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Johnson CF, Ingram F, Thomson F, Srireddy P, Jani BD, Greenlaw N. General practice pharmacist-led antipsychotic physical health monitoring: a prospective intervention scoping study. Fam Pract 2024; 41:41-49. [PMID: 38180874 DOI: 10.1093/fampra/cmad120] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND People with severe mental health illness die prematurely, often due to preventable cardiometabolic disease, which can be exacerbated by antipsychotic medicines that are effective for treating mental illness. Literature demonstrates that physical health monitoring, as recommended in guidelines, for people receiving antipsychotics is substandard. Therefore, we aimed to scope the potential of a general practice clinical pharmacist (GPCP)-led multidisciplinary intervention optimising adherence to cardiometabolic monitoring guidelines and delivering polypharmacy reviews. METHOD Prospective intervention scoping study in three urban general practices; one usual care, two intervention. Patients 18-65 years old prescribed oral antipsychotics were identified from records, and invited for cardiometabolic monitoring and GPCP medication review, from January to December 2022. Interventions and onward referrals were recorded and collated. Anonymised pre- and post-review data were analysed, and actions were graded for clinical importance. RESULTS In total 1.5% (210/14,159) of patients aged 18-65 years met inclusion criteria; usual care practice (n = 58); and intervention practices (n = 152). From baseline, the usual care practice achieved an absolute 7% increase in the cardiometabolic monitoring care bundle (glucose/glycosylated haemoglobin, lipids, blood pressure plus body mass index) versus 19-58% in the intervention practices. Two-thirds (92/152) of patients participated in medication reviews, requiring pharmacological and/or non-pharmacological clinical actions. The majority of actions were graded as moderate importance. Seven percentage of patients were identified as new pre-diabetic/diabetic and 6% were at high risk of cardiovascular disease requiring statin initiation. CONCLUSION A pharmacist-led multidisciplinary general practice-based approach may be effective at optimising cardiometabolic monitoring; identifying and treating diabetic and cardiovascular risk factors.
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Affiliation(s)
- Chris F Johnson
- Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Fiona Ingram
- Pharmacy Services, Renfrewshire Health and Social Care Partnership, NHS Greater Glasgow and Clyde, Renfrew, United Kingdom
| | - Fiona Thomson
- Anchor Mill Medical Practice, Paisley, United Kingdom
| | - Pavan Srireddy
- Florence Street Resource Centre, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Bhautesh D Jani
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences University of Glasgow, Glasgow, United Kingdom
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Johnson CF, Maskrey M, MacBride-Stewart S, Lees A, Macdonald H, Thompson A. New ways of working releasing general practitioner capacity with pharmacy prescribing support: a cost-consequence analysis. Fam Pract 2022; 39:648-655. [PMID: 35016210 DOI: 10.1093/fampra/cmab175] [Citation(s) in RCA: 3] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND General practice in the United Kingdom is experiencing a workforce crisis. Greater multidisciplinary working, including more general practice pharmacists, is seen as part of the solution. However, it is unknown what impact and cost-consequences that pharmacists may have in freeing general practitioner (GP) capacity. OBJECTIVE To evaluate the cost-consequences of additional pharmacists in releasing GP capacity. METHODS This cost-consequences evaluation of a prospective observational cohort study in 15 urban practices involving 69 GPs in 1 locality serving a population of 82,000 people. GPs recorded the time they spent addressing key targeted prescribing activities during 5 distinct 2-week audit periods. Pharmacists performed these key prescribing activities to release GP capacity. An additional 225 h of pharmacists' time per week was committed to the locality. Standardized staff costings were used to estimate the financial impact. Prescribing indicator performance was assessed against the other 7 localities within the health board. RESULTS When compared with employing extra nonsalaried GPs this required an estimated additional investment of £16.73 (range £5.97-20.87) per h to free GP capacity. This achieved a sustainable 47% (73 h per week, F(4,56) = 16.05, P < 0.001) reduction in GP time spent on key prescribing activities; equating to 4.9 h (95% confidence interval 3.1-6.7) per practice per week. No significant step changes in locality safety and quality prescribing measures, and no negative effects on locality-level prescribing cost-efficiency work were observed. CONCLUSION Appropriately resourced general practice pharmacy teams delivered prescribing cost-efficiencies as well as sustainably freeing GP capacity by performing key prescribing activities.
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Affiliation(s)
- Chris F Johnson
- Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Margaret Maskrey
- Inverclyde Health and Social Care Partnership NHS Greater Glasgow and Clyde, Port Glasgow, United Kingdom
| | | | - Ann Lees
- Planning, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Hector Macdonald
- Inverclyde Health and Social Care Partnership NHS Greater Glasgow and Clyde, Port Glasgow, United Kingdom
| | - Audrey Thompson
- Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
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Johnson CF, Maxwell M, Williams B, Dougall N, MacGillivray S. Dose-response effects of selective serotonin reuptake inhibitor monotherapy for the treatment of depression: systematic review of reviews and meta-narrative synthesis. BMJ Med 2022; 1:e000017. [PMID: 36936596 PMCID: PMC9978765 DOI: 10.1136/bmjmed-2021-000017] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/05/2022] [Indexed: 12/04/2022]
Abstract
Objective To assess and clarify the relations between selective serotonin reuptake inhibitor (SSRI) dose efficacy, acceptability (early treatment discontinuation (dropouts)), and tolerability (reported adverse drug effects), and critically evaluate methods previously used to examine SSRI dose-response effects for the treatment of depression in adults. Design Systematic review of reviews and meta-narrative synthesis. Data sources Embase, Medline, PsycINFO, Scopus, and the Cochrane Collaboration library, from 1975 to December 2021. Reference lists of national depression treatment guidelines were systemically searched by hand. Eligibility criteria for selecting studies Reviews assessing SSRI monotherapy dose-response effects for the treatment of depression in adults (age ≥18 years) reporting efficacy, acceptability, or tolerability. Reviews meeting inclusion criteria had a high degree of heterogeneity, due to methodological diversity; therefore, a meta-narrative synthesis approach was applied. Standard daily doses were defined as 20 mg citalopram, fluoxetine, paroxetine; 50 mg sertraline; and 10 mg escitalopram. Risk of bias was assessed using the Risk of Bias in Systematic Reviews tool, in line with Cochrane recommendations. Results The search identified 9138 records; 387 full text reports were assessed for eligibility, 42 of which matched the inclusion criteria. The majority, 83% (n=35), of reviews included data for studies with a duration of ≤12 weeks (ie, the acute phase of depression treatment). Of 39 reviews assessing efficacy, the majority (n=26) indicated that individual SSRIs and SSRI class demonstrated flat dose-response effects; standard doses were optimal for efficacy. Acceptability or tolerability were assessed in 28 reviews. Higher than standard daily doses were associated with higher dropout rates and a greater incidence of adverse drug effects (eg, nausea, sexual dysfunction, fatigue, anxiety). Despite a range of methods being reported, there was an overall consensus regarding SSRI dose related efficacy, dropouts, and adverse drug effects. Conclusion Standard daily doses of SSRIs for the treatment of depression in adults provide a favourable balance between efficacy, acceptability, and tolerability. Patients are encouraged to talk to their prescriber or community pharmacist if they experience adverse effects or have any concerns about their drug treatments.
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Affiliation(s)
- Chris F Johnson
- Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Margaret Maxwell
- Midwifery and AHP Research Unit, University of Stirling, Stirling, UK
| | - Brian Williams
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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Bowers H, Kendrick T, van Ginneken N, Glowacka M, Williams S, Leydon GM, May C, Dowrick C, Moncrieff J, Johnson CF, Moore M, Laine R, Geraghty AWA. A Digital Intervention for Primary Care Practitioners to Support Antidepressant Discontinuation (Advisor for Health Professionals): Development Study. J Med Internet Res 2021; 23:e25537. [PMID: 34269688 PMCID: PMC8325079 DOI: 10.2196/25537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The number of people receiving antidepressants has increased in the past 3 decades, mainly because of people staying on them longer. However, in many cases long-term treatment is not evidence based and risks increasing side effects. Additionally, prompting general practitioners (GPs) to review medication does not improve the rate of appropriate discontinuation. Therefore, GPs and other health professionals may need help to support patients discontinuing antidepressants in primary care. OBJECTIVE This study aims to develop a digital intervention to support practitioners in helping patients discontinue inappropriate long-term antidepressants (as part of a wider intervention package including a patient digital intervention and patient telephone support). METHODS A prototype digital intervention called Advisor for Health Professionals (ADvisor HP) was planned and developed using theory, evidence, and a person-based approach. The following elements informed development: a literature review and qualitative synthesis, an in-depth qualitative study, the development of guiding principles for design elements, and theoretical behavioral analyses. The intervention was then optimized through think-aloud qualitative interviews with health professionals while they were using the prototype intervention. RESULTS Think-aloud qualitative interviews with 19 health professionals suggested that the digital intervention contained useful information and was readily accessible to practitioners. The development work highlighted a need for further guidance on drug tapering schedules for practitioners and clarity about who is responsible for broaching the subject of discontinuation. Practitioners highlighted the need to have information in easily and quickly accessible formats because of time constraints in day-to-day practice. Some GPs felt that some information was already known to them but understood why this was included. Practitioners differed in their ideas about how they would use ADvisor HP in practice, with some preferring to read the resource in its entirety and others wanting to dip in and out as needed. Changes were made to the wording and structure of the intervention in response to the feedback provided. CONCLUSIONS ADvisor HP is a digital intervention that has been developed using theory, evidence, and a person-based approach. The optimization work suggests that practitioners may find this tool to be useful in supporting the reduction of long-term antidepressant use. Further quantitative and qualitative evaluation through a randomized controlled trial is needed to examine the feasibility, effectiveness, and cost-effectiveness of the intervention.
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Affiliation(s)
- Hannah Bowers
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Tony Kendrick
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Marta Glowacka
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Samantha Williams
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Geraldine M Leydon
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Carl May
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Joanna Moncrieff
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Chris F Johnson
- Pharmacy & Prescribing Support Unit, Pharmacy Services, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
| | - Michael Moore
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Rebecca Laine
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Adam W A Geraghty
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
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Khan TA, Hussain S, Ikram A, Mahmood S, Riaz H, Jamil A, Amin A, Haider YG, Sandhu M, Mushtaq A, Barbui C, Johnson CF, Godman B. Prevalence and treatment of neurological and psychiatric disorders among tertiary hospitals in Pakistan; findings and implications. Hosp Pract (1995) 2020; 48:145-160. [PMID: 32343632 DOI: 10.1080/21548331.2020.1762366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Mental health and neurological disorders are prevalent in Pakistan. However, there are considerable concerns with their management due to issues of access, availability of trained personnel and stigma alongside paucity of such data. Consequently, there is a need to document current treatment approaches starting with tertiary hospitals in Pakistan where patients with more severe mental and neurological disorders are typically treated. Subsequently, use the findings to help direct future policies and initiatives. METHODS Multi-centered, cross-sectional, prospective study principally evaluating current medicine usage among patients attending tertiary hospitals in Pakistan with psychiatric and neurological disorders. In addition, possible factors contributing to the prevalence of these disorders in this population to help with future care. All 23 tertiary care hospitals in the ten major Districts in Pakistan were included, which cover 75% of the population. RESULTS 57,664 patients were evaluated of which 35.3% were females. Both females and males had multiple brain disorders and multiple co-morbidities. Schizophrenia was the most prevalent disorder overall among both females (25.2%) and males (30.4%). A median of six medicines were prescribed per patient, with antipsychotics and antidepressants the most prescribed medicines. Clozapine was the most prescribed medicine in males (12.25%) and females (11.83%) including for psychiatric disorders, with sodium valproate the most prescribed medicine in epilepsy in males (42.44% of all anti-epileptic medicines) as well as females (46.38%). There was a greater prevalence of both disorders among the lower classes. A greater prevalence of schizophrenia was seen in patients abusing alcohol and smokers. The divorce rate was higher among the studied patients and the prevalence of depression was higher among the widowed population. CONCLUSIONS There were concerns with the quality of prescribing including the extent of polypharmacy as well as possible overuse of clozapine especially in patients with epilepsy, both of which need addressing.
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Affiliation(s)
- Tanveer Ahmed Khan
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Shahzad Hussain
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Aamer Ikram
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Sidra Mahmood
- Department of Pharmacy, Quaid-e-Azam University , Islamabad, Pakistan
| | - Humayun Riaz
- Department of Pharmaceutics, Rashid Latif College of Pharmacy , Lahore, Pakistan
| | - Ayesha Jamil
- Faculty of Pharmacy, Hajvery University , Lahore, Pakistan
| | - Amina Amin
- Faculty of Pharmacy, Hajvery University , Lahore, Pakistan
| | | | - Marva Sandhu
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Atifa Mushtaq
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona , Verona, Italy
| | - Chris F Johnson
- Pharmacy Services, National Health Service Greater Glasgow and Clyde (NHS GGC) , Glasgow, UK
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge , Stockholm, Sweden.,Department of Pharmacoepidemiolgy, Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University , Glasgow, UK.,Health Economics Centre, Liverpool University , Liverpool, UK.,Division of Public Health Pharmacy and Management, School of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University , Pretoria, South Africa
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Johnson CF, Smith J, Harrison H, Hassett R. Exploring learning needs for general practice based pharmacist: Are behavioural and influencing skills needed? Pharm Pract (Granada) 2020; 18:1814. [PMID: 32477433 PMCID: PMC7243743 DOI: 10.18549/pharmpract.2020.2.1814] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/26/2020] [Indexed: 11/14/2022] Open
Abstract
Background Embedding pharmacists in general practice has been shown to create cost efficiencies, improve patient care and free general practitioner capacity. Consequently, there is a drive to recruit additional pharmacists to work within general practices. However, equipping pharmacists with behaviour and influencing skills may further optimise their impact. Key elements which may enhance behaviour and influencing skills include self-efficacy and resilience. Objective This study aimed to: 1) Assess general practice pharmacists' self-efficacy and resilience. 2) Explore differences primarily between pharmacists reporting lower and higher self-efficacy, secondarily for those reporting lower and higher scores for resilience. Methods All 159 NHS Greater Glasgow and Clyde general practice pharmacists were invited to complete an online survey in May 2019. The survey captured anonymised data covering: demographics; professional experience; qualifications, prescribing status and preferred learning styles. Unconscious learning needs for behavioural and influencing skills were assessed using validated tools: the new general self-efficacy scale (GSES) and short general resilience scale (GRIT). Participants' responses were differentiated by the lowest quartile and higher quartiles of GSES and GRIT scores, and analysed to identify differences. Results The survey was completed by 57% (91/159) of eligible pharmacists; mean age 38 (range 24-60) years; 91% were of white ethnicity and 89% female. The median time qualified was 14 (1-38) years and 3 (1-22) years working in general practices. Overall pharmacists scored well on the GSES, mean 25 (SD 3; 95%CI 24.4-25.6), and GRIT, mean 30 (SD 4; 95%CI 29.6-30.4), out of a maximum 32 and 40 respectively. A significant positive correlation between GSES and GRIT scores was found (Pearson's r=0.284, p=0.006). However, no significant differences were identified between pharmacists scoring in the lower and upper quartiles by GSES or GRIT. Overall respondents reported their preferred learning styles were activists (46%) or pragmatists (29%). The majority (91%) preferred blended learning methods as opposed to 38% or less for a range of online methods. Conclusions General practice pharmacists on average scored highly for self-efficacy and resilience. Higher scores did not appear to be associated with demographic, years of practice, professional or educational experience. Prospective interventions to support those with lower scores may enhance and optimise pharmacists' effectiveness in general practice.
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Affiliation(s)
- Chris F Johnson
- MRes, MSc, BSc (Hons), PGCert Psych Pharm. Specialist Mental Health and Advanced Prescribing Support Pharmacist Primary Care. Pharmacy Services, NHS Greater Glasgow and Clyde, Clarkston Court. Glasgow (United Kingdom).
| | - Jan Smith
- CPsychol, PhD, MSc, MSc, BSc (Hons), PGCert. Researcher and Chartered Health Psychologist. Pharmacy Services, NHS Greater Glasgow and Clyde, Clarkston Court. Glasgow (United Kingdom).
| | - Heather Harrison
- MPC, BSc (Hons), PGDip. Senior Prescribing Advisor. Pharmacy Services, NHS Greater Glasgow and Clyde, Clarkston Court. Glasgow (United Kingdom).
| | - Richard Hassett
- BA (Hons). Senior Information & Prescribing Analyst. Pharmacy Services, NHS Greater Glasgow and Clyde, Clarkston Court. Glasgow (United Kingdom).
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Johnson CF, Liddell K, Guerri C, Findlay P, Thom A. Medicines reconciliation at the community mental health team-general practice interface: quality improvement study. BJPsych Bull 2019; 44:12-18. [PMID: 31288874 DOI: 10.1192/bjb.2019.42] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and methodTo increase the proportion of patients with no psychotropic drug discrepancies at the community mental health team (CMHT)-general practice interface. Three CMHTs participated. Over a 14 month period, quality improvement methodologies were used: individual patient-level feedback to patient's prescribers, run charts and meetings with CMHTs. RESULTS: One CMHT improved medicines reconciliation accuracy and demonstrated significant reductions in prescribing discrepancies. One in three (119/356) patients had ≥1 discrepancy involving 20% (166/847) of all prescribed psychotropics. Discrepancies were graded as: 'fatal' (0%), 'serious' (17%) and 'negligible/minor harm' (83%) but were associated with extra avoidable prescribing costs. For medicines routinely supplied by secondary care, 68% were not recorded in general practice electronic prescribing systems.Clinical implicationsImprovements in medicines reconciliation accuracy were achieved for one CMHT. This may have been partly owing to a multidisciplinary team approach to sharing and addressing prescribing discrepancies. Improving prescribing accuracy may help to reduce avoidable drug-related harms to patients.Declaration of interestNone.
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Godman B, Kurdi A, McCabe H, Johnson CF, Barbui C, MacBride-Stewart S, Hurding S, Leporowski A, Bennie M, Morton A. Ongoing initiatives within the Scottish National Health Service to affect the prescribing of selective serotonin reuptake inhibitors and their influence. J Comp Eff Res 2019; 8:535-547. [DOI: 10.2217/cer-2018-0132] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Aim: Increasing use of selective serotonin-reuptake inhibitors (SSRIs) in Scotland, coupled with safety concerns with some SSRIs, and the increasing availability of generic SSRIs, have resulted in multiple initiatives to improve the quality and efficiency of their prescribing in Scotland. Our aim is to assess their influence to provide future direction. Materials & methods: The prescription costs analysis database was used to document utilization and expenditure on SSRIs between 2001 and 2017 alongside documenting the initiatives. Results: Multiple interventions over the years increased international nonproprietary name prescribing up to 99.9% lowering overall costs. This, coupled with initiatives to limit escitalopram prescribing due to concerns with its value, resulted in a 73.7% reduction in SSRI expenditure between 2001 and 2017 despite a 2.34-fold increase in utilization. Safety warnings resulted in a significant reduction in the prescribing of paroxetine, citalopram and escitalopram alongside a significant increase in sertraline Conclusion: Multiple initiatives have increased the quality and efficiency of SSRI prescribing in Scotland providing direction to others.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy & Biomedicial Sciences, University of Strathclyde, Glasgow, UK
- Division of Clinical Pharmacology, Karolinska, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Pharmacy & Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy & Biomedicial Sciences, University of Strathclyde, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Holly McCabe
- Department of Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, UK
| | - Chris F Johnson
- Prescribing Support Unit, National Health Service Greater Glasgow & Clyde (NHS GGC), Glasgow, UK
| | - Corrado Barbui
- WHO Collaborating Centre for Research & Training in Mental Health & Service Evaluation, Department of Neuroscience, Biomedicine & Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Sean MacBride-Stewart
- Prescribing Support Unit, National Health Service Greater Glasgow & Clyde (NHS GGC), Glasgow, UK
| | - Simon Hurding
- Therapeutics Branch, Scottish Government, Edinburgh, UK
| | - Axel Leporowski
- Department of Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, UK
| | - Marion Bennie
- Strathclyde Institute of Pharmacy & Biomedicial Sciences, University of Strathclyde, Glasgow, UK
| | - Alec Morton
- Department of Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, UK
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Nassr OA, Forsyth P, Johnson CF. Evaluation of discharge prescriptions for secondary prevention in patients with acute coronary syndromes in Iraq. Pharm Pract (Granada) 2019; 17:1372. [PMID: 31015874 PMCID: PMC6463406 DOI: 10.18549/pharmpract.2019.1.1372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/14/2018] [Accepted: 01/27/2019] [Indexed: 11/14/2022] Open
Abstract
Background: Optimal prescribing of secondary prevention medications after acute coronary syndrome (ACS) events has been shown to reduce morbidity and mortality. However, it is unknown whether these medications are optimally prescribed at discharge from acute care in Iraq. Objective: To evaluate whether patients with ACS received optimal secondary prevention medications: antiplatelets, statins, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARBs), and beta-blockers at discharge from a cardiology unit, and to assess whether statins, ACEI/ARBs and beta-blockers were prescribed at target doses based on the American Heart Association/American College of Cardiology (AHA/ACC) guidelines. Methods: Observational retrospective cross-sectional study of patients with ACS admitted to a hospital in Baghdad and survived to discharge between May 2016 and January 2017. Patient-level data and secondary prevention medications at discharge were extracted from routine medical records. Optimal dosing was defined as ≥75%, moderate dosing as 50–74%, and low dosing as <50% of the target dose. Results: 45.6% (200/439) of eligible patients were included in the study who were aged 25 to 90 years (mean 57.8 years) with 78.0% (156/200) being male. Of those included, 84.5% had a myocardial infarction and 15.5% unstable angina, and the length of hospital stay ranged from 1 to 29 days (median 4 days). In total, 53.5% of patients were prescribed all five secondary prevention medications at discharge, and after accounting for contraindications, 60.0% were treated according to AHA/ACC guidelines. The prescription rate of dual antiplatelet therapy, statins, ACEI/ARBs and beta-blockers was 92.5%, 94.5%, 69.5% and 87.0% respectively. Hypertension, diabetes mellitus and the prescription of oral nitrates were associated with the prescription of optimal secondary prevention therapy. Although 80.9% of patients were prescribed target doses of antiplatelets and statins, only 12.2% and 9.2% were prescribed target doses of ACEI/ARBs, and beta-blockers respectively. Conclusions: Approximately one in two patients received the recommended secondary prevention therapy. However, only a minority of patients were prescribed optimal doses of ACEI/ARBs and beta-blockers, in line with guidance. Quality improvement strategies should be implemented, which may include greater involvement of pharmacists within the cardiology multidisciplinary team.
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Affiliation(s)
- Ola A Nassr
- Department of clinical pharmacy, College of Pharmacy, Mustansiriya University. Baghdad, (Iraq).
| | - Paul Forsyth
- Lead Pharmacist for Clinical Cardiology (Primary Care). NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Care Hospital. Glasgow, Scotland (United Kingdom).
| | - Chris F Johnson
- Specialist Mental Health and Prescribing Support Pharmacist Primary Care, Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Care Hospital. Glasgow, Scotland (United Kingdom).
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Johnson CF, Nassr OA, Harpur C, Kenicer D, Thom A, Akram G. Benzodiazepine and z-hypnotic prescribing from acute psychiatric inpatient discharge to long-term care in the community. Pharm Pract (Granada) 2018; 16:1256. [PMID: 30416628 PMCID: PMC6207358 DOI: 10.18549/pharmpract.2018.03.1256] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/21/2018] [Indexed: 01/04/2023] Open
Abstract
Background: Benzodiazepine and z-hypnotic prescribing has slowly decreased over the past 20 years, however long-term chronic prescribing still occurs and is at odds with prescribing guidance. Objectives: To identify the pattern of benzodiazepine and z-hypnotic prescribing in psychiatric inpatients at discharge and 12 months post-discharge. Methods: Retrospective observational longitudinal cohort study of patients admitted to two adult psychiatric wards between June and November 2012 (inclusive) who were discharged with a prescription for a benzodiazepine or z-hypnotic drug. Routinely collected prescription data available from NHS Scotland Prescribing Information System was used to identify and follow community prescribing of benzodiazepine and z-hypnotics for a 12 month period post-discharge. Data were entered in Excel® and further analysed using SPSS 23. Ethical approval was not required for this service evaluation however Caldicott Guardian approval was sought and granted. Results: Eighty patients were admitted during the study period however only those patients with a single admission were included for analysis (n=74). Thirty per cent (22/74) of patients were prescribed a benzodiazepine or z-hypnotics at discharge; 14 of whom received ‘long-term’ benzodiazepine and z-hypnotics i.e. continued use over the 12 month period. Seven patients received a combination of anxiolytics and hypnotics (e.g., diazepam plus temazepam or zopiclone). Long-term use was associated with a non-significant increase in median benzodiazepine or z-hypnotic dose, expressed as diazepam equivalents. Conclusions: One in three patients were prescribed a benzodiazepine or z-hypnotics at discharge with 1 in 5 receiving continuous long-term treatment (prescriptions) for 12 months post-discharge. As chronic long-term B-Z prescribing and use still remains an issue, future strategies using routine patient-level prescribing data may support prescribers to review and minimise inappropriate long-term prescribing.
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Affiliation(s)
- Chris F Johnson
- Specialist Mental Health and Prescribing Support Pharmacist Primary Care, Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Care Hospital. Glasgow (United Kingdom).
| | - Ola Ali Nassr
- College of Pharmacy, Al-Mustansiriya University, Baghdad (Iraq).
| | - Catherine Harpur
- Registrar in Psychiatry. Dykebar Hospital, NHS Greater Glasgow & Clyde. Paisley (United Kingdom).
| | - David Kenicer
- Consultant Psychiatrist. Riverside Community Mental Health Team, NHS Greater Glasgow & Clyde. Glasgow (United Kingdom).
| | - Alex Thom
- Consultant Psychiatrist. Dykebar Hospital, NHS Greater Glasgow & Clyde. Paisley (United Kingdom).
| | - Gazala Akram
- Lecturer and Specialist Psychiatric Pharmacist, Strathclyde Institute of Pharmacy & Biomedical Sciences. University of Strathclyde. Glasgow (United Kingdom).
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11
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Johnson CF, Williams B, MacGillivray SA, Dougall NJ, Maxwell M. 'Doing the right thing': factors influencing GP prescribing of antidepressants and prescribed doses. BMC Fam Pract 2017; 18:72. [PMID: 28623894 PMCID: PMC5473964 DOI: 10.1186/s12875-017-0643-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/05/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Antidepressant prescribing continues to increase, with 5-16% of adults receiving antidepressants annually. Total prescribing growth is due in part to increased long-term use, greater selective serotonin re-uptake inhibitor (SSRI) use and the use of higher SSRI doses. Evidence does not support routine use of higher SSRI doses for depression treatment, and factors influencing the use of such doses are not well known. The aim of this study was to explore factors influencing GPs' use of antidepressants and their doses to treat depression. METHODS Semi-structured interviews with a purposive sample of 28 practising GPs; sampled by antidepressant prescribing volume, practice size and deprivation level. A topic guide drawing on past literature was used with enough flexibility to allow additional themes to emerge. Interviews were audio-recorded and transcribed verbatim. Framework analysis was employed. Constant comparison and disconfirmation were carried out across transcripts, with data collection being interspersed with analysis by three researchers. The thematic framework was then systematically applied to the data and conceptualised into an overarching explanatory model. RESULTS Depression treatment involved ethical and professional imperatives of 'doing the right thing' for individuals by striving to achieve the 'right care fit'. This involved medicalised and non-medicalised patient-centred approaches. Factors influencing antidepressant prescribing and doses varied over time from first presentation, to antidepressant initiation and longer-term treatment. When faced with distressed patients showing symptoms of moderate to severe depression GPs were confident prescribing SSRIs which they considered as safe and effective medicines, and ethically and professionally appropriate. Many GPs were unaware that higher doses lacked greater efficacy and onset of action occurred within 1-2 weeks, preferring to wait 8-12 weeks before increasing or switching. Ongoing pressures to maintain prescribing (e.g. fear of depression recurrence), few perceived continuation problems (e.g. lack of safety concerns) and lack of proactive medication review (e.g. patients only present in crisis), all combine to further drive antidepressant prescribing growth over time. CONCLUSIONS GPs strive to 'do the right thing' to help people. Antidepressants are only a single facet of depression treatment. However, increased awareness of drug limitations and regular proactive reviews may help optimise care.
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Affiliation(s)
- Chris F. Johnson
- Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, 2nd Floor, Main Building, West Glasgow Ambulatory Care Hospital, Dalnair Street, Yorkhill, Glasgow, G3 8SJ UK
| | - Brian Williams
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh, EH11 4BN UK
| | - Stephen A. MacGillivray
- School of Nursing and Health Sciences, University of Dundee, Airlie Place, Dundee, DD1 4HN UK
| | - Nadine J. Dougall
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh, EH11 4BN UK
| | - Margaret Maxwell
- Nursing Midwifery and Allied Health Professionals Research Unit, University of Stirling, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF UK
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12
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Johnson CF, Dougall NJ, Williams B, MacGillivray SA, Buchanan AI, Hassett RD. Patient factors associated with SSRI dose for depression treatment in general practice: a primary care cross sectional study. BMC Fam Pract 2014; 15:210. [PMID: 25540076 PMCID: PMC4341873 DOI: 10.1186/s12875-014-0210-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 12/12/2014] [Indexed: 11/10/2022]
Abstract
Background Antidepressant prescribing continues to rise. Increased long-term prescribing and higher doses are contributing to current growth; however, patient factors associated with the use of higher doses remain unknown. This study’s aim was to investigate patient factors associated with selective serotonin re-uptake inhibitor (SSRI) prescribed daily dose for depression treatment in general practice. Methods A stratified sample of low to high prescribing practices were selected. Routine individual patient-level data were extracted one practice at a time: September 2009 to January 2011. Patients included were ≥18 years, and prescribed an SSRI for depression. Logistic regression analysis was undertaken to assess individual predictor variables on SSRI daily dose by standard therapeutic dose versus higher dose, as SSRIs demonstrate flat dose response curves for depression treatment. Predictor variables included: age, gender, deprivation, co-morbidity, smoking status, being prescribed the same SSRI for ≥2 years, and patients’ general practice. For a subgroup of patients a second sub-group analysis included long-term benzodiazepine and/or z-hypnotic (B&Z) as a predictor variable. Results Inter-practice SSRI prescribing varied significantly; practice point prevalence ranged from 2.5% (94/3697) to 11.9% (359/3007) of the practice population ≥18 years old; median 7.3% (250/3421) (χ2 = 2277.2, df = 10, p < 0.001). Overall point prevalence was 6.3% (3518/52575), with 5.8% (3066/52575) prescribed SSRIs for depression of whom 84.7% (2596/3066) had data for regression analysis. Higher SSRI doses were significantly associated with, in descending order of magnitude, individual practice attended, being prescribed the same SSRI for ≥2 years (Odds Ratio (OR) 1.80, 95% CI 1.49 to 2.17, p < 0.001) and living in a more deprived area (OR 1.55, 95% CI 1.11 to 2.16, p = 0.009). Higher SSRI doses in the B&Z subgroup were significantly associated with individual practice attended, being prescribed a long-term B&Z (OR 2.05 95% CI 1.47 to 2.86, p < 0.001) and being prescribed the same SSRI for ≥2 years (OR 1.94, 95% CI 1.53 to 2.47, p < 0.001). Conclusion Higher SSRI doses for depression were associated with practice attended and being prescribed the same antidepressant for ≥2 years. As long-term antidepressant use increases, the use of higher doses may further contribute to prescribing growth. Electronic supplementary material The online version of this article (doi:10.1186/s12875-014-0210-9) contains supplementary material, which is available to authorized users.
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13
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Affiliation(s)
- C F Johnson
- Ohio State University, Children's Hospital, Columbus 43205, USA.
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14
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Abstract
A 7-year-old, female with mental retardation and seizure disorder was admitted with burns. Reportedly, her brother who was 12 years old was cooking dinner for himself. A towel caught fire. He threw the towel over his head, and the patient's diaper ignited. She had partial thickness second-degree burns over her right elbow, upper abdomen, both inner thighs, and buttocks with multiple blistering, which was estimated to be 7% of the total body surface. The child abuse team took a diaper similar to the one the child was wearing at the time of injury and found that it easily ignited and melted in several seconds. This is the first medically reported burn case due to a disposable diaper.
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Affiliation(s)
- C F Johnson
- Child Abuse Program, Columbus Children's Hospital, OH 43205, USA.
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15
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Lentsch KA, Johnson CF. Do physicians have adequate knowledge of child sexual abuse? The results of two surveys of practicing physicians, 1986 and 1996. Child Maltreat 2000; 5:72-78. [PMID: 11232066 DOI: 10.1177/1077559500005001009] [Citation(s) in RCA: 20] [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: 05/23/2023]
Abstract
The objective of this study was to to determine if physician knowledge of and biases regarding child sexual abuse (CSA) have changed since 1986. A questionnaire, previously used in 1986, was mailed to 370 physicians who see children in Columbus, Ohio. More respondents in 1996 correctly denied an association between specific sociologic factors and the likelihood of CSA. Seventy-two percent of physicians indicated that they check the genitalia of prepubescent females more than 50% of the time, versus 77% in 1986. Physicians who see more than 25 pediatric patients per week were significantly more likely to check the genitalia (p < .001), whereas physicians with more than 10 years experience were less likely to check genitalia (p < .05). Physicians surveyed in 1996 were more knowledgeable about socioeconomic and behavioral aspects of CSA but continued to be deficient in identifying prepubescent female genital anatomy and in reporting suspected abuse. Education is necessary to correct these deficits.
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Affiliation(s)
- K A Lentsch
- Ohio State University College of Medicine, USA
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16
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Kairys SW, Alexander RC, Block RW, Everett VD, Hymel KP, Johnson CF, Kanda MB, Malinkovich P, Bell WC, Cora-Bramble D, DuPlessis HM, Handal GA, Holmberg RE, Lavin A, Tayloe DT, Varrasso DA, Wood DL. American Academy of Pediatrics. Committee on Child Abuse and Neglect and Committee on Community Health Services. Investigation and review of unexpected infant and child deaths. Pediatrics 1999; 104:1158-60. [PMID: 10545567] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Although there is a continuing need for timely review of child deaths, no uniform system exists for investigation in the United States. Investigation of a death that is traumatic, unexpected, obscure, suspicious, or otherwise unexplained in a child younger than 18 years requires a scene investigation and an autopsy. Review of these deaths requires the participation of pediatricians and other professionals, usually as a child death review team. An appropriately constituted team should evaluate the death investigation process, review difficult cases, and compile child death statistics.
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17
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Abstract
A survey of: 1) sources of perceived stress, 2) stress management, and 3) burnout among members of the American Academy of Pediatrics Sections on Child Abuse and Emergency Medicine indicates that child abuse physicians are stressed by the history, physical examination, and court appearances in abuse cases. Rarely did physicians indicate that this stress adversely affected their sexual life or family life. Both groups considered courtroom appearances most stressful. Both groups claimed to recognize their stressors and use a variety of approaches to decrease stress. Formal training in child maltreatment was unusual among Abuse Section members, whereas Emergency Section members tended to receive this training in Fellowships. Emergency Medicine Section members reported increased perceived levels of stress. Despite recognition of stress, there was no indicated desire to leave either specialty before an average of 11 to 15 years. Emergency Medicine Section members indicated that 5% of their patients are abused. It is important that emergency medicine residency programs include child abuse education. Formal training programs for individuals who wish to limit their practice to child abuse are needed. Stressors need to be recognized and appropriately managed. Stress recognition and management techniques that have been shown to be effective should be taught and used, beginning in medical school and continuing throughout medical practice. This is necessary if the highest quality of professional personal and patient care is to be maintained.
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Affiliation(s)
- C F Johnson
- Child Abuse Program, Children's Hospital, Columbus, Ohio 43205, USA
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18
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McLeod DG, Johnson CF, Klein E, Peabody JO, Coffield S, Soloway M. PSA levels and the rate of positive surgical margins in radical prostatectomy specimens preceded by androgen blockade in clinical B2 (T2bNxMo) prostate cancer. The Lupron Depot Neoadjuvant Study Group. Urology 1997; 49:70-3. [PMID: 9123740 DOI: 10.1016/s0090-4295(97)00172-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Neoadjuvant hormonal therapy reduces positive margins in patients undergoing radical prostatectomy. All patients experience a decrease in serum prostate specific antigen (PSA), but not always to a level that is nondetectable. The results of several prospective, randomized trials indicate that the incidence of positive margins decreases with the use of androgen deprivation prior to radical prostatectomy. It has been suggested that a greater decline in PSA levels would result in fewer positive margins. In a recent US trial of patients with T2bNxMO prostate cancer, we reported that 18% of patients randomized to receive 3 months of leuprolide acetate and flutamide had positive margins, compared to 48% of those who had radical prostatectomy alone (P < 0.001). We correlated the PSA levels prior to and following androgen deprivation and the presence of a positive margin following radical prostatectomy (RP). METHODS One hundred and thirty-seven of 149 patients randomized to receive presurgery androgen deprivation (AD) underwent radical prostatectomy. Of these, 135 had a PSA level obtained both prior to androgen deprivation and prior to surgery. We analyzed the percent positive margins in patients whose PSA values became undetectable and in those whose values remained above 0.1 ng/mL despite androgen deprivation. RESULTS Eight of 43 patients (19%) with a nadir PSA < or = 0.1 ng/mL had a positive surgical margin and 16/92 (17%) with a nadir PSA > 0.1 ng/mL had tumor at the margin. There were no statistical differences in these two groups (P = 1.0 by Fisher's Exact Test [two-tailed], and the Pearson correlation was -0.015). CONCLUSIONS There was no correlation between an undetectable PSA and a PSA > 0.1 ng/mL and the presence of tumor at the margin when 3 months of AD was given prior to RP. It is possible that longer periods of AD prior to RP will reduce PSA to an undetectable level in a higher percent of patients. However, these data suggest that an undetectable level will not result in less positive margins.
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Affiliation(s)
- D G McLeod
- Walter Reed Army Medical Center, Washington, D.C. 20307, USA
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19
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Johnson CF, Brown CS, Wheeler RM, Sager JC, Chapman DK, Deitzer GF. Infrared light-emitting diode radiation causes gravitropic and morphological effects in dark-grown oat seedlings. Photochem Photobiol 1996; 63:238-42. [PMID: 11536734 DOI: 10.1111/j.1751-1097.1996.tb03020.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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] [Indexed: 11/29/2022]
Abstract
Oat (Avena sativa cv Seger) seedlings were irradiated with IR light-emitting diode (LED) radiation passed through a visible-light-blocking filter. Infrared LED irradiated seedlings exhibited differences in growth and gravitropic response when compared to seedlings grown in darkness at the same temperature. Thus, the oat seedlings in this study were able to detect IR LED radiation. These findings call into question the use of IR LED as a safe-light for some photosensitive plant response experiments. These findings also expand the defined range of wavelengths involved in radiation-gravity (light-gravity) interactions to include wavelengths in the IR region of the spectrum.
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Affiliation(s)
- C F Johnson
- Dynamac Corporation, Kennedy Space Center, FL, USA
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20
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Johnson CF, Dreschel TW, Brown CS, Wheeler RM. Optimization of moisture content for wheat seedling germination in a cellulose acetate medium for a space flight experiment. Adv Space Res 1996; 18:239-242. [PMID: 11538804 DOI: 10.1016/0273-1177(95)00883-g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The Porous Tube Plant Nutrient Delivery System (PTPNDS), a hydrophilic, microporous ceramic tube hydroponic system designed for microgravity, will be tested in a middeck locker of the Space Shuttle. The flight experiment will focus on hardware operation and assess its ability to support seed germination and early seedling growth in microgravity. The water controlling system of the PTPNDS hardware has been successfully tested during the parabolic flight of the KC-135. One challenge to the development of the space flight experiment was to devise a method of holding seeds to the cylindrical porous tube. The seed-holder must provide water and air to the seed, absorb water from the porous tube, withstand sterilization, provide a clear path for shoots and roots to emerge, and be composed of flight qualified materials. In preparation for the flight experiment, a wheat seed-holder has been designed that utilizes a cellulose acetate plug to facilitate imbibition and to hold the wheat seeds in contact with the porous tube in the correct orientation during the vibration of launch and the microgravity environment of orbit. Germination and growth studies with wheat at a range of temperatures showed that optimal moisture was 78% (by weight) in the cellulose acetate seed holders. These and other design considerations are discussed.
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Affiliation(s)
- C F Johnson
- Dynamac Corporation, Kennedy Space Center, FL 32899, USA
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21
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Brawn PN, Kuhl D, Speights VO, Johnson CF, Lind M. The incidence of unsuspected metastases from clinically benign prostate glands with latent prostate carcinoma. Arch Pathol Lab Med 1995; 119:731-3. [PMID: 7646331] [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: 01/26/2023]
Abstract
OBJECTIVE To determine how many latent prostate gland carcinomas (unsuspected carcinomas in clinically benign prostate glands) metastasize. DESIGN The prostate glands and the pelvic and paraaortic lymph nodes were removed at autopsy from 209 consecutive patients with clinically benign prostate glands. The prostate glands were completely sectioned and examined microscopically using full cross sections. Pelvic and para-aortic lymph nodes were identified and examined microscopically for metastases. RESULTS Seventy-nine (38%) of the prostate glands had latent prostate carcinomas. None of the pelvic or paraaortic lymph nodes contained metastases. CONCLUSION This study suggests that few latent prostate-gland carcinomas metastasize.
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Affiliation(s)
- P N Brawn
- Department of Pathology, Veterans Administration Medical Center, University of Michigan, Ann Arbor 48105, USA
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22
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Abstract
The coin-operated-locker baby is a type of child abuse that may be unique to Japan. The term refers to newborns who are placed, while alive or dead, in coin-operated lockers. This practice has been decreased by specific measures. It is likely that social and economic variables in Japan account for differences in the frequency and types of child abuse cases when compared to American or European societies as social conditions in Japan change the reported incidence of child abuse may increase in the future. Recently, the government of Osaka organized a group specifically designed to deal with the detection and protection of abused and neglected children. In 1993, they published a manual on how to deal with child abuse, but the Japanese judicial administration still uses old laws for abuse cases. The development of new laws is occurring in parts of the country now. This paper introduces the present status of coping with child abuse and neglect in Japan.
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Affiliation(s)
- A Kouno
- Medical Examiner of Osaka Prefecture, Osaka Medical Examiner's Office, Japan
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23
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French GM, Johnson CF. Bites in the night: determining the etiology of bite marks on an infant. Pediatr Emerg Care 1994; 10:281-3. [PMID: 7845855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- G M French
- Department of Behavioral and Developmental Pediatrics Children's Hospital, Ohio State University, Columbus 43205
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24
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Affiliation(s)
- C F Johnson
- Ohio State University College of Medicine, Columbus
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25
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Affiliation(s)
- G M French
- Department of Behavioral and Developmental Pediatrics, Children's Hospital, Ohio State University, Columbus 43205
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26
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Abstract
Variables that affect the propensity to report medical neglect were surveyed among 52 physicians on the staff of a pediatric hospital. Death was one of the 52 potential consequences of neglect listed for 7 of the 46 diseases analyzed. The time allotted before neglect would be considered varied with the stage and seriousness of the disease. Caretakers were less likely to be considered neglectful if the symptoms of the disease were minor, not obvious, or required technical sophistication for recognition. The number of acceptable reasons for missing appointments varied. The natural course of the disease process, efficacy and safety of treatment, parents' religion, intellectual level, and economic situation affected neglect reporting propensity. Definitions of medical neglect for common diseases must be standardized. Training of lay caretakers of ill children and communication of clear and reasonable expectations are necessary to help prevent medical neglect.
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Affiliation(s)
- C F Johnson
- Child Abuse Program, Children's Hospital, Columbus, OH 43205
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27
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Abstract
BACKGROUND Black men are known to have a higher incidence and mortality from prostate carcinoma than white men and are more likely to have a more advanced stage or grade of disease diagnosed. METHODS In a Veterans Administration Medical Center where black and white men have the same eligibility for medical care, the authors reviewed the stage at presentation of 861 consecutive cases of prostate carcinoma diagnosed from 1969-1990. In addition, survival, stratified by race, stage, and grade, was determined on all men in whom prostate cancer was diagnosed from 1969-1985 (525 patients). RESULTS It was found that 26% of white and 52% of black men with prostate carcinoma presented with Stage D disease. Similar proportions of white and black men with prostate carcinoma presented with Stage D disease between 1969-73 as between 1986-90. The overall survival was poorer for black men because of their higher proportion of Stage D disease, but stratified for grade and stage, survival was similar in both races. CONCLUSIONS This study suggests that factors other than eligibility for medical care may be responsible for the higher proportion of black men with prostate carcinoma presenting with Stage D prostate carcinoma.
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Affiliation(s)
- P N Brawn
- Department of Pathology, Veterans Administration Medical Center, Ann Arbor 48105
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28
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Schonfeld AD, Jackson JA, Somerville SP, Johnson CF, Anderson PW. Renin-secreting juxtaglomerular tumor causing severe hypertension: diagnosis by computerized tomography-directed needle biopsy. J Urol 1991; 146:1607-9. [PMID: 1942353 DOI: 10.1016/s0022-5347(17)38182-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Renin-secreting tumors are a rare cause of severe hypertension accompanied by hypokalemia. Typically, these tumors have been difficult to diagnose preoperatively by standard radiographic and hormonal studies. We describe a 44-year-old man who was hospitalized for paroxysmal hypertension and who had a 2.3 cm. mid upper pole renal mass on sonography. Computerized tomography-directed needle biopsy revealed a juxtaglomerular tumor and surgical excision of the tumor was curative. We discuss the unique diagnostic aspects of this case.
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Affiliation(s)
- A D Schonfeld
- Department of Medicine, Scott and White Clinic, Temple, Texas 76508
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29
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Johnson CF. Prolapse of the urethra: confusion of clinical and anatomic characteristics with sexual abuse. Pediatrics 1991; 87:722-5. [PMID: 2020521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- C F Johnson
- Child Abuse Program, Children's Hospital, Columbus, OH 43205
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30
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Abstract
The morbidity and mortality that are associated with child abuse is a serious concern for the practicing pediatrician. If abuse is to be prevented, physicians must become skilled in recognizing factors that place a child at risk for abuse. Early and minor signs of abuse and neglect must be recognized and reported to assure services if more serious abuse and neglect are to be prevented. Instruments that are used to strike children or burn them leave their imprint on the child. Marks on the skin may signal the existence of internal injuries. Nonaccidental injuries may be difficult to distinguish from accidental injuries. Physicians must approach an injury as a symptom requiring a diagnosis of cause. This is best accomplished by careful examination and documentation of each injury. If the injury is not in keeping with the history given or the child's level of development, abuse must be considered as a cause. A suspicion of abuse should result in a report.
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Affiliation(s)
- C F Johnson
- Ohio State University, College of Medicine, Columbus
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31
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Morris DA, Johnson CF. The role of auxin efflux carriers in the reversible loss of polar auxin transport in the pea (Pisum sativum L.) stem. Planta 1990; 181:117-124. [PMID: 24196683 DOI: 10.1007/bf00202333] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/1989] [Accepted: 10/27/1989] [Indexed: 06/02/2023]
Abstract
Correlatively inhibited pea shoots (Pisum sativum L.) did not transport apically applied (14)C-labelled indol-3yl-acetic acid ([(14)C]IAA), and polar IAA transport did not occur in internodal segments cut from these shoots. Polar transport in shoots and segments recovered within 24 h of removing the dominant shoot apex. Decapitation of growing shoots also resulted in the loss of polar transport in segments from internodes subtending the apex. This loss was prevented by apical applications of unlabelled IAA, or by low temperatures (approx. 2° C) after decapitation. Rates of net uptake of [(14)C]IAA by 2-mm segments cut from subordinate or decapitated shoots were the same as those in segments cut from dominant or growing shoots. In both cases net uptake was stimulated to the same extent by competing unlabelled IAA and by N-1-naphthylphthalamic acid. Uptake of the pH probe [(14)C]-5,5-dimethyloxazolidine-2,4-dione from unbuffered solutions was the same in segments from both types of shoot. Patterns of [(14)C]IAA metabolism in shoots in which polar transport had ceased were the same as those in shoots capable of polar transport. The reversible loss of polar IAA transport in these systems, therefore, was not the result of loss or inactivation of specific IAA efflux carriers, loss of ability of cells to maintain transmembrane pH gradients, or the result of a change in IAA metabolism. Furthermore, in tissues incapable of polar transport, no evidence was found for the occurrence of inhibitors of IAA uptake or efflux. Evidence is cited to support the possibility that the reversible loss of polar auxin transport is the result of a gradual randomization of effluxcarrier distribution in the plasma membrane following withdrawal of an apical auxin supply and that the recovery of polar transport involves reestablishment of effluxcarrier asymmetry under the influence of vectorial gradients in auxin concentration.
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Affiliation(s)
- D A Morris
- Department of Biology, Building 44, The University, SO9 5NH, Southampton, UK
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Abstract
During one year, four (6.5%) of the 61 children who were hospitalized for burns at a children's hospital sustained their injuries in a walker. Records from a total of nine children hospitalized with walker burns were compared to those from other hospitalized burned children. Patients who were burned while in a walker had a greater body surface area burned (11.6%) than those with burns from abuse (1.7%), neglect (2.5%), or other accidents (6.2%). A higher percentage of males were burned, and the burn patterns differed among all four groups. Seven of the nine walker burns resulted from scalds, with three scalds from hot grease. Walker-related burn patients required more physical or occupational therapy and a longer mean hospital stay. Social histories of infants with walker and other accidental burns differed from those associated with abuse or neglect. Walkers expose infants to unnecessary hazards, including potentially serious burns; their use should be discouraged.
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Affiliation(s)
- C F Johnson
- Department of Pediatrics, Ohio State University, Columbus
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Abstract
The authors reviewed the abuse reports submitted by the staff of The Children's Hospital, Columbus, Ohio, to determine the incidence and types of injuries inflicted to children's hands. The authors did not study hand injuries in children who were not reported as physically abused. The authors examined two time periods to ascertain changes injury severity. Of the 631 abuse reports submitted from 1980 to 1982, there were 52 injuries (8.2%) involving the hands. From July 1987 to July 1988 there were 42 hand injuries (13.4%) among 313 reports. In the 94 total cases, 19 (2%) children sustained injury to the hand only, including eight with burns, two with bruises, two with human bites, two with erythema, two with fractures, and one with a laceration. Children with burns to the hand alone were significantly younger than those with other types of injuries. Of the 94 children with hand and other injuries, 18 (20%) required hospital admission. Of the 19 with injuries to the hand only, five required hospital admission. A variety of instruments were used to injure these children. The hand is a delicate organ, and it is frequently the primary or incidental target of child abuse. Familiarity with the patterns and types of hand injury suffered in child abuse is essential for early recognition, reporting, and child protection.
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Affiliation(s)
- C F Johnson
- Department of Pediatrics and Psychology, Children's Hospital, Ohio State University, Columbus 43205
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Johnson CF. Intentional banding. Pediatrics 1989; 83:1077-8. [PMID: 2726344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Johnson CF, Morris DA. Applicability of the chemiosmotic polar diffusion theory to the transport of indol-3yl-acetic acid in the intact pea (Pisum sativum L.). Planta 1989; 178:242-248. [PMID: 24212754 DOI: 10.1007/bf00393200] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/1988] [Accepted: 02/01/1989] [Indexed: 06/02/2023]
Abstract
The transport of exogenous indol-3yl-acetic acid (IAA) from the apical tissues of intact, light-grown pea (Pisum sativum L. cv. Alderman) shoots exhibited properties identical to those associated with polar transport in isolated shoot segments. Transport in the stem of apically applied [1-(14)C]-or [5-(3)H]IAA occurred at velocities (approx. 8-15 mm·h(-1)) characteristic of polar transport. Following pulse-labelling, IAA drained from distal tissues after passage of a pulse and the rate characteristics of a pulse were not affected by chases of unlabelled IAA. However, transport of [1-(14)C]IAA was inhibited through a localised region of the stem pretreated with a high concentration of unlabelled IAA or with the synthetic auxins 1-napthaleneacetic acid and 2,4-dichlorophenoxyacetic acid, and label accumulated in more distal tissues. Transport of [1-(14)C]IAA was also completely prevented through regions of the intact stem treated with N-1-naphthylphthalamic acid (NPA) and 2,3,5-triiodobenzoic acid.Export of IAA from the apical bud into the stem increased with total concentration of IAA applied (labelled+unlabelled) but approached saturation at high concentrations (834 mmol·m(-3)). Transport velocity increased with concentration up to 83 mmol·m(-3) IAA but fell again with further increase in concentration.Stem segments (2 mm) cut from intact plants transporting apically applied [1-(14)C]IAA effluxed 93% of their initial radioactivity into buffer (pH 7.0) in 90 min. The half-time for efflux increased from 32.5 to 103.9 min when 3 mmol·m(-3) NPA was included in the efflux medium. Long (30 mm) stem sections cut from immediately below an apical bud 3.0 h after the apical application of [1-(14)C]IAA effluxed IAA when their basal ends, but not their apical ends, were immersed in buffer (pH 7.0). Addition of 3 mmol·m(-3) NPA to the external medium completely prevented this basal efflux.These results support the view that the slow long-distance transport of IAA from the intact shoot apex occurs by polar cell-to-cell transport and that it is mediated by the components of IAA transmembrane transport predicted by the chemiosmotic polar diffusion theory.
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Affiliation(s)
- C F Johnson
- Department of Biology, The University, Building 44, S09 5NH, Southampton, UK
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Abstract
The use of nursing diagnosis by staff nurses in a 225-bed metropolitan hospital was examined. The sample consisted of 82 newly hired nurses who had participated in a mandated staff development program on nursing process theory and use of nursing diagnosis, with an emphasis on transfer of knowledge to practice. The data collected included demographic information, attitudes concerning nursing diagnosis, pretest and posttest scores, and percent completed on the audits of chart documentation. A cross-tabulation by clinical arena was performed on the forms used to document utilization of nursing diagnosis. Analysis of the data indicated that a greater proportion of the charts for the nurses in the maternal/child clinical arena evidenced use of nursing diagnosis as a component of practice. The nurses in the critical care arena scored slightly lower. The nurses in the medical/surgical arena had the lowest compliance of both completion and utilization of nursing diagnosis. This study demonstrated that nurses can be taught to use nursing diagnosis in the clinical setting.
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Abstract
Bands around extremities may be from congenital, infectious, accidental, or purposeful causes. The older child may reveal the cause of self-inflicted or caregiver-inflicted banding. Banding in a nonverbal child will challenge the diagnostic acumen of the physician. Bands of unknown cause, or bands that may have been placed purposefully by a caretaker, must be reported as possible child abuse. Failure of the caretaker to seek help for the consequences of a band may suggest that the bands were intentionally placed. This failure may also be construed as medical neglect. Four cases of banding, which were referred to a child abuse program for consultation, are described.
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Affiliation(s)
- C F Johnson
- Ohio State University College of Medicine, Child Abuse Program, Children's Hospital, Inc., Columbus 43205
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38
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Abstract
Computed tomography (CT) permitted preoperative diagnosis of traumatic rupture of a congenital hydronephrotic renal pelvis. In cases in which renal pelvic rupture is suspected CT may obviate traditional cystoscopy and retrograde pyelography.
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Affiliation(s)
- R Gary
- Department of Urology, St. Paul-Ramsey Medical Center, Minnesota
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Morris DA, Johnson CF. Regulation of auxin transport in pea (Pisum sativum L.) by phenylacetic acid: inhibition of polar auxin transport in intact plants and stem segments. Planta 1987; 172:408-16. [PMID: 24225926 DOI: 10.1007/bf00398671] [Citation(s) in RCA: 14] [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] [Received: 03/12/1987] [Accepted: 04/24/1987] [Indexed: 05/26/2023]
Abstract
The transport of [(14)C]phenylacetic acid (PAA) in intact plants and stem segments of light-grown pea (Pisum sativum L. cv. Alderman) plants was investigated and compared with the transport of [(14)C]indiol-3yl-acetic acid (IAA). Although PAA was readily taken up by apical tissues, unlike IAA it did not undergo long-distance transport in the stem. The absence of PAA export from the apex was shown not to be the consequence of its failure to be taken up or of its metabolism. Only a weak diffusive movement of PAA was observed in isolated stem segments which readily transported IAA. When [1-(14)C]PAA was applied to a mature foliage leaf in light, only 5.4% of the (14)C recovered in ethanol extracts (89.6% of applied (14)C) had been exported from the leaf after 6.0 h. When applied to the corresponding leaf, [(14)C]sucrose was readily exported (46.4% of the total recovered ethanol-soluble (14)C after 6.0 h). [1-(14)C]phenylacetic acid applied to the root system was readily taken up but, after 5.0 h, 99.3% of the recovered (14)C was still in the root system.When applied to the stem of intact plants (either in lanolin at 10 mg·g(-1), or as a 10(-4) M solution), unlabelled PAA blocked the transport through the stem of [1-(14)C]IAA applied to the apical bud, and caused IAA to accumulate in the PAA-treated region of the stem. Applications of PAA to the stem also inhibited the basipetal polar transport of [1-(14)C]IAA in isolated stem segments. These results are consistent with recent observations (C.F. Johnson and D.A. Morris, 1987, Planta 172, 400-407) that no carriers for PAA occur in the plasma membrane of the light-grown pea stem, but that PAA can inhibit the carrier-mediated efflux of IAA from cells. The possible functions of endogenous PAA are discussed and its is suggested that an important role of the compound may be to modulate the polar transport and-or accumulation by cells of IAA.
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Affiliation(s)
- D A Morris
- Department of Biology, The University, Building 44, SO9 5NH, Southampton, UK
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Johnson CF, Morris DA. Regulation of auxin transport in pea (Pisum sativum L.) by phenylacetic acid: effects on the components of transmembrane transport of indol-3yl-acetic acid. Planta 1987; 172:400-407. [PMID: 24225925 DOI: 10.1007/bf00398670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/1987] [Accepted: 04/24/1987] [Indexed: 06/02/2023]
Abstract
Phenylacetic acid (PAA), a naturally-occurring acidic plant growth substance, was readily taken up by pea (Pisum sativum L. cv. Alderman) stem segments from buffered external solutions by a pH-dependent, non-mediated diffusion. Net uptake from a 0.2 μM solution at pH 4.5 proceeded at a constant rate for at least 60 min and, up to approx. 100 μM, the rate of uptake was directly proportional to the external concentration of the compound. The net rate of uptake of PAA was not affected by the inclusion of indol-3yl-acetic acid (IAA) in the uptake medium (up to approx. 30 μM) and, unlike the net uptake of IAA, was not stimulated by N-1-naphthylphthalamic acid (NPA) or 2,3,5-triiodobenzoic acid. At an external concentration of 0.2 μM and pH 4.5, the net rate of uptake of PAA was about twice that of IAA. It was concluded that the uptake of PAA did not involve the participation of carriers and that PAA was not a transported substrate for the carriers involved in the uptake and polar transport of IAA. Nevertheless, the inclusion of 3-100 μM unlabelled PAA in the external medium greatly stimulated the uptake by pea stem segments of [1-(14)C]IAA (external concentration 0.2 μM). It was concluded that whilst PAA was not a transported substrate for the NPA-sensitive IAA efflux carrier, it interacted with this carrier to inhibit IAA efflux from cells. Over the concentration range 3-100 μM, PAA progressively reduced the stimulatory effect of NPA on IAA uptake, indicating that PAA also inhibited carrier-mediated uptake of IAA. The consequences of these observations for the regulation of polar auxin transport are discussed.
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Affiliation(s)
- C F Johnson
- Department of Biology, The University, Building 44, S09 5NH, Southampton, UK
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Abstract
The dramatic increase in the incidence of reports of sexual abuse has placed demands on physicians to assess children for possible sexual abuse. We conducted a survey of urban pediatricians to determine their knowledge of and attitudes about sexual abuse. These physicians were found to have limited knowledge about the social and medical aspects of sexual abuse. The lack of knowledge these physicians display about prepubescent female anatomy and about the association of venereal diseases with sexual abuse decreases their recognition and reporting of sexual abuse. There is a need for physicians to improve their knowledge and skills in the diagnosis of sexual abuse if further abuse and its serious consequences are to be minimized.
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Brawn PN, Johnson CF. The metastatic potential of prostate carcinomas composed entirely of single malignant glands. Virchows Arch A Pathol Anat Histopathol 1987; 411:399-402. [PMID: 3116753 DOI: 10.1007/bf00735219] [Citation(s) in RCA: 5] [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: 01/04/2023]
Abstract
Consecutive staging lymphadenectomies on 1046 patients with prostate carcinoma identified 275 patients with metastases in a total of 1115 regional lymph nodes. No prostate carcinomas composed entirely of single malignant glands metastasized and no patient had metastases composed entirely of single malignant glands. All prostate carcinomas that metastasized had cribriform and/or undifferentiated histological patterns in the prostate and in the metastases. These findings suggest that identification of cribriform and/or undifferentiated histological patterns, through rebiopsy or further examination of the surgical specimen, should be considered prior to subjecting patients with prostate carcinomas composed entirely of single malignant glands to therapy or procedures directed against the possibility of metastatic disease.
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Affiliation(s)
- P N Brawn
- Texas A&M University School of Medicine, Olin E. Teague Veterans' Medical Center, Temple 76501
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Abstract
Failure to uncover and report nonaccidental injury may have serious consequences for the child and the physician. To determine if the information recorded in the emergency department record was adequate to eliminate the possibility of nonaccidental injury, the charts of 333 children under five years of age were reviewed. No charts contained all the information deemed necessary; in 12.6% a diagnosis of nonaccidental injury could not be eliminated. In three cases, the injury was inconsistent with the history. Missing historical information included where the injury occurred, the presence of witnesses, notation of previous injuries, and old chart review. Information regarding size, color, and age of the injury was incomplete. A complete examination was recorded 22.3% of the time. The private-pay category charts and those recorded by staff were most complete. Remedial actions, guided by periodic chart reviews, are suggested.
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Showers J, Johnson CF. Child development, child health and child rearing knowledge among urban adolescents: are they adequately prepared for the challenges of parenthood? Health Educ 1985; 16:37-41. [PMID: 3939948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
A great variety of self-inflicted foreign bodies have been removed from the lower urinary tract and male external genitalia. These foreign bodies were inserted or applied for autoerotic, psychiatric, therapeutic, or no definite reasons by the patient. Most patients were too ashamed to admit they had inserted or applied any object and usually presented when a complication had occurred from the foreign body such as difficulty voiding, hematuria, pain or swelling, extravasation, or abscess formation. Inspection and palpation diagnosed foreign bodies involving the male external genitalia in 3 patients and anterior urethra in 6. Radiographic studies with and without contrast medium and endoscopy were required to diagnose foreign bodies in the posterior urethra and bladder in 9 patients, and the exact location, shape, and orientation of the foreign bodies in all sites, radiolucent objects, and the complications of mucosal laceration and extravasation. All 16 foreign bodies in the anterior urethra (below urogenital diaphragm) were removed by endoscopic manipulation in the 6 patients. Nine foreign bodies in the posterior urethra or bladder (above the urogenital diaphragm) were removed by endoscopic manipulation in 2 females and 2 males, while suprapubic cystostomy was required in 1 female and 4 males. The 3 foreign bodies applied to the external genitalia of 3 males were removed carefully to avoid injury to the underlying skin. Foreign bodies lying below the urogenital diaphragm were palpable and readily removed endoscopically while foreign bodies above the urogenital diaphragm required greater endoscopic manipulation or open surgical procedures.
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Abstract
Children born with myelomeningocele face the morbidity of urinary tract complications after they have survived the neurologic complications of the first years of life. The incidence of urinary tract complications was evaluated in 258 children before any operation or intermittent catheter management was performed. In 119 children under one year of age the incidence of urinary tract infection of more than 10(5) colonies was 23 per cent, reflux was 22 per cent, and upper tract dilatation was 6 per cent. In children of all ages the incidence of urinary tract infection of more than 10(5) colonies was 26 per cent, reflux 34 per cent, upper tract dilatation 18 per cent, and urinary incontinence 87 per cent. In 11 children with complete denervation of the pelvic floor muscles reflux developed in 2 (18%) and upper tract dilatation in 1 (9%). In 13 children with slight or moderate denervation of the pelvic floor muscles reflux developed in 5 (38%) and upper tract dilatation in 7 (54%). The development of upper tract changes with myelomeningocele was mainly related to some innervation of the pelvic floor muscles (including periurethral striated muscle) with incoordinate detrusor/sphincter activity. These changes mainly occurred in the first two to four years of life.
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Abstract
Interviews were conducted with 58 physicians to ascertain what factors influenced their reporting of child abuse. When physicians were presented with sample cases of injured children, factors that influenced their decision to report suspected abuse included their attitudes toward physical discipline, seriousness of the injury, presence of other injuries, their familiarity with the family, appropriate parental concern, compatibility of the history and physical examination findings, and the child's behavior. Results indicated that inappropriate discipline was usually not equated with reportable child abuse. Physicians believed that abuse is not often reported because of its low incidence in the private practice setting, the fear of losing patients, the need for certainty, and the lack of confidence in community agencies. These beliefs may conflict with the welfare of young patients.
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Aliabadi HA, Gleich P, Johnson CF. When a deflatable Foley's catheter won't. Minn Med 1984; 67:557-8. [PMID: 6503922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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49
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Abstract
During the last 10 years the management of the neurogenic bladder in children has changed from indwelling urethral catheterization or urinary diversion to intermittent catheterization or artificial sphincter implantation. Neurogenic bladder dysfunction in 413 children was caused by myelomeningocele in 323, traumatic paraplegia in 47, spastic quadriplegia in 11, sacral agenesis in 18 and spinal cord disease in 14. Management included indwelling urethral catheterization in 27 children, urinary diversion in 193, intermittent catheterization in 84, an artificial sphincter in 11 and undiversion in 6. No single treatment was completely effective or without significant complications.
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Abstract
Previously, the ileal conduit had been used in children for diversion of urine from the neurogenic bladder to prevent deterioration of the upper urinary tracts and to manage urinary incontinence. Long-term results after ileal conduits in children have revealed upper tract deterioration and a high complication rate. The complications and renal deterioration rates in 139 children with ileal conduits followed up to 22 years were evaluated. Of 224 complications 114 required surgical correction. Upper urinary tract deterioration occurred in 16.5 per cent of 50 children followed for 10 or more years (mean 13.3 years). The ileal conduit has been replaced by clean intermittent catheterization, ureteral reimplantation for reflux, the artificial sphincter and undiversion in the management of neurogenic bladders in children. Long-term followup will be necessary to compare the results of these procedures to the known long-term results of the ileal conduit to determine the appropriate role of the ileal conduit in the management of children with neurogenic bladders.
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