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Douglas J, Magennis P, Begley A. 1492 The Age of Trainees When Joining the Specialist List – What Are the Differences Across Specialties? Br J Surg 2021. [DOI: 10.1093/bjs/znab259.905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Those wishing to pursue a career in surgery will be aware of stereotypes that exist within each specialty, including how long it takes to attain a certificate of completion of training (CCT). These perceptions are often historic, and whilst may be based on elements of truth, are rarely backed by robust data. Oral & maxillofacial surgery (OMFS) for example is plagued by the stigma of necessitating a second degree which gives the assumption the age of being appointed a consultant is somewhat above average. We aim to dispel (or prove, depending on one’s predisposition) such myths by analysing the age of surgeons when appointed to the General Medical Council’s specialist list.
Method
Information on the age of entry onto the surgical specialist lists between 1997 and 2018 was obtained from the General Medical Council (GMC). Data was suitably statistically analysed.
Results
19,135 surgeons joined surgical specialist lists during the study period. General and trauma and orthopaedic surgery accounted for 60% of all surgeons (n = 11,444). The age on joining surgical specialist lists ranged from 27–83 years, with a mean of 41.4 years. Neurosurgeons most frequently joined the specialist list in the youngest age bracket. OMF surgeons, along with their cardiothoracic and vascular colleagues, are joint eldest by 1.3 years.
Conclusions
Since the creation of the specialist list, training has seen several upheavals. This data shows that despite each specialty’s specific requirements and individuals’ varying paths, there is little difference in the age when the consultant destination is reached.
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Affiliation(s)
- J Douglas
- Leeds General Infirmary, Leeds, United Kingdom
| | - P Magennis
- University Hospitals Aintree, Liverpool, United Kingdom
| | - A Begley
- University Hospitals Aintree, Liverpool, United Kingdom
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Magennis P, Begley A, McLean A, Rapaport B, Dhariwal DK, Brennan PA, Hutchison I. The UK Mentoring and Support Programme (MSP) for those considering a career in Oral and Maxillofacial Surgery (OMFS). A review of a 'Register Interest in OMFS' website and the MSP as two key resources created by the British Association of Oral and Maxillofacial Surgeons to promote recruitment and retention (2008-2020). Br J Oral Maxillofac Surg 2020; 59:935-940. [PMID: 34400024 DOI: 10.1016/j.bjoms.2020.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/01/2020] [Indexed: 11/17/2022]
Abstract
In 2008, to create a rapid route for information transfer in relation training and recruitment for OMFS trainees, the British Association of Oral and Maxillofacial Surgeons (BAOMS) created a website to "Register Your Interest in OMFS" (RYIO). From 2011 a Mentoring and Support Programme (MSP) was created to provide focussed guidance for trainees aiming for specialty training. This paper reviews the effectiveness and cost of these programmes. Between 2008 and 2020, 1744 individuals used RYIO on 2715 occasions. Of these registrations, 1772 were by dentists, 193 dental students, 589 doctors and 161 medical students. 2354 were from UK and Ireland and 351 from the rest of the world. 188 registrants subsequently became UK OMFS trainees or specialists. All registrants valued the information provided. In response to RYIO trainee feedback the new 'Taste of OMFS 2020' programme was created. The MSP was originally called the Junior Trainee Programme (JTP). The MSP scheme provides a layer of mentorship/support which runs parallel to the medical/dental training post or period of study. Of 180 members of MSP, 72 have obtained specialty training posts in OMFS. There are 88 current members. Full information is available on the BAOMS website www.baoms.org.uk. Reviewing both programmes, participant feedback is excellent with tangible results whilst cost effectiveness is high.
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Affiliation(s)
- P Magennis
- Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
| | - A Begley
- Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
| | - A McLean
- University of Liverpool, United Kingdom.
| | - B Rapaport
- University of Liverpool, United Kingdom.
| | - D K Dhariwal
- John Radcliffe Hospital, Oxford, United Kingdom.
| | | | - I Hutchison
- Institute of Dentistry, Barts and The London, United Kingdom.
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Kennedy C, Magennis P, Begley A, Dhariwal D, McVicar I, Hutchison I. First degree hotspots for OMFS recruitment 1967–2010: dental and medical schools where OMFS specialists and trainees were more likely to start their careers. Br J Oral Maxillofac Surg 2020; 58:1310-1316. [DOI: 10.1016/j.bjoms.2020.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022]
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Magennis P, Begley A, Hölzle F, Ulrich H, Brennan P, Hutchison I. European OMFS in the time of Brexit – where did the UK fit and how might the future look? Br J Oral Maxillofac Surg 2020; 58:1297-1303. [DOI: 10.1016/j.bjoms.2020.09.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
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Douglas J, Begley A, Magennis P. UK Oral and Maxillofacial Surgery trainees join the specialist list at a similar age to other surgical specialists. Br J Oral Maxillofac Surg 2020; 58:1268-1272. [DOI: 10.1016/j.bjoms.2020.07.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
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Dhariwal DK, Begley A, Newlands C, Graystone J, Gerber B. Re: Does the current oral and maxillofacial surgery training pathway disadvantage female trainees? Br J Oral Maxillofac Surg 2020; 60:101-102. [PMID: 33685771 DOI: 10.1016/j.bjoms.2020.11.007] [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] [Received: 10/28/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022]
Affiliation(s)
- D K Dhariwal
- Oxford University Hospitals NHS Trust, Oxford, UK.
| | - A Begley
- University Hospital Aintree, Liverpool
| | | | - J Graystone
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - B Gerber
- Oxford University Hospitals NHS Trust, Oxford, UK
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Magennis P, Begley A, Douglas J, Dhariwal DK. Changes in United Kingdom oral and maxillofacial surgical specialty trainees since 1995 - numbers, gender, first degrees, and nations of origin. Br J Oral Maxillofac Surg 2020; 58:1325-1332. [PMID: 33277066 DOI: 10.1016/j.bjoms.2020.09.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022]
Abstract
Training in UK surgery has changed dramatically since 1995, from a relative lack of structure to time-limited and highly documented programmes. Training in oral and maxillofacial surgery (OMFS) has shared these changes and included some significant changes of its own. Minutes from the OMFS Specialty Advisory Committee (SAC) were reviewed over the last 25 years to record the number and location of newly approved posts. The General Medicine Council's (GMC) OMFS specialist list in 2019 was combined with the records of OMFS specialists' dental qualifications held by the General Dental Council (GDC) and augmented from a database of OMFS trainees and consultants in the UK. Data on demographics, location, and nature of the first medical or dental degree were noted for analysis. A total of 691 OMFS specialists and trainees were identified from GMC, OMFS SAC and consultant databases. Of these, 12 consultants held only dental qualification/registration. First degree data could not be obtained for 12 specialists (all male). A further 20 OMFS specialists, whose training was outside the UK, were also excluded from further analysis. In 1995 there were 95 national training posts, by 2013 there were 150. Over the last quarter of a century, there has been an increase in medicine first trainees, an increase in female trainees and specialists, and a relative decrease in OMFS trainees from the Indian subcontinent. The varied origins of the OMFS workforce has contributed to greater diversity and inclusion within the specialty. In the UK, OMFS appears to have produced the correct number of specialists whilst maintaining a high standard of training. The next change in OMFS training programmes is to deliver The Postgraduate Medical Education and Training Board's (PMETB) recommendations. As we move to achieve this it is imperative that as new doors open, we do not close others.
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Affiliation(s)
- P Magennis
- Liverpool University Hospitals NHS Foundation Trust.
| | - A Begley
- Liverpool University Hospitals NHS Foundation Trust.
| | - J Douglas
- OMFS Specialty Trainee Yorkshire & Humber.
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Magennis P, Begley A, Douglas J, Dhariwal DK. Workforce intelligence: what data do we need to collect to understand trends in substantive oral and maxillofacial surgery consultant posts? A retrospective review and plan for the future. Br J Oral Maxillofac Surg 2020; 58:1317-1324. [PMID: 33288290 DOI: 10.1016/j.bjoms.2020.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022]
Abstract
Understanding workforce pressures within surgery is an inexact science. This paper assembles evidence regarding oral and maxillofacial surgery (OMFS) consultant appointments in the UK and plans for prospective data collection in the future. Information about the number of OMFS specialists joining the UK specialist list was obtained from the General Medical Council and compared to a database of substantive OMFS consultant posts. OMFS consultants were asked to contribute information about their training programmes and consultant appointments (date, interview experience, and sub-specialty interest). This information was collated on Excel© and analysed using WinStat©. Data on OMFS consultant posts advertised in 'NHS Jobs' and the British Medical Journal were collected. The mean (SD) number of specialists joining the specialist list per year is 24.1 (5.2) with a median of 24 and a range of 15 - 36. The number of trainees completing training and numbers joining the OMFS specialist list are in balance at present. The median delay between OMFS specialist listing and appointment as a consultant was 72 days and mean of 169 with the 25th centile of five days, standard deviation of 239 days and maximum of 5.2 years. Of those returning data, 135 (47%) candidates were the sole interviewee and 83 (29%) had one other candidate at their successful interview. The mean application ratio for each post was 1.9 and the median number of candidates was one, mean 1.6 and maximum candidates seven. About half of the posts were filled by trainees from their regional training rotation. Prospective data collection on advertised posts, interviews held, expected retirements/new posts, combined with a route for trainees approaching CCT to highlight their availability may streamline recruitment and allow a more rapid recognition of recruitment problems.
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Affiliation(s)
- P Magennis
- A Liverpool University Hospitals NHS Foundation Trust.
| | - A Begley
- A Liverpool University Hospitals NHS Foundation Trust.
| | - J Douglas
- OMFS Specialty Trainee Yorkshire & Humber.
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Magennis P, Begley A, Hölzle F, Ulrich HP, Brennan PA, Hutchison I. United Kingdom immigration and emigration of oral and maxillofacial Surgery (OMFS) specialists 2000-2020: how might Brexit impact on OMFS? Br J Oral Maxillofac Surg 2020; 58:1304-1309. [PMID: 33280947 DOI: 10.1016/j.bjoms.2020.09.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 11/26/2022]
Abstract
The United Kingdom left the European Union (EU) in January 2020. As it is unclear how many of the rights of OMFS surgeons to travel and work will remain after the transition period, we have reviewed how these rights have been used in the past. The OMFS specialist list from the GMC was compared with a database of current OMFS colleagues. Data were analysed using WinStat® (R. Fitch Software). Of 494 active surgeons on the OMFS specialist list, 23 (5%) completed their OMFS training outside the UK. Of these, 22 were specialists from Europe of whom 12 were substantive NHS consultants with others working as Fellows or visiting the UK occasionally. Two per cent of UK OMFS consultants are -specialists from Europe, the majority from Greece. Of the OMFS specialists who completed training in the UK since 1995, 24 are currently working outside the UK, and of them, 16 left the UK to return to their nation of origin (all 11 of those working in the European Economic Area [EEA] were born there). Of the seven UK-born specialists working overseas, none was working in the EEA. Twenty per cent of UK trainees whose primary degree was known (n = 117) received their primary qualification outside the UK, 38 in from the EU, and 79 from further afield. The majority of these UK trained specialists with non-UK first degrees (n = 101) stayed in the UK to work after training. The most significant impact of Brexit on OMFS could be a restriction on the opportunity for non-UK doctors and dentists to come to the UK to train and stay to work.
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Affiliation(s)
- P Magennis
- Liverpool University Hospitals NHS Foundation Trust.
| | - A Begley
- Liverpool University Hospitals NHS Foundation Trust.
| | - F Hölzle
- Department of OMFS, RWTH Aachen University Hospital, Aachen, Germany.
| | | | | | - I Hutchison
- Barts and The London Institute of Dentistry.
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Magennis P, Begley A, Douglas J, Dhariwal DK. Duration of specialty training in Oral and Maxillofacial Surgery in the United Kingdom for trainees joining the OMFS specialist list between 2002 and 2019. Br J Oral Maxillofac Surg 2020; 58:1282-1290. [PMID: 33288289 DOI: 10.1016/j.bjoms.2020.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION OMFS Specialty Training in the UK is usually 5 years and 'starts' at Specialty Training Year 3 (ST3). In 2007 a pilot of 'run-through' training started with Core Training (CT) posts linked to specialty training (ST1 posts). ST1 posts are usually 12 months but may be up to 24 months. METHOD UK OMFS consultants joining the OMFS specialist list between 2002 and 2019 were contacted regarding their training. If their training was extended beyond the expected date of completion, they were asked to give a primary and secondary reason from a simplified list. Results were analysed with Winstat©. RESULTS A total of 382 consultants were contacted, 325 responding (86%) and of these 290 were appointed at ST3 and their mean extension of training time was 0.63 years. For those 35 who were appointed to ST1, their training was on average 0.77 years longer than planned. Undertaking a Fellowship (33%) was the commonest reason for extension, followed by administrative delay (24%), unsuccessful attempts at the FRCS exam (12%) and training reasons (10%). Female trainees (n=37) spent on average 1.28 years longer than planned in training compared to male trainees (288 - 0.67 years). Gender differences were also present in the main reasons for extension with 12% of female respondents giving family reasons as the main cause, whereas only 2% of males gave this reason. Problems with training was the main cause for extension for 19% of females compared to 8% of males. CONCLUSIONS Understanding factors which extend training and the length of these extensions could have the twin benefits of openness for new trainees and directing support to existing trainees. Differential attainment and Equality Diversity & Inclusion (EDI) are domains whose monitoring is required by the General Medical Council and undertaken by training authorities. The small numbers of trainees in OMFS programmes may not always allow training variance to be recognised.
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Affiliation(s)
| | - A Begley
- Aintree University Hospitals NHS Trust.
| | - J Douglas
- Health Education England Yorkshire & Humber.
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Magennis P, Begley A, Martin IC, Hutchison I. 2012 - The year when BAOMS and its officers prevented closure of all UK shortened medical and dental courses. Br J Oral Maxillofac Surg 2020; 58:1343-1347. [PMID: 33028504 DOI: 10.1016/j.bjoms.2020.07.036] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
In Spring 2011 the Department of Health (DH) received a request to review European Union Directive 2005/36 EU - the directive relating to the recognition of professional qualifications. The Department of Health lawyer raised concerns that the existing shortened dental courses may be in breach of EU law. There were three shortened dental courses in the UK: 4year graduate entry courses in Liverpool/Peninsula and 3-year Dental Programme for Medical Graduates (DPMG) in Kings, London. During the summer the General Dental Council (GDC) was made aware of these concerns. In autumn 2011 the Chief Dental Officer for England with the GDC, told the Dental Deans' Council (DDC) that shortened dental courses were illegal. On 12th Jan 2012 students on the DPMG were told that they would have to complete a full 5-year dental degree. The GDC said that this interpretation of EU law would also impact on shortened medical courses. In view of the potentially enormous impact that this would have on OMFS training, BAOMS engaged all the resources it could and by assembling legal opinions including written contributions from Sir David Edward, whose opinion was being misinterpreted by the GDC and DH, and by sharing these resources with all the stakeholders, BAOMS was able to preserve shortened dental and medical courses. Now that the UK has left the European Union, negotiations around mutual recognition of qualifications may mean this issue will resurface. We should remain vigilant.
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Affiliation(s)
- P Magennis
- OMFS Consultant - Aintree University Hospital, Liverpool University Hosptials NHS Foundation Trust.
| | - A Begley
- OMFS Consultant - Aintree University Hospital, Liverpool University Hosptials NHS Foundation Trust
| | - I C Martin
- Retired OMFS consultant - Sunderland Royal Infirmary
| | - I Hutchison
- OMFS Professor, Institute of Dentistry, Bart and The London
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Russell RD, Black LJ, Begley A. The unresolved role of the neurologist in providing dietary advice to people with multiple sclerosis. Mult Scler Relat Disord 2020; 44:102304. [PMID: 32570182 DOI: 10.1016/j.msard.2020.102304] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND People with MS often make dietary changes after diagnosis with the aim of slowing disease progression. Although people with MS commonly use the internet for information on diet and MS, neurologists are their preferred source of information. However, little is known about what dietary advice is provided by neurologists. OBJECTIVES To explore the perceptions of neurologists about diet and MS, and to identify the type of dietary advice they provide to their patients with MS. METHODS In this exploratory qualitative study, 11 semi-structured interviews were conducted with neurologists in Western Australia. Audio files were transcribed verbatim, and transcripts were thematically analysed using a general inductive approach. RESULTS Four themes emerged: 1) juggling the evidence on the role of diet in MS; 2) acknowledging the risks and benefits of specific diets; 3) distancing from the diet 'gurus'; and 4) the unresolved role of the neurologist in providing dietary advice. CONCLUSION Neurologists could meet their patients' expectations by providing evidence-based dietary advice, such as promoting the benefits of diets that adhere to national dietary guidelines, and being prepared to explain potential risks of restrictive diets. Information about healthy eating needs to be targeted to people with MS.
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Affiliation(s)
| | | | - A Begley
- Kent Street, Perth, WA 6102, SA.
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Russell RD, Black LJ, Pham NM, Begley A. The effectiveness of emotional wellness programs on mental health outcomes for adults with multiple sclerosis: a systematic review and meta-analysis. Mult Scler Relat Disord 2020; 44:102171. [PMID: 32554283 DOI: 10.1016/j.msard.2020.102171] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND People with multiple sclerosis (MS) have a greater prevalence of depression and anxiety than the general population. Emotional wellness programs (any psychological or psychosocial interventions that focus on awareness, acceptance, managing, or challenging thoughts and feelings) could be important for people with MS. However, there have been no reviews on the effectiveness of emotional wellness programs for people with MS. The objective of this review was to determine the effectiveness of emotional wellness programs on mental health outcomes for adults with MS. INCLUSION CRITERIA Randomised controlled trials (RCTs) and quasi-experimental trials evaluating emotional wellness programs for adults with any form of MS were included. Mental health outcomes included were depression, anxiety, quality of life, and stress. The comparator groups were waitlist controls, usual care, or another intervention. METHODS This review was registered with PROSPERO (registration number CRD42019131082) and conducted in accordance with PRISMA guidelines. CINAHL, Cochrane, MEDLINE, PsycInfo, Web of Science, ProQuest Dissertations and Theses, Cochrane register of Controlled Trials, and Google Scholar were searched for English- language publications. Titles and abstracts were initially screened, followed by a screen of full text articles. Studies were critically appraised for methodological quality using the JBI standardised critical appraisal checklists. Data were extracted on intervention details, study outcome measures, behaviour change techniques, and results. Random effects meta-analyses were performed for outcomes assessed in at least five studies, with results reported as the standardised mean difference (SMD). RESULTS This review comprised 25 RCTs and four quasi-experimental studies (n participants=2323); 21 were included in meta-analyses. Meta-analyses produced statistically significant results favouring the interventions (SMD (95% CI) for depression -0.55 (-0.87, -0.24); anxiety -0.42 (-0.70, -0.14); quality of life 0.28 (0.14, 0.43); and stress -1.00 (-1.58, -0.43)). The most commonly used behaviour change techniques were behaviour practice/rehearsal, social comparison, and social support. CONCLUSIONS This review provides evidence to support the effectiveness of emotional wellness programs for improving mental health outcomes in adults with MS. However, these findings should be interpreted with caution given the high degree of heterogeneity between the studies, and potential for biases in analysis due to missing data and/or incomplete reporting.
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Affiliation(s)
- R D Russell
- School of Public Health, Curtin University, Perth, Australia
| | - L J Black
- School of Public Health, Curtin University, Perth, Australia
| | - N M Pham
- School of Public Health, Curtin University, Perth, Australia; Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - A Begley
- School of Public Health, Curtin University, Perth, Australia.
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Houghton D, Munir N, Triantafyllou A, Begley A. Tophaceous pseudogout of the temporomandibular joint with erosion into the middle cranial fossa. Int J Oral Maxillofac Surg 2020; 49:1286-1289. [PMID: 32278623 DOI: 10.1016/j.ijom.2020.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/29/2020] [Accepted: 03/16/2020] [Indexed: 02/07/2023]
Abstract
This report presents a case of extensive tophaceous pseudogout involving the temporomandibular joint (TMJ), causing erosion into the middle cranial fossa. Pseudogout is a benign metabolic arthropathy caused by calcium pyrophosphate dihydrate crystal deposition within joints and peri-articular tissue. Pseudogout more frequently occurs in large joints such as the knee, wrist, symphysis pubis, and shoulder. Tophaceous pseudogout involving the TMJ is rare, with only seven cases involving erosion into the middle cranial fossa reported previously. Despite skull base erosion being a rare consequence of this erosive disease, this case highlights the importance of appropriate investigation and multidisciplinary team management.
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Affiliation(s)
- D Houghton
- Maxillofacial Unit, Liverpool Head and Neck Centre, Aintree University Hospital, Liverpool, UK.
| | - N Munir
- Department of Otorhinolaryngology, Liverpool Head and Neck Centre, Aintree University Hospital, Liverpool, UK
| | - A Triantafyllou
- Department of Oral Pathology, Aintree University Hospitals, Liverpool, UK
| | - A Begley
- Maxillofacial Unit, Liverpool Head and Neck Centre, Aintree University Hospital, Liverpool, UK
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Russell RD, Langer-Gould A, Gonzales EG, Smith JB, Brennan V, Pereira G, Lucas RM, Begley A, Black LJ. Obesity, dieting, and multiple sclerosis. Mult Scler Relat Disord 2019; 39:101889. [PMID: 31838309 DOI: 10.1016/j.msard.2019.101889] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/12/2019] [Accepted: 12/07/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Obesity is common in the United States and is associated with a higher risk of relapse and comorbidities, and increased disease progression, in people with MS. METHODS We examined the prevalence of overweight and obesity in the MS Sunshine Study, a matched case-control study of multiple sclerosis in Southern California (470 cases, 519 controls). We reported the proportion of participants who adopted a specific diet for nutrition or weight loss purposes, and identified independent predictors of dieting. RESULTS In the total population, 32% and 37% were overweight and obese, respectively. Case participants were no more likely to adopt a specific diet for nutrition or weight loss purposes than control participants (10% and 11%, respectively). Being obese, younger, female or non-Hispanic were independently associated with dieting. CONCLUSION Despite the evidence that obesity can worsen MS prognosis, and the high prevalence of overweight/obesity, case participants were no more likely to adopt a specific diet than control participants. Improved nutrition education may help people with MS make healthy dietary changes for nutrition or weight loss purposes.
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Affiliation(s)
- R D Russell
- School of Public Health, Curtin University, Perth, Australia
| | - A Langer-Gould
- Neurology Department, Los Angeles Medical Center, Southern California Permanente Medical Group/Kaiser Permanente, Los Angeles, United States
| | - E G Gonzales
- Department of Research and Evaluation, Kaiser Permanente, Pasadena, United States
| | - J B Smith
- Department of Research and Evaluation, Kaiser Permanente, Pasadena, United States
| | - V Brennan
- School of Public Health, Curtin University, Perth, Australia
| | - G Pereira
- School of Public Health, Curtin University, Perth, Australia
| | - R M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - A Begley
- School of Public Health, Curtin University, Perth, Australia
| | - L J Black
- School of Public Health, Curtin University, Perth, Australia.
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Fullarton M, Martin I, Begley A, Magennis P. Getting It Right First Time (GIRFT) — the Oral & Maxillofacial Surgery Report: what happens next? Br J Oral Maxillofac Surg 2019; 57:393-394. [DOI: 10.1016/j.bjoms.2019.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/22/2019] [Indexed: 10/26/2022]
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Magennis P, Begley A. If trainers regularly validate trainees’ eLogbook records, they will spot a trainee who is not keeping theirs up-to-date. Br J Oral Maxillofac Surg 2017; 55:864-865. [DOI: 10.1016/j.bjoms.2017.06.017] [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] [Received: 06/18/2017] [Accepted: 06/21/2017] [Indexed: 11/25/2022]
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McDonald C, Kamisetty A, Twohig E, Fullarton M, Allen W, Java K, Begley A. A common password improves validation rates for elogbook: A brief overview of how a shared password is a secure and effective method of improving rates of validation of trainees' procedures in elogbook. Br J Oral Maxillofac Surg 2017; 55:e60. [PMID: 28716334 DOI: 10.1016/j.bjoms.2017.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/26/2017] [Indexed: 11/18/2022]
Affiliation(s)
- C McDonald
- Department of Oral and Maxillofacial Surgery, Aintree University Hospitals NHS Foundation Trust, University Hospital Aintree, Lower Lane, Liverpool L9 7AL.
| | - A Kamisetty
- Department of Oral and Maxillofacial Surgery, Aintree University Hospitals NHS Foundation Trust, University Hospital Aintree, Lower Lane, Liverpool L9 7AL
| | - E Twohig
- Department of Oral and Maxillofacial Surgery, Aintree University Hospitals NHS Foundation Trust, University Hospital Aintree, Lower Lane, Liverpool L9 7AL
| | - M Fullarton
- Department of Oral and Maxillofacial Surgery, Aintree University Hospitals NHS Foundation Trust, University Hospital Aintree, Lower Lane, Liverpool L9 7AL
| | - W Allen
- Department of Oral and Maxillofacial Surgery, Aintree University Hospitals NHS Foundation Trust, University Hospital Aintree, Lower Lane, Liverpool L9 7AL
| | - K Java
- Department of Oral and Maxillofacial Surgery, Aintree University Hospitals NHS Foundation Trust, University Hospital Aintree, Lower Lane, Liverpool L9 7AL
| | - A Begley
- Department of Oral and Maxillofacial Surgery, Aintree University Hospitals NHS Foundation Trust, University Hospital Aintree, Lower Lane, Liverpool L9 7AL
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Begley A, Magennis P. OMFS: Do your research. Br Dent J 2016; 221:537. [PMID: 27811904 DOI: 10.1038/sj.bdj.2016.801] [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: 11/09/2022]
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Magennis P, Begley A, Dover M. Dental registration of UK OMFS consultants and trainees in 2015 – a significant change? Not ‘ARF’. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Magennis P, Begley A. Made in Scotland from… Irn-Bru® bottles. A cheap, effective carrier for scientific posters. Br J Oral Maxillofac Surg 2015; 53:566-8. [DOI: 10.1016/j.bjoms.2015.02.020] [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] [Received: 08/15/2014] [Accepted: 02/18/2015] [Indexed: 10/23/2022]
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Vesey J, Dodd M, Begley A. The longevity of TMJ replacements over an 18 year period (1995-2013) in Liverpool. Br J Oral Maxillofac Surg 2014. [DOI: 10.1016/j.bjoms.2014.07.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kasckow JW, Karp JF, Whyte E, Butters M, Brown C, Begley A, Bensasi S, Reynolds CF. Subsyndromal depression and anxiety in older adults: health related, functional, cognitive and diagnostic implications. J Psychiatr Res 2013; 47:599-603. [PMID: 23414701 PMCID: PMC3594429 DOI: 10.1016/j.jpsychires.2013.01.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 11/30/2012] [Accepted: 01/18/2013] [Indexed: 10/27/2022]
Abstract
Subsyndromal depression in later life is common in primary care. Comorbid anxiety disorders could exacerbate the negative effect of subsyndromal depression on functioning, health-related quality of life, comorbidity and/or cognition. We examined anxiety disorders co-existing with subsyndromal depression in participants ≥ age 50 in an NIH trial of Problem Solving Therapy for Primary Care for indicated prevention of major depression. There were 247 participants, with Centers for Epidemiologic Studies - Depression scores ≥ 11. Participants could have multiple psychiatric diagnoses: 22% of the sample had no DSM IV diagnosis; 39% of the sample had only 1 DSM IV diagnosis; 28% had 2 diagnoses; 6% had 3 DSM IV diagnoses; 4% had 4 DSM IV diagnoses; and 1% had 5 diagnoses. Furthermore, 34% of participants had a current comorbid DSM IV diagnosis of a syndromal anxiety disorder. We hypothesized that those with subsyndromal depression, alone relative to those with co-existing anxiety disorders, would report better health-related quality of life, less disability, less medical comorbidity and less cognitive impairment. However, there were no differences in quality of life based on the SF 12 nor in disability based on Late Life Function and Disability Instrument scores. There were no differences in medical comorbidity based on the Cumulative Illness Scale-Geriatrics scale scores nor in cognitive function based on the Executive Interview (EXIT), Hopkins Verbal Learning Test-Revised and Mini-Mental Status Exam. Our findings suggest that about one third of participants 50 years and older with subsyndromal depression have comorbid anxiety disorders; however, this does not appear to be associated with worse quality of life, functioning, disability, cognitive function or medical comorbidity.
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Affiliation(s)
- JW Kasckow
- VA Pittsburgh MIRECC and Behavioral Health, 7180 Highland Dr (116a), Pittsburgh, PA 15206,Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213,Corresponding Author John Kasckow, MD, PhD, VA Pittsburgh Health Care System Behavioral Health, 7180 Highland Dr (116a), Pittburgh, PA 15206, Ph: (412) 954-4344,
| | - JF Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213
| | - E Whyte
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213
| | - M Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213
| | - C Brown
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213
| | - A Begley
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213
| | - S Bensasi
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213
| | - CF Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213
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Gildengers AG, Chisholm D, Butters MA, Anderson SJ, Begley A, Holm M, Rogers JC, Reynolds CF, Mulsant BH. Two-year course of cognitive function and instrumental activities of daily living in older adults with bipolar disorder: evidence for neuroprogression? Psychol Med 2013; 43:801-11. [PMID: 22846332 PMCID: PMC3593938 DOI: 10.1017/s0033291712001614] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND While bipolar disorder (BD) is a leading cause of disability, and an important contributor to disability in BD is cognitive impairment, there is little systematic research on the longitudinal course of cognitive function and instrumental activities of daily living (IADLs) in late-life. In this report, we characterize the 2-year course of cognitive function and IADLs in older adults with BD. Method We recruited non-demented individuals 50 years and older with BD I or BD II (n = 47) from out-patient clinics or treatment studies at the University of Pittsburgh. Comparator subjects ('controls') were 22 individuals of comparable age and education with no psychiatric or neurologic history, but similar levels of cardiovascular disease. We assessed cognitive function and IADLs at baseline, 1- and 2-year time-points. The neuropsychological evaluation comprised 21 well-established and validated tests assessing multiple cognitive domains. We assessed IADLs using a criterion-referenced, performance-based instrument. We employed repeated-measures mixed-effects linear models to examine trajectory of cognitive function. We employed non-parametric tests for analysis of IADLs. RESULTS The BD group displayed worse cognitive function in all domains and worse IADL performance than the comparator group at baseline and over follow-up. Global cognitive function and IADLs were correlated at all time-points. The BD group did not exhibit accelerated cognitive decline over 2 years. CONCLUSIONS Over 2 years, cognitive impairment and associated functional disability of older adults with BD appear to be due to long-standing neuroprogressive processes compounded by normal cognitive aging rather than accelerated cognitive loss in old age.
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Affiliation(s)
- A. G. Gildengers
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - D. Chisholm
- University of Pittsburgh School of Rehabilitation Sciences, Department of Occupational Therapy, Pittsburgh, PA, USA
| | - M. A. Butters
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - S. J. Anderson
- University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA, USA
| | - A. Begley
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - M. Holm
- University of Pittsburgh School of Rehabilitation Sciences, Department of Occupational Therapy, Pittsburgh, PA, USA
| | - J. C. Rogers
- University of Pittsburgh School of Rehabilitation Sciences, Department of Occupational Therapy, Pittsburgh, PA, USA
| | - C. F. Reynolds
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - B. H. Mulsant
- Centre for Addiction and Mental Health and the University of Toronto, Department of Psychiatry, Toronto, ON, Canada
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Kasckow J, Brown C, Morse J, Begley A, Bensasi S, Reynolds CF. Post-traumatic stress disorder symptoms in emotionally distressed individuals referred for a depression prevention intervention: relationship to problem-solving skills. Int J Geriatr Psychiatry 2012; 27:1106-11. [PMID: 23044651 PMCID: PMC3468913 DOI: 10.1002/gps.2826] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 06/29/2011] [Revised: 10/24/2011] [Accepted: 10/25/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study examined the rates of syndromal and subthreshold post-traumatic stress disorder (PTSD) and PTSD symptom scores in participants with symptoms of emotional distress, subsyndromal depression, and a history of traumatic exposure. Participants had been referred to a study of an indicated depression prevention intervention using problem-solving therapy in primary care. We hypothesized that higher severity of PTSD symptom scores would predict poorer problem-solving skills. In addition, some reports have suggested that there are higher rates of PTSD in minority populations relative to Caucasians; thus we hypothesized that race would also predict problem-solving skills in these individuals. METHODS We examined the rates of traumatic exposure, syndromal, and subthreshold PTSD. In those exposed to trauma, we performed a multiple linear regression to examine the effects of PTSD symptoms, depression symptoms, race, age, and gender on social problem-solving skills. RESULTS Of the 244 participants, 64 (26.2%) reported a traumatic event; 6/234 (2.6%) had syndromal PTSD, and 14/234 (6.0%) had subthreshold PTSD. By way of regression analysis, higher PTSD symptom scores predicted poorer problem-solving skills. In addition, racial status (Caucasian vs. African American) predicted problem-solving skills; Caucasians exhibited lower levels of problem-solving skills. CONCLUSIONS Individuals presenting with subsyndromal depressive symptoms may also have a history of traumatic exposure, subthreshold and syndromal PTSD. Thus, screening these individuals for PTSD symptoms is important and may inform clinical management decisions because problem-solving skills are lower in those with more severe PTSD symptoms (even after adjusting for race, age, gender, and depressive symptoms).
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Affiliation(s)
- J Kasckow
- VA Pittsburgh MIRECC and Behavioral Health, Pittsburgh, PA, USA.
| | - C Brown
- UPMC Western Psychiatric Institute and Clinics, 3811 O’Hara St, Pittsburgh, PA 15213
| | - J Morse
- UPMC Western Psychiatric Institute and Clinics, 3811 O’Hara St, Pittsburgh, PA 15213
| | - A Begley
- UPMC Western Psychiatric Institute and Clinics, 3811 O’Hara St, Pittsburgh, PA 15213
| | - S Bensasi
- UPMC Western Psychiatric Institute and Clinics, 3811 O’Hara St, Pittsburgh, PA 15213
| | - CF Reynolds
- UPMC Western Psychiatric Institute and Clinics, 3811 O’Hara St, Pittsburgh, PA 15213
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Tu XM, Kowalski J, Begley A, Houck P, Mazumdar S, Miewald J, Buysse DJ, Kupfer DJ. Data recycling: A response to the changing technology from the statistical perspective with application to psychiatric sleep research. J Appl Stat 2001. [DOI: 10.1080/02664760120076698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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27
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Buysse DJ, Hall M, Begley A, Cherry CR, Houck PR, Land S, Ombao H, Kupfer DJ, Frank E. Sleep and treatment response in depression: new findings using power spectral analysis. Psychiatry Res 2001; 103:51-67. [PMID: 11472790 DOI: 10.1016/s0165-1781(01)00270-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study examined quantitative measures of sleep electroencephalogram (EEG) and phasic rapid eye movements (REM) as correlates of remission and recovery in depressed patients. To address correlates of remission, pre-treatment EEG sleep studies were examined in 130 women outpatients with major depressive disorder treated with interpersonal psychotherapy (IPT). To address correlates of recovery, baseline and post-treatment EEG sleep studies were examined in 23 women who recovered with IPT alone and 23 women who recovered with IPT+fluoxetine. Outcomes included EEG power spectra during non-rapid eye movement (NREM) sleep and REM sleep and quantitative REMs. IPT non-remitters had increased phasic REM compared with remitters, but no significant differences in EEG power spectra. IPT+fluoxetine recoverers, but not IPT recoverers, showed increases in phasic REM and REM percentage from baseline to recovery. In NREM sleep, the IPT+fluoxetine group showed a decrease in alpha power from baseline to recovery, while the IPT group showed a slight increase. The number of REMs was a more robust correlate of remission and recovery than modeled quantitative EEG spectra during NREM or REM sleep. Quantitative REMs may provide a more direct measure of brainstem function and dysfunction during REM sleep than quantitative sleep EEG measures.
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Affiliation(s)
- D J Buysse
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, E-1127 WPIC, Pittsburgh, PA 15213, USA.
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Dew MA, Reynolds CF, Mulsant B, Frank E, Houck PR, Mazumdar S, Begley A, Kupfer DJ. Initial recovery patterns may predict which maintenance therapies for depression will keep older adults well. J Affect Disord 2001; 65:155-66. [PMID: 11356239 DOI: 10.1016/s0165-0327(00)00280-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although active maintenance treatments appear superior to placebo in preventing depression recurrence in older adults, few data are available to guide maintenance modality selection to maximize the probability of continued wellness for a given patient. Patients' temporal patterns of acute treatment response may predict who requires which maintenance therapy to remain well. METHODS Depression levels were observed over 16 weeks of combined nortriptyline (NT) and interpersonal psychotherapy (IPT) in 140 persons aged >or=60 years with recurrent major depression. Subjects were empirically classified into four groups: rapid, sustained responders; delayed, sustained responders; mixed responders without sustained improvement; prolonged nonresponders. Groups were compared on subsequent recovery rates and on time to depression recurrence after randomization to 3 years of combined maintenance therapy (monthly IPT with NT), monotherapy (either IPT or NT alone), or medication clinic with placebo. Pretreatment psychosocial and clinical variables were controlled. RESULTS Initial response profile predicted ultimate recovery rates, as well as who remained well, given the maintenance treatment received. Rapid initial responders showed lower recurrence risk with either combined or monotherapy, relative to placebo. Specific types of monotherapy appeared equally effective in rapid responders. In initially mixed responders, only combined therapy was superior to placebo. It was marginally superior to monotherapy. For delayed responders, combined therapy was superior to placebo; monotherapy did not differ from the other maintenance conditions. Prolonged nonresponders did not benefit from maintenance treatment. LIMITATIONS Subjects had only recurrent, unipolar depression. Initial response profile groups were established empirically and require replication. Sample sizes in initial response profile by maintenance treatment cells were small. CONCLUSION The ability to match patients to maintenance treatments more likely to prevent recurrence may be enhanced by considering the temporal profile of initial response to acute treatment.
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Affiliation(s)
- M A Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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Weber E, Stack J, Pollock BG, Mulsant B, Begley A, Mazumdar S. Weight change in older depressed patients during acute pharmacotherapy with paroxetine and nortriptyline: a double-blind randomized trial. Am J Geriatr Psychiatry 2000; 8:245-50. [PMID: 10910424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The authors examined weight change in 32 elderly patients treated for 12 weeks with either nortriptyline or paroxetine during acute-phase pharmacotherapy. Random assignment to treatment and double-blind assessment of weight change were performed, including ascertainment of premorbid (i.e., pre-depression) weight. Pretreatment severity of depression was correlated with weight loss during the depressive episode and depression-related weight loss, in turn, correlated with weight regained during antidepressant treatment. There was no differential weight change associated with nortriptyline vs. paroxetine. Rather, subjects in both groups approximated their premorbid weights by 12 weeks of acute-phase pharmacotherapy with either agent. However, additional investigation of weight change during continuation and maintenance pharmacotherapy is necessary and would be clinically useful for the long-term management of elderly patients with depression.
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Affiliation(s)
- E Weber
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA
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Sidebottom AJ, Begley A, May P, Richardson D. Aetiology of nasopharyngeal glioma. Int J Oral Maxillofac Surg 2000; 29:210-1. [PMID: 10970085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
A case of nasopharyngeal glioma is presented in which the postnatal scans clearly show intracranial communication, whilst subsequent scans and surgical exploration could not demonstrate this finding. This case seems to confirm that the aetiology of these lesions is due to an encephalocele that subsequently loses its connection with the brain.
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Affiliation(s)
- A J Sidebottom
- Supra-Regional Craniofacial Unit, Alder Hey Children's Hospital, Liverpool, UK.
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Abstract
This paper presents a brief outline of the attributes and therapeutic nature of hope in the context of truth-telling. It is suggested that, in some circumstances, withholding the truth to protect hope can be considered a morally acceptable option when truth-telling has the potential to destroy hope's therapeutic effects. A clinical vignette that highlights how the practitioner can be confronted with a clash of principles is presented. The possible consequences of both truth-telling and the withholding of truth are discussed and the moral positions of the health-care professionals involved are examined. This article is intended to provide a framework for discussion/group work, particularly at undergraduate level.
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Affiliation(s)
- A Begley
- School of Nursing and Midwifery, Queen's University of Belfast, Northern Ireland.
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Abstract
Namibia is a sparsely populated nation in southwest Africa. A state-run health service provides care to most of the population. The geography and population distribution dictate the delivery systems for prehospital and emergency care. A state-run ambulance service provides basic patient transportation to the state-run hospitals. There is no 911 system. Two private aeromedical companies in Namibia provide the full range of ground and aeromedical treatment, diver rescue, and helicopter and fixed-wing transport services. The scope of care includes cricothyrotomies, chest tubes, and rapid-sequence intubation. Equipment is modern and virtually identical to what is used in the United States. There are no emergency physicians in Namibia. General medical officers are the backbone of the state-run health service. General medical officers assigned to cover the ED are called casualty officers. No specialized training beyond internship is required, and assignments to casualty are viewed as temporary until better positions become available. Only the largest state hospital in the capital has a dedicated, 24-hour emergency staff. The private prehospital care/transport systems are well organized and sophisticated. Formal efforts should be undertaken to develop ties with our colleagues in Namibia. Potential areas for collaboration include injury surveillance and prevention, field trauma resuscitation, and prehospital care.
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Affiliation(s)
- J Tintinalli
- Department of Emergency Medicine, University of North Carolina, Chapel Hill 27599-7594, USA
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Begley A, Magennis P, Watson L. Prophylaxis for patients on systemic corticosteroids: an evidence-based protocol contrasted with current prescribing practices in UK maxillofacial units. Br J Oral Maxillofac Surg 1998. [DOI: 10.1016/s0266-4356(98)90586-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Reynolds CF, Frank E, Houck PR, Mazumdar S, Dew MA, Cornes C, Buysse DJ, Begley A, Kupfer DJ. Which elderly patients with remitted depression remain well with continued interpersonal psychotherapy after discontinuation of antidepressant medication? Am J Psychiatry 1997; 154:958-62. [PMID: 9210746 DOI: 10.1176/ajp.154.7.958] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study was conducted to identify which elderly patients with remitted recurrent major depression remain well with maintenance interpersonal psychotherapy after discontinuation of active antidepressant medication (nortriptyline). METHOD The authors examined outcomes of maintenance therapy over 1 year for 47 elderly patients who were randomly assigned to monthly maintenance interpersonal psychotherapy with placebo (N = 19) or to placebo and a supportive medication clinic without interpersonal psychotherapy (N = 28). A Kaplan-Meier survival analysis was performed on the basis of treatment assignment and subjective sleep quality assessed by the Pittsburgh Sleep Quality Index, on which good subjective sleep quality is indicated by a score of 5 or lower. RESULTS Nine (90%) of 10 patients reporting good subjective sleep quality (by 1 month into continuation treatment) remained well for at least 1 year when treated with monthly maintenance interpersonal psychotherapy, versus five (31%) of 16 patients with good sleep quality assigned to a medication clinic, three (33%) of nine patients with impaired sleep quality treated with maintenance interpersonal psychotherapy, and two (17%) of 12 patients with impaired sleep quality assigned to a medication clinic. CONCLUSIONS Recovery of good subjective sleep quality by early continuation treatment is useful in identifying which remitted elderly depressed patients will remain well with monthly maintenance interpersonal psychotherapy, following discontinuation of antidepressant medication, and which patients may be more vulnerable to recurrence of major depressive episodes in the absence of antidepressant medication.
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Affiliation(s)
- C F Reynolds
- Mental Health Clinical Research Center for the Study of Mood Disorders, University of Pittsburgh School of Medicine, PA, USA.
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36
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Magennis P, Begley A. A practical coding system for mandibular fractures. Br J Oral Maxillofac Surg 1997. [DOI: 10.1016/s0266-4356(97)90653-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Magennis P, Begley A. Small plate osteosynthesis—the anonymous implant: a survey of plating systems used and current practice at oral and maxillofacial units in the UK. Br J Oral Maxillofac Surg 1997. [DOI: 10.1016/s0266-4356(97)90654-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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38
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Reynolds CF, Frank E, Perel JM, Mazumdar S, Dew MA, Begley A, Houck PR, Hall M, Mulsant B, Shear MK, Miller MD, Cornes C, Kupfer DJ. High relapse rate after discontinuation of adjunctive medication for elderly patients with recurrent major depression. Am J Psychiatry 1996; 153:1418-22. [PMID: 8890674 DOI: 10.1176/ajp.153.11.1418] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The authors documented outcomes of elderly depressed patients requiring adjunctive medication during acute-phase pharmacotherapy because of slow or partial response to nortriptyline. Twenty-eight patients (17.7%) received inpatient care at some point during acute-phase treatment. METHOD Rates of response, relapse, and sustained remission were examined in 158 elderly patients with recurrent major depression, grouped by whether they received brief treatment with adjunctive medication (lithium, perphenazine, or paroxetine) (N = 39) or did not (N = 119). RESULTS The group receiving adjunctive medication had a lower rate of response to acute therapy (64.1% versus 83.2%), a higher relapse rate during continuation therapy (52.0% versus 6.1%), and a lower rate of sustained remission (recovery) (48.7% versus 76.5%) than did the group without augmentation. CONCLUSIONS Elderly depressed patients requiring augmented pharmacotherapy to achieve remission may need continuation of adjunctive medication to remain well and to avoid early relapse. Alternatively, factors that lead to augmentation in the first place (e.g., heightened anxiety) may also increase the risk of relapse.
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Affiliation(s)
- C F Reynolds
- Mental Health Clinical Research Center for the Study of Late-Life Mood Disorders, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, PA 15213, USA.
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39
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Affiliation(s)
- A Begley
- Accident and Emergency Department, Ulster Hospital, Dundonald, Northern Ireland, UK
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Begley A, Bell KE, Byrnes DP, McKinstry CS. Traumatic carotico-cavernous fistula presenting as delayed epilepsy. Ulster Med J 1993; 62:101-4. [PMID: 8516965 PMCID: PMC2449025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A Begley
- Royal Victoria Hospital, Belfast
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Magennis P, Begley A. Hospital patients who smoke. West J Med 1993. [DOI: 10.1136/bmj.306.6877.585-c] [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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