-HLA-E and -G IgG. The prevalence of HLA-F-monospecific antibodies in SLE patients was also associated with the clinical disease activity. Anti-HLA-F IgG is possibly involved in the clearance of HLA-F shed from lymphocytes and inflamed tissues to lessen the disease's severity, and thus emerges as a beneficial immune biomarker. Therefore, anti-HLA-Ib IgG should be considered as a biomarker in standard SLE diagnostics.
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Affiliation(s)
- V. Jucaud
- Terasaki Foundation LaboratoryLos AngelesCAUSA
| | | | | | - L. E. Morales‐Buenrostro
- Department of Nephrology and Mineral MetabolismNational Institute of Medical Sciences and Nutrition ‘Salvador Zubirán’Mexico CityMexico
| | - F. Hiepe
- Department of Rheumatology and Clinical ImmunologyCharité Universitätsmedizin Berlin, Germany, Humboldt University of Berlin
| | - T. Rose
- Department of Rheumatology and Clinical ImmunologyCharité Universitätsmedizin Berlin, Germany, Humboldt University of Berlin
| | - R. Biesen
- Department of Rheumatology and Clinical ImmunologyCharité Universitätsmedizin Berlin, Germany, Humboldt University of Berlin
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Rumbach A, Rose T, Bomford C. Analysis of speech-language pathology students’ knowledge regarding the use of non-speech oral motor exercises (NSOMEs) in clinical practice: An exploratory pilot study. Speech, Language and Hearing 2016. [DOI: 10.1080/2050571x.2015.1116730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jennes S, Hanchart B, Keersebilck E, Rose T, Soete O, François PM, Engel H, Van Trimpont F, Davin C, Trippaerts M, Vanderheyden B, Etienne L, Lacroix C, Teodorescu S, Mashaekhi S, Persoons P, Baekelandt D, Hachimi Idrissil S, Watelet JB. Management of burn wounds of the head and neck region. B-ENT 2016; Suppl 26:107-126. [PMID: 29461737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Management of burn wounds of the head and neck region. Management of the severely burned patient is ery often a challenge, not only due to major disturbances in anatomy and physiological processes, but also because the relatively low incidence of this pathology in both civilian and military practice results in care providers'lack of experience. The purpose of this educational document is to provide doctors confronted with these formidable trauma patients with basic management guidelines as well as some practical tips. In summary, and most importantly, these patients should be reated as any other multitrauma patient. First aid is essential and can be provided by non-medical staff. Initial medical nanagement should focus on the usual, familiar trauma algorithms of ABCDEF from the emergency management of evere burns (EMSB) manual' or the ABCDEs of the manual of advanced trauma life support (ATLS)2 or advanced burn life support (ABLS). Medical care should proceed through the following steps - Step one: establish a reliable intravenous nfusion; step two: protect the airway; step three: establish and maintain a haemodynamic state compatible with sufficient organ perfusion in order to reduce aggravation of the burn wounds and increase overall survival likelihood; step four: provide analgesia with adequate sedation and provide anaesthesia for escharotomy, fasciotomy or other surgical injuries; step five: maintain normothermia; step six: feed the patient by starting enteral nutrition as early as possible; step seven: prevent infection using antiseptic wound management, systemic antibiotics and tetanus prophylaxis. All of these intricate steps require continuous reassessment and adjustment, but the existence of other wounds (blast injuries, penetrating and blunt trauma) even further complicates the management of burn casualties.
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Verbeken G, Huys I, De Vos D, De Coninck A, Roseeuw D, Kets E, Vanderkelen A, Draye JP, Rose T, Jennes S, Ceulemans C, Pirnay JP. Access to bacteriophage therapy: discouraging experiences from the human cell and tissue legal framework. FEMS Microbiol Lett 2015; 363:fnv241. [PMID: 26678555 DOI: 10.1093/femsle/fnv241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 01/12/2023] Open
Abstract
Cultures of human epithelial cells (keratinocytes) are used as an additional surgical tool to treat critically burnt patients. Initially, the production environment of keratinocyte grafts was regulated exclusively by national regulations. In 2004, the European Tissues and Cells Directive 2004/23/EC (transposed into Belgian Law) imposed requirements that resulted in increased production costs and no significant increase in quality and/or safety. In 2007, Europe published Regulation (EC) No. 1394/2007 on Advanced Therapy Medicinal Products. Overnight, cultured keratinocytes became (arguably) 'Advanced' Therapy Medicinal Products to be produced as human medicinal products. The practical impact of these amendments was (and still is) considerable. A similar development appears imminent in bacteriophage therapy. Bacteriophages are bacterial viruses that can be used for tackling the problem of bacterial resistance development to antibiotics. Therapeutic natural bacteriophages have been in clinical use for almost 100 years. Regulators today are framing the (re-)introduction of (natural) bacteriophage therapy into 'modern western' medicine as biological medicinal products, also subject to stringent regulatory medicinal products requirements. In this paper, we look back on a century of bacteriophage therapy to make the case that therapeutic natural bacteriophages should not be classified under the medicinal product regulatory frames as they exist today. It is our call to authorities to not repeat the mistake of the past.
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Affiliation(s)
- G Verbeken
- Laboratory for Molecular and Cellular Technology, Burn Wound Centre, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium Faculty of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium Department of Behavioural Sciences, Royal Military Academy, Renaissancelaan 30, 1000 Brussels, Belgium
| | - I Huys
- Faculty of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium KU Leuven Centre for IT & IP law, Sint Michielsstraat 6, box 3443, 3000 Leuven, Belgium
| | - D De Vos
- Laboratory for Molecular and Cellular Technology, Burn Wound Centre, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium Department of Behavioural Sciences, Royal Military Academy, Renaissancelaan 30, 1000 Brussels, Belgium
| | - A De Coninck
- Department of Dermatology, University Hospital Brussels (UZ Brussel), Free University Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - D Roseeuw
- Department of Dermatology, University Hospital Brussels (UZ Brussel), Free University Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - E Kets
- Burn Wound Centre, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium
| | - A Vanderkelen
- Laboratory for Molecular and Cellular Technology, Burn Wound Centre, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium
| | - J P Draye
- Laboratory for Molecular and Cellular Technology, Burn Wound Centre, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium
| | - T Rose
- Laboratory for Molecular and Cellular Technology, Burn Wound Centre, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium Burn Wound Centre, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium
| | - S Jennes
- Burn Wound Centre, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium
| | - C Ceulemans
- Department of Behavioural Sciences, Royal Military Academy, Renaissancelaan 30, 1000 Brussels, Belgium
| | - J P Pirnay
- Laboratory for Molecular and Cellular Technology, Burn Wound Centre, Queen Astrid Military Hospital, Bruynstraat 1, 1120 Brussels, Belgium
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Rose T, Worrall L, Hickson L, Hoffmann T. Do People With Aphasia Want Written Stroke and Aphasia Information? A Verbal Survey Exploring Preferences for When and How to Provide Stroke and Aphasia Information. Top Stroke Rehabil 2015; 17:79-98. [DOI: 10.1310/tsr1702-79] [Citation(s) in RCA: 26] [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: 12/26/2022]
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Rose T, Gruetzkau A, Dähnrich C, Dzionek A, Hirseland H, Riemekasten G, Schlumberger W, Enghard P, Radbruch A, Burmester GR, Hiepe F, Biesen R. THU0195 IFNα and its response proteins IP-10 and SIGLEC-1 as biomarkers of disease activity in systemic lupus erythematosus. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.2160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Flausino OA, Dufau L, Regasini LO, Petrônio MS, Silva DHS, Rose T, Bolzani VS, Reboud-Ravaux M. Alkyl hydroxybenzoic acid derivatives that inhibit HIV-1 protease dimerization. Curr Med Chem 2013; 19:4534-40. [PMID: 22963666 DOI: 10.2174/092986712803251557] [Citation(s) in RCA: 9] [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] [Received: 07/19/2012] [Revised: 08/14/2012] [Accepted: 08/26/2012] [Indexed: 11/22/2022]
Abstract
The therapeutic potential of gallic acid and its derivatives as anti-cancer, antimicrobial and antiviral agents is well known. We have examined the mechanism by which natural gallic acid and newly synthesized gallic acid alkyl esters and related protocatechuic acid alkyl esters inhibit HIV-1 protease to compare the influence of the aromatic ring substitutions on inhibition. We used Zhang-Poorman's kinetic analysis and fluorescent probe binding to demonstrate that several gallic and protecatechuic acid alkyl esters inhibited HIV-1 protease by preventing the dimerization of this obligate homodimeric aspartic protease rather than targeting the active site. The tri-hydroxy substituted benzoic moiety in gallates was more favorable than the di-substituted one in protocatechuates. In both series, the type of inhibition, its mechanism and the inhibitory efficiency dramatically depended on the length of the alkyl chain: no inhibition with alkyl chains less than 8 carbon atoms long. Molecular dynamics simulations corroborated the kinetic data and propose that gallic esters are intercalated between the two N- and C-monomer ends. They complete the β-sheet and disrupt the dimeric enzyme. The best gallic ester (14 carbon atoms, K(id) of 320 nM) also inhibited the multi-mutated protease MDR-HM. These results will aid the rational design of future generations of non-peptide inhibitors of HIV-1 protease dimerization that inhibit multi-mutated proteases. Finally, our work suggests the wide use of gallic and protocatechuic alkyl esters to dissociate intermolecular β-sheets involved in protein-protein interactions.
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Affiliation(s)
- O A Flausino
- Enzymologie Moléculaire et Fonctionnelle, UR4, UPMC-Sorbonne Universités, 7 Quai St Bernard, 75252 Paris Cedex 05, France
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Worrall LE, Howe T, O'Callaghan A, Hill AJ, Rose M, Wallace SJ, Rose T, Brown K, Power E, O'Halloran R, Rohde A. The World Report on Disability as a blueprint for international, national, and local aphasia services. Int J Speech Lang Pathol 2013; 15:106-112. [PMID: 23101515 DOI: 10.3109/17549507.2012.721004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This commentary aims to extend the debate of the lead article authors (Wylie, McAllister, Davidson, and Marshall, 2013) by translating the nine recommendations of the World Report on Disability into a plan of action for the aphasia community. Solutions for the advancement of aphasia science and services are presented at international (macro), national (meso), and local (micro) levels. Implications for speech-language pathologists and aphasia service delivery are discussed. An overarching call to action is the need for speech-language pathologists to support a strong and vibrant aphasia community at all levels, so that the voices of people with aphasia can be heard.
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Affiliation(s)
- Linda E Worrall
- Centre for Clinical Research Excellence in Aphasia Rehabilitation, The University of Queensland, Brisbane, Australia.
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Gaillou E, Post JE, Rose T, Butler JE. Cathodoluminescence of natural, plastically deformed pink diamonds. Microsc Microanal 2012; 18:1292-1302. [PMID: 23217341 DOI: 10.1017/s1431927612013542] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The 49 type I natural pink diamonds examined exhibit color restricted to lamellae or bands oriented along {111} that are created by plastic deformation. Pink diamonds fall into two groups: (1) diamonds from Argyle in Australia and Santa Elena in Venezuela are heavily strained throughout and exhibit pink bands alternating with colorless areas, and (2) diamonds from other localities have strain localized near the discrete pink lamellae. Growth zones are highlighted by a blue cathodoluminescence (CL) and crosscut by the pink lamellae that emit yellowish-green CL that originates from the H3 center. This center probably forms by the recombination of nitrogen-related centers (A-aggregates) and vacancies mobilized by natural annealing in the Earth's mantle. Twinning is the most likely mechanism through which plastic deformation is accommodated for the two groups of diamonds. The plastic deformation creates new centers visible through spectroscopic methods, including the one responsible for the pink color, which remains unidentified. The differences in the plastic deformation features, and resulting CL properties, for the two groups might correlate to the particular geologic conditions under which the diamonds formed; those from Argyle and Santa Elena are deposits located within Proterozoic cratons, whereas most diamonds originate from Archean cratons.
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Affiliation(s)
- E Gaillou
- Department of Mineral Sciences, Natural History Museum of Los Angeles County, Los Angeles, CA 90007, USA.
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Marquass B, Mahn T, Engel T, Gossner J, Theopold JD, von Dercks N, Racynski C, Rose T, Josten C, Hepp P. [Clinical and radiological mid-term results after autologous osteochondral transplantation under consideration of quality of life]. Z Orthop Unfall 2012; 150:360-7. [PMID: 22918823 DOI: 10.1055/s-0032-1314958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Treatment of full-thickness cartilage defects remains a challenge in musculoskeletal surgery. Autologous osteochondral transplantation represents a possible solution for the repair of affected areas. However, some problems like degenerative changes of the transplanted cylinders and the surrounding cartilage or lack of cylinder integration to the surrounding cartilage arise with this method. Thus mid-term results respecting the quality of life are useful for assessment of the method. PATIENTS/MATERIAL AND METHODS We investigated 22 patients with a mean follow-up of 88 ± 14.5 months after autologous osteochondral transplantation due to a full-thickness cartilage defect of the medial femoral condyle. Beside clinical scores we assessed at follow-up the quality of life using the SF-36 health survey and the EQ-5D. Furthermore, radiological changes were detected and MRI was performed in 21 patients. A control group of 19 patients, treated with microfracture, was matched in terms of BMI, gender and age. Exclusion criteria for this group were tibial kissing lesion, ligament instability, arthrosis and malalignment. RESULTS In a longitudinal comparison with results 13.5 months after operation, no difference in Lysholm score was found. In plain radiographs higher degrees of arthritic changes in the medial compartment compared to the unaffected knee were observed. MRI revealed a mean modified MOCART score of 41.2 ± 7.7 for the OAT group and of 39.4 ± 16.1 for the microfracture group, without being significant. For OAT patients all cylinders showed an osseous integration. However, cylinder oedema was found in 9 patients. Those patients had a higher intensity of pain on a visual analogue scale. Quality of life was better for OAT patients in the physical scale of SF-36, but not in the mental scale. CONCLUSION Autologous osteochondral transplantation has an unaltered significance in treating full-thickness cartilage defects and leads to satisfying mid-term results. The development of early arthritic changes might not be preventable by this method. Oedema of the transplanted cylinders is attended by higher pain intensity and might be an indirect sign of cartilage degeneration.
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Affiliation(s)
- B Marquass
- Klinik für Unfall-, Wiederherstellungs- und Plastische Chirurgie, Universitätsklinikum Leipzig.
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Freund S, Rath A, Rose T, Sandig V, Reichl U. Produktivität einer neuen humanen Zelllinie unter verschiedenen Kultivierungsbedingungen. CHEM-ING-TECH 2012. [DOI: 10.1002/cite.201250211] [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: 11/10/2022]
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De Vos D, Bilocq F, Verbeken G, Pieters T, Dijkshoorn L, Bogaerts P, Glupczynski Y, Deschaght P, Heuninckx W, Bosmans P, Vaneechoutte M, Rose T, Pot B, van der Reijden T, Pirnay JP, Jennes S, soentjens P. Thermally injured and Acinetobacter baumannii colonizations/infections during a five-year period at the Brussels Burn Wound Centre. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.565] [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] Open
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Pilge H, Spang J, Rose T, Wolter H, Woertler K, Imhoff AB. Osteolysis after rotator cuff repair with bioabsorbable anchors. Arch Orthop Trauma Surg 2012; 132:305-10. [PMID: 21847551 DOI: 10.1007/s00402-011-1369-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [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] [Received: 08/28/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE The current study was designed to evaluate the rate of osteolysis and the clinical and functional outcomes in patients who underwent mini-open rotator cuff repairs using first generation bioabsorbable suture anchors. Our hypothesis was that patients with osteolysis noted on post-repair MRI would have an accompanying decrease in functional and clinical patient outcomes when compared with patients who did not have osteolysis evident on post-repair MRI. TYPE OF STUDY Clinical retrospective study. METHODS Between September 2000 and May 2004, 76 patients were repaired using first generation Bio-Corkscrew suture anchors (Arthrex, Naples, FL). 30 patients were available for complete follow-up evaluation. The mean follow-up time was 36 months (range 24-58). Patients were assessed with the Constant-Murley Score, radiographs and magnetic resonance imaging (MRI). Post-operative strength was measured using an Isokinetic Cybex-Dynamometer. 14 patients had osteolysis evident on MRI (Group A) while 16 patients did not have osteolysis on MRI (Group B). RESULTS In both groups, a total of 70 bio-anchors were used. 22 anchors showed osteolytic changes on MRI (Group A). Concerning ROM, there was no statistical difference in both groups. The Constant-Score was statistically not different in both groups A (92.4) and B (83.7). On MRI-scans, there were repair failures in both groups (A, 2 reruptures; B, 3 reruptures). CONCLUSIONS Although, we found a high rate of osteolysis after rotator cuff repair with bioabsorbable anchors, these results did not change the clinical outcomes after rotator cuff repair. Recurrent tears were not significantly different in both groups and are comparable to rerupture rates in prior studies. More studies are needed to verify the effect of osteolysis over the long term.
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Affiliation(s)
- H Pilge
- Klinik für Orthopädie und Unfallchirurgie, Klinikum rechts der Isar, Technischen Universität München, Ismaningerstrasse 22, Munich, Germany.
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Verbeken G, Verween G, Pascual B, De Corte P, Rose T, Jennes J, Vanderkelen A, Marichal M, Heuninckx W, De Vos D, Pirnay J. P109 Evaluation of a microbiological screening and acceptance procedure for cryopreserved skin allografts based on 14-day cultures. Burns 2011. [DOI: 10.1016/s0305-4179(11)70094-8] [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: 10/14/2022]
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Walter J, Nier A, Rose T, Egberts J, Schafmayer C, Kuechler T, Broering D, Schniewind B. Palliative partial pancreaticoduodenectomy impairs quality of life compared to bypass surgery in patients with advanced adenocarcinoma of the pancreatic head. Eur J Surg Oncol 2011; 37:798-804. [DOI: 10.1016/j.ejso.2011.06.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 06/24/2011] [Accepted: 06/28/2011] [Indexed: 11/12/2022] Open
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Martus P, Jahnke K, Korfel A, Rose T, Fischer L, Moehle R, Klasen HA, Rauch M, Roeth A, Hertenstein B, Fischer T, Hundsberger T, Mergenthaler H, Leithäuser M, Birnbaum T, Herrlinger U, Schubert J, Birkmann J, Weller M, Thiel E. Prognostic factors for chemotherapy-related toxicity in primary central nervous system lymphoma (PCNSL) treated with high-dose methotrexate (HDMTX) with or without ifosfamide: Results from a German phase III trial (G-PCNSL-SG-1). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Rose T. Observations on the Treatment of Syphilis, with an account of several cases of that disease in which a cure was effected without the use of Mercury. Med Chir Trans 2011; 8:347-424. [PMID: 20895324 DOI: 10.1177/095952871700800116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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