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Biscoe N, Baumann J, Murphy D. Network analysis of comorbid post-traumatic stress disorder and alcohol misuse in treatment-seeking UK Armed Forces veterans. BMJ Mil Health 2024; 170:281-282. [PMID: 36702523 DOI: 10.1136/military-2022-002329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 01/27/2023]
Affiliation(s)
| | - J Baumann
- Research Department, Combat Stress, Leatherhead, UK
| | - D Murphy
- Research Department, Combat Stress, Leatherhead, UK
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Wadden KP, Hollohan N, Furneaux T, Maher R, Barrett CM, Fuller D, Basset F, Murphy D, Murphy S, Healey S, McGowan E, Twells LK. PRO-FIT-CARE study: the feasibility assessment of a pilot online exercise intervention for persons living with obesity and female infertility. Front Sports Act Living 2024; 6:1332376. [PMID: 38774277 PMCID: PMC11107087 DOI: 10.3389/fspor.2024.1332376] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/10/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Moderate-to-high physical activity participation is associated with a reduced risk of infertility. Yet, exercise interventions that target cardiorespiratory fitness, independent of weight loss, are lacking in obesity and female fertility research. Purpose The primary objective of the PRO-FIT-CARE (PROmoting FITness for CArdiometabolic & REproductive Health) study was to assess the feasibility of a moderate-to-high-intensity online exercise program for persons with obesity and female infertility. Methods Feasibility, safety, acceptability, and efficacy were assessed by examining: (1) recruitment and consent rate, (2) study retention, (3) adverse events, (4) participant satisfaction, (5) adherence, and (6) cardiorespiratory fitness. Results Eleven of thirty-two women contacted agreed to participate in the program (34.4% consent rate). Eight participants (72.7%) completed the study. One musculoskeletal injury was reported. There was a 30% adherence rate based on prescribed exercise intensity (60%-80% of heart rate maximum). One of eleven participants attended 80% of the exercise intervention. Based on a weekly satisfaction survey, the program had an overall high level of satisfaction. Compared to sex and age normative data, post-intervention, two of eight participants improved their cardiorespiratory fitness percentile rank. Conclusion The study highlights challenges with adherence to an online exercise program. While the program was safe and participants reported high levels of program satisfaction, approaches to improve adherence must be incorporated.
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Affiliation(s)
- K. P. Wadden
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - N. Hollohan
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - T. Furneaux
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - R. Maher
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - C. M. Barrett
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - D. Fuller
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - F. Basset
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - D. Murphy
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
- Discipline of Obstetrics and Gynecology, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - S. Murphy
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
- Discipline of Obstetrics and Gynecology, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - S. Healey
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
- Discipline of Obstetrics and Gynecology, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - E. McGowan
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - L. K. Twells
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
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Kong CY, Williams J, Hemadasa N, Murphy D, Bews-Hair M. The Introduction of Magtrace® Lymphatic Tracer for Axillary Sentinel Node Biopsy for Breast Cancer in a Rural Scottish District General Hospital: Initial Experience, Perspectives, Outcomes and Learning Curves. Clin Breast Cancer 2024:S1526-8209(24)00099-5. [PMID: 38653647 DOI: 10.1016/j.clbc.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/14/2024] [Accepted: 03/23/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Magtrace is a supraparamagnetic iron lymphatic tracer that has had increasing use in sentinel node biopsy (SNB) for breast cancer and has theoretical logistical benefits in centres where nanocolloid use may be associated with such issues. We describe our initial experience with the introduction of Magtrace into our routine practice by dual localisation with nanocolloid, comparing performance, and concordance. MATERIALS AND METHODS This was prospective study of the first patients undergoing axillary SNB using Magtrace in a single centre. These patients had dual localisation with nanocolloid and Magtrace. Subjective global assessments of Magtrace and nanocolloid performance as well as objective signal strength and anatomical concordance were compared across multiple timepoints in the operative journey. RESULTS A total of 30 consecutive patients underwent SNB within the timeframe of this study. While there were no failed SNB, 8 issues were reported including 4 issues of perceived imperfect localisation on global assessment. No patient had a failed or abandoned SNB, and only 1 case had a potential challenge in subsequent management after histopathological examination of the retrieved nodes. The majority of these issues occurred in the first half of the study period. There was overall weak to moderate positive correlation between Magtrace and nanocolloid signals of the retrieved sentinel nodes (Spearman's ρ = 0.392, P = .043). CONCLUSION This study suggests that introducing Magtrace was feasible and safe in the context of a rural breast cancer service. A possible strategy to ameliorate the learning curve associated with these procedures is the routine dual localisation in the initial phases of performing Magtrace localisation.
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Affiliation(s)
- Chia Yew Kong
- Department of Surgery, Dumfries and Galloway Royal Infirmary, Dumfries, UK; Academic Unit of Surgery, Glasgow Royal Infirmary and University of Glasgow, Glasgow, UK.
| | - Jacob Williams
- Department of Surgery, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Niroshini Hemadasa
- Department of Surgery, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Dermot Murphy
- Department of Surgery, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Maria Bews-Hair
- Department of Surgery, Dumfries and Galloway Royal Infirmary, Dumfries, UK
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Murphy D, Leon R, Carr S, de Blacam C. Frostbite injuries from recreational nitrous oxide use. Ir Med J 2024; 117:910. [PMID: 38446089] [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: 03/07/2024]
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Phelps AJ, Adler AB, Belanger SAH, Bennett C, Cramm H, Dell L, Fikretoglu D, Forbes D, Heber A, Hosseiny F, Morganstein JC, Murphy D, Nazarov A, Pedlar D, Richardson JD, Sadler N, Williamson V, Greenberg N, Jetly R. Addressing moral injury in the military. BMJ Mil Health 2024; 170:51-55. [PMID: 35705259 DOI: 10.1136/bmjmilitary-2022-002128] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/04/2022] [Indexed: 11/03/2022]
Abstract
Moral injury is a relatively new, but increasingly studied, construct in the field of mental health, particularly in relation to current and ex-serving military personnel. Moral injury refers to the enduring psychosocial, spiritual or ethical harms that can result from exposure to high-stakes events that strongly clash with one's moral beliefs. There is a pressing need for further research to advance understanding of the nature of moral injury; its relationship to mental disorders such as posttraumatic stress disorder and depression; triggering events and underpinning mechanisms; and prevalence, prevention and treatment. In the meantime, military leaders have an immediate need for guidance on how moral injury should be addressed and, where possible, prevented. Such guidance should be theoretically sound, evidence-informed and ethically responsible. Further, the implementation of any practice change based on the guidance should contribute to the advancement of science through robust evaluation. This paper draws together current research on moral injury, best-practice approaches in the adjacent field of psychological resilience, and principles of effective implementation and evaluation. This research is combined with the military and veteran mental health expertise of the authors to provide guidance on the design, implementation and evaluation of moral injury interventions in the military. The paper discusses relevant training in military ethical practice, as well as the key roles leaders have in creating cohesive teams and having frank discussions about the moral and ethical challenges that military personnel face.
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Affiliation(s)
- Andrea J Phelps
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Victoria, Australia
| | - A B Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - S A H Belanger
- Royal Military College of Canada, Kingston, Ontario, Canada
- Canadian Institute for Military and Veteran Health Research, Kingston, Ontario, Canada
| | - C Bennett
- New Zealand Defence Force, Wellington, New Zealand
| | - H Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - L Dell
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Victoria, Australia
| | - D Fikretoglu
- Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada
| | - D Forbes
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Victoria, Australia
| | - A Heber
- Veterans Affairs Canada, Charottetown, Prince Edward Island, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - F Hosseiny
- Canadian Centre of Excellence on PTSD and Related Mental Health Conditions, Ottawa, Ontario, Canada
| | - J C Morganstein
- Center for the Study of Traumatic Stress, Department of Psychiatry, School of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - D Murphy
- Combat Stress, Leatherhead, UK
- King's Centre for Military Health Research, King's College London, London, UK
| | - A Nazarov
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - D Pedlar
- Canadian Institute for Military and Veteran Health Research, Kingston, Ontario, Canada
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - J D Richardson
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - N Sadler
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Victoria, Australia
| | - V Williamson
- Institute of Psychiatry Psychology, and Neuroscience, King's College London, London, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - N Greenberg
- King's Centre for Military Health Research, King's College London, London, UK
| | - R Jetly
- Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
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Moreno L, Weston R, Owens C, Valteau-Couanet D, Gambart M, Castel V, Zwaan CM, Nysom K, Gerber N, Castellano A, Laureys G, Ladenstein R, Rössler J, Makin G, Murphy D, Morland B, Vaidya S, Thebaud E, van Eijkelenburg N, Tweddle DA, Barone G, Tandonnet J, Corradini N, Chastagner P, Paillard C, Bautista FJ, Gallego Melcon S, De Wilde B, Marshall L, Gray J, Burchill SA, Schleiermacher G, Chesler L, Peet A, Leach MO, McHugh K, Hayes R, Jerome N, Caron H, Laidler J, Fenwick N, Holt G, Moroz V, Kearns P, Gates S, Pearson ADJ, Wheatley K. Bevacizumab, Irinotecan, or Topotecan Added to Temozolomide for Children With Relapsed and Refractory Neuroblastoma: Results of the ITCC-SIOPEN BEACON-Neuroblastoma Trial. J Clin Oncol 2024:JCO2300458. [PMID: 38190578 DOI: 10.1200/jco.23.00458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/25/2023] [Accepted: 10/05/2023] [Indexed: 01/10/2024] Open
Abstract
PURPOSE Outcomes for children with relapsed and refractory high-risk neuroblastoma (RR-HRNB) remain dismal. The BEACON Neuroblastoma trial (EudraCT 2012-000072-42) evaluated three backbone chemotherapy regimens and the addition of the antiangiogenic agent bevacizumab (B). MATERIALS AND METHODS Patients age 1-21 years with RR-HRNB with adequate organ function and performance status were randomly assigned in a 3 × 2 factorial design to temozolomide (T), irinotecan-temozolomide (IT), or topotecan-temozolomide (TTo) with or without B. The primary end point was best overall response (complete or partial) rate (ORR) during the first six courses, by RECIST or International Neuroblastoma Response Criteria for patients with measurable or evaluable disease, respectively. Safety, progression-free survival (PFS), and overall survival (OS) time were secondary end points. RESULTS One hundred sixty patients with RR-HRNB were included. For B random assignment (n = 160), the ORR was 26% (95% CI, 17 to 37) with B and 18% (95% CI, 10 to 28) without B (risk ratio [RR], 1.52 [95% CI, 0.83 to 2.77]; P = .17). Adjusted hazard ratio for PFS and OS were 0.89 (95% CI, 0.63 to 1.27) and 1.01 (95% CI, 0.70 to 1.45), respectively. For irinotecan ([I]; n = 121) and topotecan (n = 60) random assignments, RRs for ORR were 0.94 and 1.22, respectively. A potential interaction between I and B was identified. For patients in the bevacizumab-irinotecan-temozolomide (BIT) arm, the ORR was 23% (95% CI, 10 to 42), and the 1-year PFS estimate was 0.67 (95% CI, 0.47 to 0.80). CONCLUSION The addition of B met protocol-defined success criteria for ORR and appeared to improve PFS. Within this phase II trial, BIT showed signals of antitumor activity with acceptable tolerability. Future trials will confirm these results in the chemoimmunotherapy era.
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Affiliation(s)
- Lucas Moreno
- Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Guy Makin
- Central Manchester and Manchester Children's University Hospitals NHS Trust, Manchester, United Kingdom
| | - Dermot Murphy
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Bruce Morland
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Sucheta Vaidya
- The Royal Marsden NHS Foundation Trust & Institute for Cancer Research, London, United Kingdom
| | | | | | - Deborah A Tweddle
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | | | | | | | | | | | | | | | | | - Lynley Marshall
- The Royal Marsden NHS Foundation Trust & Institute for Cancer Research, London, United Kingdom
| | - Juliet Gray
- University Hospital Southampton, Southampton, United Kingdom
| | | | | | - Louis Chesler
- The Royal Marsden NHS Foundation Trust & Institute for Cancer Research, London, United Kingdom
| | - Andrew Peet
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Martin O Leach
- The Royal Marsden NHS Foundation Trust & Institute for Cancer Research, London, United Kingdom
| | - Kieran McHugh
- Great Ormond Street Hospital, London, United Kingdom
| | | | - Neil Jerome
- The Royal Marsden NHS Foundation Trust & Institute for Cancer Research, London, United Kingdom
| | | | | | | | - Grace Holt
- University of Birmingham, Birmingham, United Kingdom
| | | | - Pamela Kearns
- University of Birmingham, Birmingham, United Kingdom
| | - Simon Gates
- University of Birmingham, Birmingham, United Kingdom
| | - Andrew D J Pearson
- The Royal Marsden NHS Foundation Trust & Institute for Cancer Research, London, United Kingdom
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Kuah XYC, Lucas-Herald AK, McCarrison S, Boyle R, Adey C, Amato-Watkins A, Bhattathiri P, Campbell E, Cowie F, Dorris L, Fulton B, Mcintosh D, Murphy D, Ronghe M, O'Kane R, Todd L, Sangra M, Sastry J, Millar E, Hassan S, Shaikh MG. Presentation and outcomes of paediatric craniopharyngioma in the west of Scotland: a 25 year experience. J Neurooncol 2024; 166:51-57. [PMID: 38224403 DOI: 10.1007/s11060-023-04490-5] [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] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/25/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE Craniopharyngiomas can be aggressive leading to significant complications and morbidity. It is not clear whether there are any predictive factors for incidence or outcomes. Our aim was therefore to record the incidence, presentation, characteristics and progression of paediatric craniopharyngiomas in the West of Scotland. METHOD Retrospective case note review for children diagnosed with paediatric craniopharyngiomas at the Royal Hospital for Children Glasgow, from 1995 to 2021 was conducted. All analyses were conducted using GraphPad Prism 9.4.0. RESULTS Of 21 patients diagnosed with craniopharyngiomas, the most common presenting symptoms were headaches (17/21, 81%); visual impairment (13/21, 62%); vomiting (9/21, 43%) and growth failure (7/21, 33%). Seventeen (81%) patients underwent hydrocephalus and/or resection surgery within 3 months of diagnosis, usually within the first 2 weeks (13/21, 62%). Subtotal resection surgeries were performed in 71% of patients, and median time between subsequent resection surgeries for tumour recurrence was 4 years (0,11). BMI SDS increased at 5 year follow-up (p = 0.021) with 43% being obese (BMI > + 2SD). More patients acquired hypopituitarism post-operatively (14/16, 88%) compared to pre-operatively (4/15, 27%). A greater incidence of craniopharyngiomas were reported in more affluent areas (10/21, 48%) (SIMD score 8-10) compared to more deprived areas (6/10, 29%) (SIMD score 1-3). Five patients (24%) died with a median time between diagnosis and death of 9 years (6,13). CONCLUSION Over 25 years the management of craniopharyngioma has changed substantially. Co-morbidities such as obesity are difficult to manage post-operatively and mortality risk can be up to 25% according to our cohort.
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Affiliation(s)
- Xuan Ye Chanel Kuah
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
- Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Angela K Lucas-Herald
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
- Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Sarah McCarrison
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
- Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Roisin Boyle
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
- Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Claire Adey
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Parameswaran Bhattathiri
- Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Emer Campbell
- Department of Paediatric Neurosurgery, Royal Hospital for Children, Glasgow, UK
| | - Fiona Cowie
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Liam Dorris
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ben Fulton
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Diana Mcintosh
- Department of Paediatric Oncology, Royal Hospital for Children, Glasgow, UK
| | - Dermot Murphy
- Department of Paediatric Oncology, Royal Hospital for Children, Glasgow, UK
| | - Milind Ronghe
- Department of Paediatric Oncology, Royal Hospital for Children, Glasgow, UK
| | - Roddy O'Kane
- Department of Paediatric Neurosurgery, Royal Hospital for Children, Glasgow, UK
| | - Lorraine Todd
- Department of Paediatric Neurosurgery, Royal Hospital for Children, Glasgow, UK
| | - Meharpal Sangra
- Department of Paediatric Neurosurgery, Royal Hospital for Children, Glasgow, UK
| | - Jairam Sastry
- Department of Paediatric Oncology, Royal Hospital for Children, Glasgow, UK
| | - Eoghan Millar
- Department of Ophthalmology, Royal Hospital for Children, Glasgow, UK
| | - Samih Hassan
- Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - M Guftar Shaikh
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK.
- Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK.
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Mee JF, Murphy D, Curran M. Bovine congenital defects recorded by veterinary practitioners. Reprod Domest Anim 2024; 59:e14501. [PMID: 37975255 DOI: 10.1111/rda.14501] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/06/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
A mobile phone app was used by 59 veterinary practitioners to collect case histories and images of 191 cattle with congenital defects distributed nationally over a 3-year period. The majority of cases were recorded during the spring calving season (57.6%) in pluriparous dairy dams. The majority of calves were recorded at birth or within the first week (66.5%) in singletons born at full-term. On the majority of farms (75.9%), this was the only congenitally deformed bovine recorded up to that point in the year and on the majority of farms, there were no congenitally deformed cattle recorded in the previous 5 years. The majority of congenital defects (83.5%) were recorded in the musculoskeletal or digestive systems. The three most commonly recorded individual defects were intestinal atresia (24.1%), schistosomus reflexus (20.4%) and ankylosis (6.8%); multiple defects were recorded in 13.1% of cases. These findings highlight the relatively high prevalence of intestinal atresia and schistosomus reflexus in calves attended by veterinary practitioners, which warrants implementation of preventive measures. The project highlights the potential benefits of veterinary-practitioner apps to detect changing trends in endemic, or the emergence of novel, congenital or other conditions.
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Affiliation(s)
- J F Mee
- Teagasc, Animal and Bioscience Research Department, Moorepark Research Centre, Fermoy, Co. Cork, Ireland
| | - D Murphy
- XLVets Ireland & Sliabh Luachra Veterinary Centre, Rathmore, Co. Kerry, Ireland
| | - M Curran
- XLVets Ireland, Newport, Co. Tipperary, Ireland
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Murphy D, Stephenson J, Bouhbib Y, Graby J, Khavandi A, Lyen S, Hudson B, Rodrigues JCL. Investigating the impact of non-gated thoracic CT prior to CTCA to reduce layered testing. Clin Radiol 2023; 78:947-954. [PMID: 37718182 DOI: 10.1016/j.crad.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023]
Abstract
AIM To determine the proportion of computed tomography (CT) coronary angiography (CTCA) referrals with coronary artery calcification (CAC) evident on previous non-cardiac CT imaging and how this impacted the diagnostic yield for CTCA, the requirement for additional diagnostic testing, and the associated costs to confirm or refute obstructive coronary artery disease (CAD). MATERIALS AND METHODS A retrospective review of CTCA examinations was undertaken between 01/05/2018 and 31/05/2020 in which the examinations were cross referenced for previous non-gated thoracic CT at Royal United Hospitals Bath. Major epicardial vessel CAC on baseline CT was re-evaluated by published semi-quantitative methods, giving a per-patient CAC score (mild = 1-3, moderate = 4-6, severe >6). Subsequent incomplete CTCA diagnostic yield, further testing, and cost implications were examined. RESULTS Of the 2140 CTCA examinations identified, 13% (280/2140) had a preceding non-gated thoracic CT (53% female, age 63 ± 11 years). The incomplete diagnostic rate increased with CAC grade, mild 32%, (RR 12; 95% CI 4-40), moderate 64% (RR 25; 95% CI 8-80), severe 75%, (RR 29; 95% CI 9-94). Additional diagnostic testing occurred in 4% for the mild CAC category, and 14% and 42% for moderate and severe, respectively. When severe CAC was identified on a non-gated thoracic CT a cost saving of £171/patient (dobutamine stress echo [DSE]) and £61/patient (myocardial perfusion scintigraphy [MPS]) was established with a direct to functional testing pathway. CONCLUSIONS In patients referred for CTCA where severe CAC was identified on a preceding non-gated thoracic CT a direct to functional testing altered management in 42% of cases and was cost-effective.
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Affiliation(s)
- D Murphy
- Department of Cardiology, Royal United Hospitals Bath, Bath, UK; Department for Health, University of Bath, Bath, UK
| | - J Stephenson
- Department of Cardiology, Royal United Hospitals Bath, Bath, UK
| | - Y Bouhbib
- Department of Radiology, Royal United Hospitals Bath, Bath, UK
| | - J Graby
- Department of Cardiology, Royal United Hospitals Bath, Bath, UK; Department for Health, University of Bath, Bath, UK
| | - A Khavandi
- Department of Cardiology, Royal United Hospitals Bath, Bath, UK
| | - S Lyen
- Department of Radiology, Royal United Hospitals Bath, Bath, UK
| | - B Hudson
- Department of Radiology, Royal United Hospitals Bath, Bath, UK
| | - J C L Rodrigues
- Department for Health, University of Bath, Bath, UK; Department of Radiology, Royal United Hospitals Bath, Bath, UK.
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Gibb I, Delaney R, Murphy D, Hunt N. Post-mortem computed tomography in the investigation of conflict and terrorist related deaths: UK military experience of developing a multidisciplinary service. Clin Radiol 2023; 78:804-811. [PMID: 36031431 DOI: 10.1016/j.crad.2022.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/21/2022]
Abstract
This paper discusses the introduction, development and utility of post-mortem imaging relating specifically to conflict-related and terrorist-related deaths and considers the use of computed tomography (CT) in the investigations. We demonstrate how a multi-disciplinary approach involving direct communication between forensic pathologist and radiologist can maximise evidential yield, reduce the need for unnecessary dissection and further our understanding of such injuries. This summarises our shared experience of hundreds of cases, each having been individually discussed and reviewed, and has helped shape our understanding of conflict injury as well as contributing to the development of mitigation strategies and adaptations to protective equipment. A series of clinical cases are presented to demonstrate some of the strengths and weaknesses of the process.
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Affiliation(s)
- I Gibb
- Centre for Blast Injury Studies, Imperial College London, London, UK; Centre for Defence Radiology, c/o HMS Nelson, Portsmouth, Hampshire, UK.
| | - R Delaney
- South West Forensic Pathology Group Practice
| | - D Murphy
- Metropolitan Police Force, New Scotland Yard, London, SW1A 2JL, UK
| | - N Hunt
- Home Office Registered Forensic Pathologist (Retired)
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11
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Molloy N, Murphy D. Associations between sleep difficulties and health outcomes in treatment-seeking veterans. Occup Med (Lond) 2023; 73:439-445. [PMID: 37862450 PMCID: PMC10588775 DOI: 10.1093/occmed/kqad094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Sleep disturbance in UK Armed Forces personnel appears to be frequent due to factors such as hostile sleeping environments and can persist even once they have transitioned into civilian life. Despite this, there is currently very limited literature surrounding the prevalence and associated factors of insomnia disorder among UK veterans. AIMS This study aimed to expand knowledge of the prevalence and associated demographic, military, health and functional outcomes with probable insomnia disorder within a clinical sample of veterans. METHODS Treatment-seeking veterans from a national UK mental health charity were invited to complete a questionnaire including socio-demographic, military, health and well-being questions. RESULTS Of the sample, 489 (43%) completed the questionnaire. Seventy per cent of the sample reported having probable insomnia disorder. Having probable insomnia disorder was significantly associated with being younger and having physical health problems. Moreover, unadjusted models found associations between probable insomnia disorder and common mental health difficulties, obsessive-compulsive disorder and complex post-traumatic stress disorder. CONCLUSIONS The results suggest that many UK veterans with physical and mental health difficulties experience co-morbid insomnia disorder. Therefore, it is important that clinical services are aware of this prevalence and use targeted interventions to reduce the frequency of insomnia disorder in this population.
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Affiliation(s)
- N Molloy
- King’s Centre for Military Health Research (KCMHR), King’s College London, London SE5 9RJ, UK
| | - D Murphy
- Combat Stress, Tyrwhitt House , Leatherhead KT22 0BX, UK
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12
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Williamson C, Baumann J, Murphy D. Military families: the impacts of having a first child during service on military mothers. BMJ Mil Health 2023; 169:403-407. [PMID: 34599082 DOI: 10.1136/bmjmilitary-2021-001928] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/08/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The rights, roles and responsibilities of servicewomen in the UK Armed Forces has changed dramatically over time. Previously, service personnel were automatically discharged from the military if they became pregnant. As the percentage of servicewomen in the UK Armed Forces increases, having children during service is becoming more common and maternity policies are now in place. Having children during military service can impact on the health and well-being of servicewomen, including a greater risk of illness when returning to work. METHODS A cross-sectional, self-report survey was used for data collection. The response rate was approximately 45%. Female Army veterans were recruited via a female military association. The survey collected data on parental status, the timing of their first child (during or after service), and several current mental and physical health and well-being outcomes. RESULTS Of the 750 female Army veterans who completed the survey, 406 reported having children. Of those with children, 14.5% had their first child during service compared with 85.5% after service. The most frequently endorsed health outcomes were low social support, loneliness and common mental health difficulties. Participants who had their first child during military service were more likely to have left the service non-voluntarily. CONCLUSIONS This study provided insight into the impacts of having a first child during military service on servicewomen. Overall, female Army veterans who had their first child during service had poorer outcomes, including leaving service non-voluntarily. However, none of the health or well-being outcomes remained significant after adjusting the results. This study explored a widely under researched population and field of research. Future research should seek to expand on our findings and continue to explore the impacts of having a first child during military service for military mothers.
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Affiliation(s)
- Charlotte Williamson
- King's Centre for Military Health Research, King's College London, London, UK
- Department of Research, Combat Stress, Leatherhead, Surrey, UK
| | - J Baumann
- Department of Research, Combat Stress, Leatherhead, Surrey, UK
| | - D Murphy
- King's Centre for Military Health Research, King's College London, London, UK
- Department of Research, Combat Stress, Leatherhead, Surrey, UK
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13
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Hendrikx LJ, Williamson V, Murphy D. Adversity during military service: the impact of military sexual trauma, emotional bullying and physical assault on the mental health and well-being of women veterans. BMJ Mil Health 2023; 169:419-424. [PMID: 34697241 DOI: 10.1136/bmjmilitary-2021-001948] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/12/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Despite making up about 11% of the UK military, there remains limited investigation on the impact of adversity women experience during their service in the UK military. Military adversity can result in a range of well-being difficulties that may persist following transition out of military. The present study therefore examined the prevalence and correlates of different types of military adversity (defined as sexual harassment, sexual assault, emotional bullying and physical assault) within a community sample of UK women veterans. METHODS Participants were recruited from a UK charity supporting women veterans. 750 women veterans completed an online survey collecting information on sociodemographic and military factors, military adversity, as well as mental health and well-being difficulties. Associations between variables were explored using multivariate logistic regressions. RESULTS The findings indicate a high prevalence of military adversity (22.5% sexual harassment, 5.1% sexual assault, 22.7% emotional bullying and 3.3% physical assault). Younger women, those who held an officer rank during service and those who reported having a combat or combat support role during service were most at risk of military adversity. All types of adversity were significantly associated with probable post-traumatic stress disorder. Sexual harassment was additionally significantly associated with physical somatisation; sexual assault with alcohol difficulties; and emotional bullying with common mental health difficulties, low social support and loneliness. CONCLUSIONS This study indicates that UK women veterans are at risk of a range of adverse experiences during military service and provides evidence of the impact of such adversities on mental health and well-being. Further research is required to better understand these relationships.
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Affiliation(s)
| | - V Williamson
- Kings Centre for Military Health Research, King's College London, London, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - D Murphy
- Research Department, Combat Stress, Leatherhead, UK
- Kings Centre for Military Health Research, King's College London, London, UK
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14
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Rasheed MA, Murphy D. Prolonged neuraxial block following spinal anaesthesia in a patient with carnitine palmitoyl transferase II deficiency undergoing caesarean section. Int J Obstet Anesth 2023; 55:103895. [PMID: 37276780 DOI: 10.1016/j.ijoa.2023.103895] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 04/11/2023] [Accepted: 04/24/2023] [Indexed: 06/07/2023]
Abstract
Carnitine palmitoyl transferase II (CPT II) deficiency is a rare disorder of fatty acid metabolism in cell mitochondria. There is limited information about the disease process and complications of anaesthesia, particularly in the obstetric population. Due to the increased risks of general anaesthesia in patients with CPT II deficiency, neuraxial anaesthesia is the preferred method of anaesthesia. We describe a patient with CPT II deficiency who had spinal anaesthesia for caesarean section. Subsequently, the patient had prolonged neuraxial blockade, a previously undescribed complication in a patient with CPT II deficiency.
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Affiliation(s)
- M A Rasheed
- School of Medicine, National University of Ireland, Galway, Ireland.
| | - D Murphy
- Department of Anaesthesia, Critical Care and Pain Medicine, Cork University Hospital, Cork, Ireland
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15
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Wang Y, Murphy D, Li S, Chen B, Peluso H, Sondhi V, Abougergi MS. Thirty-Day Readmission Among Patients With Uncomplicated Choledocholithiasis: A Nationwide Readmission Database Analysis. J Clin Gastroenterol 2023; 57:624-630. [PMID: 35648885 DOI: 10.1097/mcg.0000000000001724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/21/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIM We aimed to determine the rate of 30-day hospital readmissions of uncomplicated choledocholithiasis and its impact on mortality and health care use in the United States. METHODS Nonelective admissions for adults with uncomplicated choledocholithiasis were selected from the Nationwide Readmission Database 2016-2018. The primary outcome was the all-cause 30-day readmission rate. Secondary outcomes were reasons for readmission, readmission mortality rate, procedures, and resource use (length of stay and total hospitalization costs and charges). Independent risk factors for readmission were identified using Cox regression analysis. RESULTS The 30-day rate of readmission was 9.3%. Biliary and pancreatic disorders and postprocedural complications accounted for 36.6% and 10.3% of readmission, respectively. The mortality rate among patients readmitted to the hospital was higher than that for index admissions (2.0% vs. 0.4%, P <0.01). Readmitted patients were less likely to receive endoscopic retrograde cholangiopancreatography (61% vs. 69%, P <0.01) and laparoscopic cholecystectomy (12.5% vs. 26%, P <0.01) during the index admissions. A total of 42,150 hospital days was associated with readmission, and the total health care in-hospital economic burden was $112 million (in costs) and $470 million (in charges). Independent predictors of readmission were male sex, Medicare (compared with private) insurance, higher Elixhauser Comorbidity Index score, no endoscopic retrograde cholangiopancreatography or laparoscopic cholecystectomy, postprocedural complications of the digestive system, hemodynamic or respiratory support, urban hospitals, and lower hospital volume of uncomplicated choledocholithiasis. CONCLUSIONS The uncomplicated choledocholithiasis 30-day readmission rate is 9.3%. Readmission was associated with higher mortality, morbidity, and resource use. Multiple independent predictors of readmission were identified.
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Affiliation(s)
- Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, MA
| | - Dermot Murphy
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, MA
| | - Si Li
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, PA
| | - Bing Chen
- Department of Medicine, Mount Sinai Morningside and West, New York City, NY
| | - Heather Peluso
- Department of Surgery, Prisma Health Upstate, Greenville
| | - Vikram Sondhi
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, MA
| | - Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia
- Catalyst Medical Consulting, Simpsonville, SC
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16
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Zhao Z, Murphy D, Gifford H, Williams S, Darlington A, Relton S, Fang H, Wong DC. Corrigendum: Analysis of an adaptive lead weighted ResNet for multiclass classification of 12-Lead ECGs (2022 Physiol. Meas.43034001). Physiol Meas 2023; 44:069501. [PMID: 37334977 DOI: 10.1088/1361-6579/acdb48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Z Zhao
- University of Manchester, United Kingdom
- Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - D Murphy
- University of Manchester, United Kingdom
| | - H Gifford
- University of Exeter, Exeter, United Kingdom
| | - S Williams
- University of Leeds, Leeds, United Kingdom
| | | | - S Relton
- University of Leeds, Leeds, United Kingdom
| | - H Fang
- Loughborough University, Loughborough, United Kingdom
| | - D C Wong
- University of Manchester, United Kingdom
- University of Leeds, United Kingdom
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17
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Bonson A, Murphy D, Aldridge V, Greenberg N, Williamson V. Veterans' experiences of moral injury, treatment and recommendations for future support. BMJ Mil Health 2023:military-2022-002332. [PMID: 37192765 DOI: 10.1136/military-2022-002332] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Moral injury (MI) significantly impacts the lives of many UK military veterans however, there is a lack of manualised treatment to address the needs of this population. To develop future treatments that are acceptable and well tolerated, veterans should be consulted on their experiences of existing psychological treatments and suggestions for future treatments. METHODS 10 UK military veterans were interviewed about their experiences of receiving treatment for psychological difficulties after MI, and beliefs about core components of future treatments. Thematic analysis of these interviews were conducted. RESULTS 2 superordinate themes were identified: experiences of previous mental health treatment and perceptions of the proposed treatments. Reflections on cognitive behavioural therapy were mixed, with some describing that it did not ameliorate their guilt or shame. In future treatments, focusing on values, using written letters and including therapy sessions with close companions were considered beneficial. Veterans reported that a strong rapport with therapist was key for MI treatment. CONCLUSION Findings provide a useful account of how current post-trauma treatments may be experienced by patients with MI. Although limited by sample size, the results highlight therapeutic approaches that may be helpful in future and provide important considerations for therapists treating MI.
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Affiliation(s)
| | - D Murphy
- Research Department, Combat Stress, Leatherhead, UK
- King's Centre for Military Health Research, King's College London, London, UK
| | - V Aldridge
- Research Department, Combat Stress, Leatherhead, UK
| | - N Greenberg
- King's Centre for Military Health Research, King's College London, London, UK
| | - V Williamson
- King's Centre for Military Health Research, King's College London, London, UK
- Department of Experimental Psychology, Ann Watts Building, University of Oxford, Oxford, UK
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18
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Williams J, Kong C, Blackhall V, Hemadasa N, Kourounis G, Potter K, Musyoka C, McKirdy M, Campbell J, Arthur L, Murphy D, Bews-Hair M. P219 Early experience with Magtrace ® for sentinel node biopsies in two Scottish breast cancer units. Breast 2023. [DOI: 10.1016/s0960-9776(23)00337-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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19
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Hendrikx LJ, Murphy D. Using statistical techniques to understand the unique needs of military personnel experiencing mental health difficulties: moving away from assuming patient homogeneity to understanding heterogeneity. BMJ Mil Health 2023:e002253. [PMID: 36750256 DOI: 10.1136/military-2022-002253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/20/2023] [Indexed: 02/09/2023]
Abstract
Gold standard treatments for military personnel seeking support for mental health difficulties are often standardised and manualised to ensure high levels of treatment fidelity. While manualised treatments are preferable to less evidence-based idiosyncratic approaches, they may not fully account for the differences in symptom profiles present in patients with the same psychological diagnosis. Indeed, recent findings have highlighted that a significant proportion of individuals do not benefit from the 'gold standard' treatments. This brief report discusses the utility of statistical techniques, specifically latent profile analysis and network analysis, to support the transition to more evidence-based idiosyncratic, personalised care for clinical military, and general, populations. Further incorporation of such analysis methods may support arriving at a framework to support the personalisation of care in terms of the selection and adaption of evidence-based approach treatments based on individual clinical need.
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Affiliation(s)
| | - D Murphy
- Research Department, Combat Stress, Leatherhead, Surrey, UK
- King's College London, London, UK
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20
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Huang X, Abougergi MS, Sun C, Murphy D, Sondhi V, Chen B, Zheng X, Chen S, Wang Y. Incidence and outcomes of thromboembolic and bleeding events in patients with liver cirrhosis in the USA. Liver Int 2023; 43:434-441. [PMID: 35635760 DOI: 10.1111/liv.15325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/11/2022] [Accepted: 05/26/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND & AIMS Understanding the epidemiology of bleeding and thromboembolism (clotting) in liver cirrhosis provides important data for future studies and policymaking; however, head-to-head comparisons of bleeding and clotting remain limited. METHODS This is a populational retrospective cohort study using the US National Readmission Database of 2018 to compare the incidence and outcomes of bleeding and clotting events in patients with liver cirrhosis. The primary outcomes were the 11-month incidence proportion of bleeding and clotting events. RESULTS Of 1 304 815 participants, 26 569 had liver cirrhosis (45.0% women, mean age 57.2 [SD, 12.7] years). During the 11-month follow-up, in patients with cirrhosis, for bleeding and clotting events, the incidence proportions was 15.3% and 6.6%; the risk-standardized all-cause mortality rates were 2.4% and 1.0%; the rates of intensive care intervention were 4.1% and 1.9%; the rates of rehabilitation transfer were .2% and .2%; the cumulative length of stays were 45 100 and 23 566 days; total hospital costs were 147 and 84 million US dollars; total hospital charges were 620 and 365 million US dollars. Compared to non-cirrhosis, liver cirrhosis was associated with higher rates of bleeding (adjusted hazard ratio, 3.02 [95% CI, 2.85-3.20]) and portal vein thrombosis (PVT) (18.46 [14.86-22.92]), and slightly lower risks of other non-PVT venous thromboembolic events (.82 [.75-.89]). CONCLUSIONS Bleeding is more common than thromboembolism in patients with liver cirrhosis, causes higher morbidity, mortality and resource utilization. Liver cirrhosis is an independent risk factor for bleeding and PVT, but not non-PVT thromboembolism including venous thromboembolism, acute myocardial infarction and ischemic stroke.
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Affiliation(s)
- Xiaoquan Huang
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA.,Catalyst Medical Consulting, Simpsonville, South Carolina, USA
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, Chicago, Illinois, USA
| | - Dermot Murphy
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, Massachusetts, USA
| | - Vikram Sondhi
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, Massachusetts, USA
| | - Bing Chen
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Xin Zheng
- Division of Gastroenterology, Department of Medicine, Loma Linda University, Loma Linda, California, USA
| | - Shiyao Chen
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, Massachusetts, USA
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21
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Leightley D, Murphy D. Personalised digital technology for mental health in the armed forces: the potential, the hype and the dangers. BMJ Mil Health 2023; 169:81-83. [PMID: 36455986 DOI: 10.1136/military-2022-002279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
The COVID-19 pandemic has resulted in a digital technology revolution which included widespread use in remote healthcare settings, remote working and use of technology to support friends and family to stay in touch. The armed forces have also increased its use of digital technology, but not at the same rate, and it is important that they do not fall behind in the revolution. One area where digital technology could be helpful is the treatment and management of mental health conditions. In a civilian setting, digital technology adoption has been found to be acceptable and feasible yet there is little use in the armed forces. In this personal view, we explore the potential use of personalised digital technology for mental health, the hype surrounding it and the dangers.This paper forms part of the special issue of BMJ Military Health dedicated to personalised digital technology for mental health in the armed forces.
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Affiliation(s)
- Daniel Leightley
- King's Centre for Military Health Research, King's College London, London, UK
| | - D Murphy
- Research Department, Combat Stress, Leatherhead, UK
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22
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Wang Y, Huang X, Abougergi MS, Sun C, Murphy D, Sondhi V, Chen B, Zheng X, Chen S. Response to 'Queries Regarding Medication Information and Influences on Bleeding and Clotting Events'. Liver Int 2022; 42:2917. [PMID: 36121101 DOI: 10.1111/liv.15426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, Massachusetts, USA
| | - Xiaoquan Huang
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, USA.,Catalyst Medical Consulting, Simpsonville, South Carolina, USA
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, Chicago, Illinois, USA
| | - Dermot Murphy
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, Massachusetts, USA
| | - Vikram Sondhi
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, Massachusetts, USA
| | - Bing Chen
- Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
| | - Xin Zheng
- Division of Gastroenterology, Department of Medicine, Loma Linda University, Loma Linda, California, USA
| | - Shiyao Chen
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China
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23
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Serfioti D, Murphy D, Greenberg N, Williamson V. Effectiveness of treatments for symptoms of post-trauma related guilt, shame and anger in military and civilian populations: a systematic review. BMJ Mil Health 2022:e002155. [PMID: 36442888 DOI: 10.1136/military-2022-002155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Individuals who have been exposed to a traumatic event can develop profound feelings of guilt, shame and anger. Yet, studies of treatments for post-traumatic stress disorder (PTSD) have largely investigated changes in PTSD symptoms relating to a sense of ongoing fear or threat and the effectiveness of such treatments for post-trauma related guilt, shame or anger symptom reduction is comparatively not well understood. METHODS This review systematically examined the effectiveness of existing treatment approaches for three symptoms associated with exposure to traumatic events: guilt, shame and anger. Studies included had to be published after 2010 with a sample size of n=50 or greater to ensure stable treatment outcome estimates. RESULTS 15 studies were included, consisting of both civilian and (ex-) military population samples exposed to a wide range of traumatic events (eg, combat-related, sexual abuse). Findings indicated a moderate strength of evidence that both cognitive-based and exposure-based treatments are similarly effective in reducing symptoms. Cognitive-based treatments were found to effectively reduce post-trauma related guilt and anger, while exposure-based treatments appeared effective for post-trauma related guilt, shame and anger. CONCLUSIONS The findings suggest the importance of confronting and discussing the traumatic event during therapy, rather than using less directive treatments (eg, supportive counselling).Nonetheless, while these results are promising, firm conclusions regarding the comparative effectiveness and long-term impact of these treatments could not be drawn due to insufficient evidence. Further empirical research is needed to examine populations exposed to traumatic events and investigate which treatment approaches (or combination thereof) are more effective in the long-term.
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Affiliation(s)
- Danai Serfioti
- University of Derby, Derby, UK
- KCMHR, Institute of Psychiatry Psychology and Neuroscience Department of Basic and Clinical Neuroscience, London, UK
- Nottingham Trent University, Nottingham, UK
| | | | - N Greenberg
- Academic Department for Military Mental Health, King's College London, London, UK
| | - V Williamson
- KCMHR, Institute of Psychiatry Psychology and Neuroscience Department of Basic and Clinical Neuroscience, London, UK
- University of Oxford, Oxford, UK
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Murphy D, Crowley A, Fitzpatrick M. 55 A MOBILITY PROFILE OF STROKE PATIENTS ADMITTED TO A LEVEL 4 ACUTE HOSPITAL OVER A 6-MONTH PERIOD. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In order to best direct physiotherapy stroke resources and further service development it is important to characterise the mobility of stroke patients presenting to an acute hospital.
Methods
A previous audit completed in 2018 in the same organisation established that by using the Berg Balance Scale (BBS) and the Mobility Scale for Acute Stroke (MSAS) as admission outcome measures, a baseline profile could be established while limiting the floor and ceiling effects. A retrospective audit was completed of all patients referred to the stroke physiotherapy service admitted with acute stroke in a 6 month period. An excel spreadsheet was used to record patients’ admission BBS and MSAS. This was recorded along with the mainstay of physiotherapy treatment and discharge destination.
Results
145 stroke patients were assessed by stroke physiotherapy between Oct 2021 and April 2022. Of those patients 30% scored full marks on the MSAS which indicates that they were independently mobile with or without an aid post stroke. 26% of patients scored 3 or less on the BBS which would imply they were unable to sit without help.
Conclusion
This audit provides valuable information on the mobility profile of stroke patients presenting to an acute Level 4 hospital. On admission, patients seem to fall into 3 distinct categories based on their physical function post stroke. One group remained independently mobile post stroke, one group were heavily dependent being unable to sit without assistance and the final cohort requiring some level of supervision or assistance for mobility and balance. This information could be used to facilitate therapy and resource planning.
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Affiliation(s)
- D Murphy
- St. Vincent's University Hospital , Dublin, Ireland
| | - A Crowley
- St. Vincent's University Hospital , Dublin, Ireland
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25
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Rafferty M, Murphy D, Cloney T, Brent L, Dukelow T, Ahern E. 255 THE ROLE OF GERIATRIC MEDICINE IN CARE OF OLDER ADULTS WITH MAJOR TRAUMA. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
In recent Major Trauma Audit Reports the most common cause of major trauma is low falls, 46-49% of injured patients were aged over 65. These are an important group to identify and to prioritise for geriatrician led MDT care. There is currently no specialist geriatric medicine service in Ireland for older adults with major trauma. We aimed to evaluate patients with major trauma currently co-managed by orthopaedic surgery and geriatric medicine, the role of geriatric medicine and the potential role of a major trauma geriatric service.
Methods
We reviewed local data collected for the Irish Hip Fracture Database to examine the incidence of major trauma presenting in older adults and the role of geriatric medicine. We included patients who had injuries in addition to hip fracture including radius, ulna, clavicle, humerus, rib, vertebra, pelvis fracture subdural haemorrhage, diffuse brain injury and traumatic subarachnoid haemorrhage.
Results
In 2020, there were 437 older adults admitted with hip fractures and likely 2185 patients presenting with fragility fractures. We identified 32(7%) patients who sustained other major injuries in addition to hip fracture. Nationally, these patients have a higher in-hospital mortality (11% v 5%). All of these patients had comprehensive geriatric assessment (CGA) and geriatrician-led MDT care. These patients are at high risk for poorer outcomes; delirium, pressure ulcers, hospital acquired infection and disability, prolonged length of stay, delayed transfers of care, premature institutionalisation and death.
Conclusion
There is a role for expansion of proactive early identification and geriatric medicine input for all older adults with major trauma, in addition to those with hip fractures and other injuries. The increased mortality in these patients has not previously been published. International evidence supports early intervention from a specialist geriatric medicine service, with CGA to provide exceptional, continuous and co-ordinated care.
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Affiliation(s)
- M Rafferty
- Cork University Hospital , Cork, Ireland
| | - D Murphy
- Cork University Hospital , Cork, Ireland
| | - T Cloney
- Cork University Hospital , Cork, Ireland
| | - L Brent
- National Office of Clinical Audit , Dublin, Ireland
| | - T Dukelow
- Cork University Hospital , Cork, Ireland
| | - E Ahern
- Cork University Hospital , Cork, Ireland
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Murphy J, Kelly R, Cathasaigh CN, Murphy D, Cloney T, Hayes K, Arrigan G, O'Sullivan A, Barry P, James K, Healy L. 168 AN EXPLORATION OF ATRIAL FIBRILLATION AND ANTICOAGULATION IN STROKE PATIENTS WHO UNDERGO THROMBECTOMY IN A TERTIARY THROMBECTOMY CENTRE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial Fibrillation is a significant cause of ischaemic stroke. Prevalence of atrial fibrillation in patients requiring thrombectomy is approximately 33%. Embolic thrombi which develop due to Atrial fibrillation may become targets for clot removal by thrombectomy in appropriate patients. Anticoagulation is one of the mainstays of treatment for atrial fibrillation.
Methods
A list of patients who had thrombectomy performed for ischaemic stroke in 2021 was compiled. Charts were reviewed to establish the prevalence of atrial fibrillation and the rates of appropriate dosing of anticoagulant. Of those who were not anticoagulated, we aimed to establish if there was a clear reason for this. This was performed in a tertiary referral centre with 24/7 access to thrombectomy.
Results
97 patients had thrombectomy performed for ischaemic stroke in 2021. 34/97(35%) had atrial fibrillation (21/97 pre-existing , 13/97 newly diagnosed on admission). 15/21 were anticoagulated and 6/21 were not anticoagulated at the time of their stroke. 5/6 had a clear reason documented for stopping anticoagulation. One patient had stopped anticoagulation due to cost. Of those with atrial fibrillation who were anticoagulated at the time of their stroke, 11 were anticoagulated with a Direct-Acting AntiCoagulant (DOAC) and four were anticoagulated with Warfarin. Of the Warfarin group, just one patients’ INR was therapeutic at the time of their stroke. Of the DOAC group, all were on the appropriate dose.
Conclusion
Stroke patients requiring thrombectomy are a group who may suffer the largest strokes. Incidence of atrial fibrillation was similar to previous studies. It was encouraging that there was a documented reason for all patients who were not anticoagulated, and that the DOAC dose was appropriate. Issues with therapeutic levels of Warfarin are further highlighted here. This study concludes that we may not be as bad at anticoagulation as we may think.
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Affiliation(s)
- J Murphy
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - R Kelly
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - CN Cathasaigh
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - D Murphy
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - T Cloney
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - K Hayes
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - G Arrigan
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - A O'Sullivan
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - P Barry
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - K James
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - L Healy
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
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Murphy D, Crowley A, Fitzpatrick M. 56 SARCOPENIA SCREENING FOR INDEPENDENTLY MOBILE STROKE PATIENTS IN AN ACUTE HOSPITAL SETTING. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Sarcopenia appears to be under-assessed and under-treated in the stroke population. It has been suggested by EWGSOP2 criteria, that if there is a clinical suspicion of sarcopenia, an intervention for this is appropriate. In order to establish the need for this in the independent stroke population an audit of the clinical prevalence of sarcopenia in independently mobile stroke patients was completed.
Methods
An excel spreadsheet was compiled of a convenient sample of stroke patients who were independently mobile post stroke. Their grip strength and five times sit to stand was audited along with the patient’s age and sex. This information was then used to assess for sarcopenia risk as per the EWGSOP2 guidelines.
Results
Fifteen patients were assessed, all of whom were independently mobile with or without an aid post admission for a primary diagnosis of acute stroke. Their age ranged from 64 to 86. Of these patients 93% were deemed likely to have sarcopenia based on their clinical assessment. This was based on grip strength measurements and time taken to complete five sit to stands. These clinical signs indicate low muscle strength and likely sarcopenia.
Conclusion
Currently no intervention is provided for these patients in relation to sarcopenia from the physiotherapy department. This audit indicates that this is currently an unmet need and these patients may benefit from an intervention to address this significant issue.
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Affiliation(s)
- D Murphy
- St. Vincent's University Hospital , Dublin, Ireland
| | - A Crowley
- St. Vincent's University Hospital , Dublin, Ireland
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Hadzic D, Ryan T, Murphy D. 165 PHARMACIST-LED MEDICINES RECONCILIATION: AN OBSERVATIONAL STUDY TO EVALUATE INFORMATION SOURCES AS A QUALITY INDICATOR OF THE SERVICE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Medicines Reconciliation (MR) involves obtaining a Best-Possible Medication History (BPMH) and is essential for reducing medication errors and adverse events. Recommendations on how best to undertake MR range from utilising the patient alone to using ≥2 sources (in addition to the patient). Few studies evaluate the use of >1 source as a measure of MR quality.
Methods
This observational study was undertaken in a major teaching hospital that provides a dedicated pharmacist-led MR service. Eligible patients (aged ≥65 years, admitted through the Emergency Department) were randomly recruited. MRs were compiled using 2 sources and compared to individual 1-source MRs (both in addition to patient/carer interview). Additional Medication Discrepancies (AMDs), or differences between 1-source and 2-source MR, were assessed and potential predictors analysed.
Results
A total of 114 patients were included. Community pharmacy was the most frequently used and most accurate source (full agreement in 97.4% of BPMHs). Two-thirds of MRs would not differ if either of the two sources were used in isolation, alongside patient/carer interview. The remaining MRs identified a total of 85 AMDs (1–6 per MR). The majority were drug omissions (49.4%). Most were deemed “low” potential clinical significance (59%). Higher patient/carer reliability was associated with lower incidence (p=0.001) and fewer AMDs (p=0.001).
Conclusion
Contrary to some international guidelines, using >1 source (in addition to patient/carer interview) does not add value to the BPMH in the majority of cases.
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Affiliation(s)
- D Hadzic
- Mater Misericordiae University Hospital Pharmacy Department, , Dublin, Ireland
- Trinity College School of Pharmacy and Pharmaceutical Sciences, The University of Dublin, , Dublin, Ireland
| | - T Ryan
- Trinity College School of Pharmacy and Pharmaceutical Sciences, The University of Dublin, , Dublin, Ireland
| | - D Murphy
- Mater Misericordiae University Hospital Pharmacy Department, , Dublin, Ireland
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Rafferty M, Murphy D, Creech J, Dukelow T, Ahern E. 256 THE DEVELOPMENT OF A PATIENT AND CARER INFORMATION LEAFLET FOR PATIENTS FOLLOWING HIP FRACTURE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Consistent delivery of high-quality information to family and caregivers can significantly improve patient experience and care during and after hospital admission. This became especially important with limited visiting hours during the COVID pandemic and our unit noted the need for appropriate written information. We aimed to complete a search of available resources nationally and internationally and develop our own information pack for distribution to our patients.
Methods
Literature search was conducted for available patient and carer information resources nationally and internationally including grey literature search. Key areas and patient priorities were identified. We then began developing a patient information booklet for distribution in our unit.
Results
We identified several key areas to be included in our information pack including what to expect during the hospital admission. This included pre-operative care, operative management, post-operative care especially delirium, pain, nutrition and continence promotion. Information regarding post-discharge care including off-site rehabilitation, rehabilitation at home and future actions including bone health and falls prevention interventions with home modification advice was also included. We developed a patient and caregiver information leaflet for our unit using data from the Irish Hip Fracture Database and our local unit practices and pathways to ensure information was relevant to our patients.
Conclusion
We completed the design of a patient and caregiver information leaflet highlighting important aspects of care post hip fracture in our unit.
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Affiliation(s)
- M Rafferty
- Cork University Hospital , Cork, Ireland
| | - D Murphy
- Cork University Hospital , Cork, Ireland
| | - J Creech
- Cork University Hospital , Cork, Ireland
| | - T Dukelow
- Cork University Hospital , Cork, Ireland
| | - E Ahern
- Cork University Hospital , Cork, Ireland
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30
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Gaffney E, Murphy D, Walsh A, Connolly S, Basdeo SA, Keane J, Phelan JJ. Defining the role of neutrophils in the lung during infection: Implications for tuberculosis disease. Front Immunol 2022; 13:984293. [PMID: 36203565 PMCID: PMC9531133 DOI: 10.3389/fimmu.2022.984293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
Neutrophils are implicated in the pathogenesis of many diseases involving inflammation. Neutrophils are also critical to host defence and have a key role in the innate immune response to infection. Despite their efficiencies against a wide range of pathogens however, their ability to contain and combat Mycobacterium tuberculosis (Mtb) in the lung remains uncertain and contentious. The host response to Mtb infection is very complex, involving the secretion of various cytokines and chemokines from a wide variety of immune cells, including neutrophils, macrophages, monocytes, T cells, B cells, NK cells and dendritic cells. Considering the contributing role neutrophils play in the advancement of many diseases, understanding how an inflammatory microenvironment affects neutrophils, and how neutrophils interact with other immune cells, particularly in the context of the infected lung, may aid the design of immunomodulatory therapies. In the current review, we provide a brief overview of the mechanisms that underpin pathogen clearance by neutrophils and discuss their role in the context of Mtb and non-Mtb infection. Next, we examine the current evidence demonstrating how neutrophils interact with a range of human and non-human immune cells and how these interactions can differentially prime, activate and alter a repertoire of neutrophil effector functions. Furthermore, we discuss the metabolic pathways employed by neutrophils in modulating their response to activation, pathogen stimulation and infection. To conclude, we highlight knowledge gaps in the field and discuss plausible novel drug treatments that target host neutrophil metabolism and function which could hold therapeutic potential for people suffering from respiratory infections.
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Llera A, Brammer M, Oakley B, Tillmann J, Zabihi M, Amelink JS, Mei T, Charman T, Ecker C, Dell'Acqua F, Banaschewski T, Moessnang C, Baron-Cohen S, Holt R, Durston S, Murphy D, Loth E, Buitelaar JK, Floris DL, Beckmann CF. Evaluation of data imputation strategies in complex, deeply-phenotyped data sets: the case of the EU-AIMS Longitudinal European Autism Project. BMC Med Res Methodol 2022; 22:229. [PMID: 35971088 PMCID: PMC9380301 DOI: 10.1186/s12874-022-01656-z] [Citation(s) in RCA: 1] [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: 02/10/2022] [Accepted: 06/02/2022] [Indexed: 12/19/2022] Open
Abstract
An increasing number of large-scale multi-modal research initiatives has been conducted in the typically developing population, e.g. Dev. Cogn. Neur. 32:43-54, 2018; PLoS Med. 12(3):e1001779, 2015; Elam and Van Essen, Enc. Comp. Neur., 2013, as well as in psychiatric cohorts, e.g. Trans. Psych. 10(1):100, 2020; Mol. Psych. 19:659–667, 2014; Mol. Aut. 8:24, 2017; Eur. Child and Adol. Psych. 24(3):265–281, 2015. Missing data is a common problem in such datasets due to the difficulty of assessing multiple measures on a large number of participants. The consequences of missing data accumulate when researchers aim to integrate relationships across multiple measures. Here we aim to evaluate different imputation strategies to fill in missing values in clinical data from a large (total N = 764) and deeply phenotyped (i.e. range of clinical and cognitive instruments administered) sample of N = 453 autistic individuals and N = 311 control individuals recruited as part of the EU-AIMS Longitudinal European Autism Project (LEAP) consortium. In particular, we consider a total of 160 clinical measures divided in 15 overlapping subsets of participants. We use two simple but common univariate strategies—mean and median imputation—as well as a Round Robin regression approach involving four independent multivariate regression models including Bayesian Ridge regression, as well as several non-linear models: Decision Trees (Extra Trees., and Nearest Neighbours regression. We evaluate the models using the traditional mean square error towards removed available data, and also consider the Kullback–Leibler divergence between the observed and the imputed distributions. We show that all of the multivariate approaches tested provide a substantial improvement compared to typical univariate approaches. Further, our analyses reveal that across all 15 data-subsets tested, an Extra Trees regression approach provided the best global results. This not only allows the selection of a unique model to impute missing data for the LEAP project and delivers a fixed set of imputed clinical data to be used by researchers working with the LEAP dataset in the future, but provides more general guidelines for data imputation in large scale epidemiological studies.
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Affiliation(s)
- A Llera
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands. .,Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands. .,LIS Data Solutions, Machine Learning Group, Santander, Spain.
| | - M Brammer
- Institute of Psychiatry, Psychology, and Neuroscience, Sackler Institute for Translational Neurodevelopment, King's College London, London, UK
| | - B Oakley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - J Tillmann
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - M Zabihi
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J S Amelink
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands.,Max Planck Institute for Psycholinguistics, Language & Genetics Department, Nijmegen, The Netherlands
| | - T Mei
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - T Charman
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - C Ecker
- Institute of Psychiatry, Psychology, and Neuroscience, Sackler Institute for Translational Neurodevelopment, King's College London, London, UK.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt Am Main, Goethe University, Frankfurt, Germany
| | - F Dell'Acqua
- Institute of Psychiatry, Psychology, and Neuroscience, Sackler Institute for Translational Neurodevelopment, King's College London, London, UK
| | - T Banaschewski
- Child and Adolescent Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - C Moessnang
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt Am Main, Goethe University, Frankfurt, Germany.,Department of Applied Psychology, SRH University, Heidelberg, Germany
| | - S Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - R Holt
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - S Durston
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D Murphy
- Institute of Psychiatry, Psychology, and Neuroscience, Sackler Institute for Translational Neurodevelopment, King's College London, London, UK.,Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - E Loth
- Institute of Psychiatry, Psychology, and Neuroscience, Sackler Institute for Translational Neurodevelopment, King's College London, London, UK.,Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - J K Buitelaar
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - D L Floris
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands.,Methods of Plasticity Research, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - C F Beckmann
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands.,Wellcome Centre for Integrative Neuroimaging - Centre for Functional MRI of the Brain (WIN FMRIB), University of Oxford, Oxford, UK
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Goyal S, Chua C, Chen YS, Murphy D, O 'Neill GK. Utility of 3D printed models as adjunct in acetabular fracture teaching for Orthopaedic trainees. BMC Med Educ 2022; 22:595. [PMID: 35918716 PMCID: PMC9344721 DOI: 10.1186/s12909-022-03621-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the use of 3-D printed models as compared to didactic lectures in the teaching of acetabular fractures for Orthopaedic trainees. METHODS This was a randomised prospective study conducted in a tertiary hospital setting which consisted of 16 Orthopaedic residents. Ten different cases of acetabular fracture patterns were identified and printed as 3-D models. The baseline knowledge of orthopaedic residents regarding acetabular fracture classification and surgical approach was determined by an x-ray based pre-test. Trainees were then randomly assigned into two groups. Group I received only lectures. Group II were additionally provided with 3-D printed models during the lecture. Participants were then assessed for comprehension and retention of teaching. RESULTS Sixteen trainees participated in the trial. Both Group 1 and 2 improved post teaching with a mean score of 2.5 and 1.9 to 4.4 and 6 out of 10 respectively. The post test score for fracture classification and surgical approach were significantly higher for 3-D model group (p < 0.05). Trainees felt that the physical characteristics of the 3-D models were a good representation of acetabular fracture configuration, and should be used routinely for teaching and surgical planning. CONCLUSION 3-D printed model of real clinical cases have significant educational impact compared to lecture-based learning towards improving young trainees' understanding of complex acetabular fractures.
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Affiliation(s)
- S Goyal
- Department of Orthopaedics, University Orthopaedics and Hand & Reconstructive Microsurgery Centre, National University Health System, Level 11, Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Cxk Chua
- Department of Orthopaedics, University Orthopaedics and Hand & Reconstructive Microsurgery Centre, National University Health System, Level 11, Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Y S Chen
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore
| | - D Murphy
- Department of Orthopaedics, University Orthopaedics and Hand & Reconstructive Microsurgery Centre, National University Health System, Level 11, Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - G K O 'Neill
- Department of Orthopaedics, University Orthopaedics and Hand & Reconstructive Microsurgery Centre, National University Health System, Level 11, Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
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Mendez M, San Jose Caceres A, Oakley B, Murphy D, Arango C, Parellada M, Canitano R, Quoidbach V. Care pathway for autistic children and their families in Europe. Eur Psychiatry 2022. [PMCID: PMC9567829 DOI: 10.1192/j.eurpsy.2022.1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Autism is a lifelong complex neurodevelopmental condition that affects brain development and behaviour with significant consequences for everyday life (WHO, 2018). Despite its personal, familial and societal impact, there is still a European-wide lack of harmonised guidelines about the support needed from early stages, the most sensitive time to gain positive future outcomes (Berajamo-Martin et al, 2019). Objectives The objectives were: 1. To analyse autistic children care pathway and patient/carer journey in three European countries: Italy, Spain and U.K. 2. To propose policy recommendations on how to improve this pathway. Methods To identify major barriers and treatment gaps, we conducted a rapid literature review of the care pathway in Europe and a survey aimed at parents or carers of autistic children ages 0 to 18 living in the three countries. The survey gathered information on screening, diagnosis, accessibility and support received before, during and after diagnosis. Members of the working group met to discuss results and propose policy recommendations. Results 1. Current care pathway analysis showed the following treatment gaps: Long waiting time from first concerns until screening visit and confirmed diagnosis. Delayed or no access to intervention once diagnosis has been confirmed. Overall limited information about autism and how to access early detection services. Overall deficient support to families. 2. Please see Box 1 for our proposed policy recommendations. Box 1. Policy recommendations ![]()
Conclusions Our findings and recommendations will inform policy harmonisation in Europe to shorten long waiting times, diagnosis process and intervention, and therefore, improve autistic people and their families’ journey experience and quality of life. Disclosure No significant relationships.
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Goodman DT, Murphy D, Dorairaj J. Case Study: Soft Tissue Infection with Raoultella ornithinolytica. JPRAS Open 2022; 33:17-20. [PMID: 35633992 PMCID: PMC9133572 DOI: 10.1016/j.jpra.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/23/2022] [Indexed: 11/25/2022] Open
Abstract
Raoultella ornithinolytica is a rare encapsulated Gram-negative aerobic and facultative anaerobic rod belonging to the Enterobacteriaceae family. It tends to inhabit water and soil environments and can be found on insects, fish, ticks, and termites, but can also found in the hospital environment.1,2R ornithinolytica has been documented in respiratory, urinary, gastrointestinal, and biliary tract infections as well as bacteraemia and systemic infections but has rarely been documented in soft tissue infections.2 This case study describes a recurrent paronychia infection secondary to R ornithinolytica in a young woman not responding to antibiotics and successfully treated with surgical management.
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Crowley P, Cloney T, McGurk C, Murphy D, Ahern E. Nursing Homes, Falls and the Myth of 24 Hour Supervision. Ir Med J 2022; 115:592. [PMID: 35695999] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- P Crowley
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - T Cloney
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - C McGurk
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - D Murphy
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - E Ahern
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
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Zhao Z, Murphy D, Gifford H, Williams S, Darlington A, Relton SD, Fang H, Wong DC. Analysis of an adaptive lead weighted ResNet for multiclass classification of 12-lead ECGs. Physiol Meas 2022; 43. [PMID: 35255483 DOI: 10.1088/1361-6579/ac5b4a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/07/2022] [Indexed: 11/11/2022]
Abstract
Background. Twelve lead ECGs are a core diagnostic tool for cardiovascular diseases. Here, we describe and analyse an ensemble deep neural network architecture to classify 24 cardiac abnormalities from 12 lead ECGs.Method. We proposed a squeeze and excite ResNet to automatically learn deep features from 12-lead ECGs, in order to identify 24 cardiac conditions. The deep features were augmented with age and gender features in the final fully connected layers. Output thresholds for each class were set using a constrained grid search. To determine why the model made incorrect predictions, two expert clinicians independently interpreted a random set of 100 misclassified ECGs concerning left axis deviation.Results. Using the bespoke weighted accuracy metric, we achieved a 5-fold cross-validation score of 0.684, and sensitivity and specificity of 0.758 and 0.969, respectively. We scored 0.520 on the full test data, and ranked 2nd out of 41 in the official challenge rankings. On a random set of misclassified ECGs, agreement between two clinicians and training labels was poor (clinician 1:κ= -0.057, clinician 2:κ= -0.159). In contrast, agreement between the clinicians was very high (κ= 0.92).Discussion. The proposed prediction model performed well on the validation and hidden test data in comparison to models trained on the same data. We also discovered considerable inconsistency in training labels, which is likely to hinder development of more accurate models.
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Affiliation(s)
- Z Zhao
- University of Manchester, United Kingdom.,Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - D Murphy
- University of Manchester, United Kingdom
| | - H Gifford
- University of Exeter, Exeter, United Kingdom
| | - S Williams
- University of Leeds, Leeds, United Kingdom
| | | | - S D Relton
- University of Leeds, Leeds, United Kingdom
| | - H Fang
- Loughborough University, Loughborough, United Kingdom
| | - D C Wong
- University of Manchester, United Kingdom
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Martins DA, Mazibuko N, Zelaya F, Vasilakopoulou S, Loveridge J, Oates A, Maltezos S, Mehta M, Wastling S, Howard M, McAlonan G, Murphy D, Williams SCR, Fotopoulou A, Schuschnig U, Paloyelis Y. Author Correction: Effects of route of administration on oxytocin-induced changes in regional cerebral blood flow in humans. Nat Commun 2022; 13:1876. [PMID: 35361784 PMCID: PMC8971402 DOI: 10.1038/s41467-022-29419-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- D A Martins
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - N Mazibuko
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - F Zelaya
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S Vasilakopoulou
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J Loveridge
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A Oates
- South London and Maudsley NHS Foundation Trust, London, UK
| | - S Maltezos
- Adult Autism and ADHD Service, South London and Maudsley NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M Mehta
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S Wastling
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK.,Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - M Howard
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - G McAlonan
- Department of Forensic and Neurodevelopmental Science (SM), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - D Murphy
- Department of Forensic and Neurodevelopmental Science (SM), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S C R Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A Fotopoulou
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Y Paloyelis
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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McGurk C, Burke B, Murphy D, Claffey P, O'Keeffe S, Ahern E. Is it Time to Bin Next of Kin? Ir Med J 2022; 115:573. [PMID: 35532972] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- C McGurk
- Department of Geriatric Medicine, Cork University Hospital, Cork Ireland
| | - B Burke
- Department of Geriatric Medicine, Cork University Hospital, Cork Ireland
| | - D Murphy
- Department of Geriatric Medicine, Cork University Hospital, Cork Ireland
| | - P Claffey
- Department of Geriatric Medicine, Cork University Hospital, Cork Ireland
| | - S O'Keeffe
- Department of Geriatric Medicine, Galway University Hospital, Galway, Ireland
| | - E Ahern
- Department of Geriatric Medicine, Cork University Hospital, Cork Ireland
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Doan P, Counter W, Sheehan-Dare G, Papa N, Ho B, Lee J, Liu V, Thompson J, Agrawal S, Roberts M, Algharzo O, Buteau J, Hofman M, Moon D, Murphy D, Stricker P, Emmett L. Diagnostic accuracy, concordance and certainty with 68Ga-PSMA-11 PET/MRI fusion compared to mpMRI and 68Ga-PSMA-11 PET/CT alone for prostate cancer diagnosis: A PRIMARY trial sub-study. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00822-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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PARMAR S, Murphy D, Warrens H, Samir R, Anderson L, Banerjee D. POS-268 THE IMPACT OF HEART FAILURE AND CHRONIC KIDNEY DISEASE STAGES ON MORTALITY IN PATIENTS WITH BOTH CONDITIONS: AN AUDIT OF A NOVEL JOINT CLINIC. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Chen K, O'Brien J, Jenjitranant P, Alghazo O, Kelly B, Murphy D, Moon D. Robotic partial nephrectomy for complex hilar renal masses - key techniques for a successful outcome. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01356-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Al-Zubaidy M, Ghareeb A, Mostafa I, Mehta A, Murphy D, Sadiq S, Song A, Tzoumas N, Steel DH. Infographic: residual intraretinal edema after 25-gauge vitrectomy and macular pucker removal: Is intraoperative sustained-release dexamethasone a real treatment option? Eye (Lond) 2022; 36:5-6. [PMID: 33972711 PMCID: PMC8727609 DOI: 10.1038/s41433-021-01533-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
- M. Al-Zubaidy
- grid.1006.70000 0001 0462 7212Institute of Biosciences, Newcastle University, Newcastle upon Tyne, UK
| | - A. Ghareeb
- grid.1006.70000 0001 0462 7212Institute of Biosciences, Newcastle University, Newcastle upon Tyne, UK
| | - I. Mostafa
- grid.1006.70000 0001 0462 7212Institute of Biosciences, Newcastle University, Newcastle upon Tyne, UK
| | - A. Mehta
- grid.1006.70000 0001 0462 7212Institute of Biosciences, Newcastle University, Newcastle upon Tyne, UK
| | - D. Murphy
- grid.1006.70000 0001 0462 7212Institute of Biosciences, Newcastle University, Newcastle upon Tyne, UK
| | - S. Sadiq
- grid.1006.70000 0001 0462 7212Institute of Biosciences, Newcastle University, Newcastle upon Tyne, UK
| | - A. Song
- grid.1006.70000 0001 0462 7212Institute of Biosciences, Newcastle University, Newcastle upon Tyne, UK
| | - N. Tzoumas
- grid.1006.70000 0001 0462 7212Institute of Biosciences, Newcastle University, Newcastle upon Tyne, UK
| | - D. H. Steel
- grid.1006.70000 0001 0462 7212Institute of Biosciences, Newcastle University, Newcastle upon Tyne, UK
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Malhotra R, Huq SS, Chong M, Murphy D, Daruwalla ZJ. Outcomes in Nonagenarians with Hip Fractures Treated Conservatively and Surgically. Malays Orthop J 2021; 15:21-28. [PMID: 34966491 PMCID: PMC8667238 DOI: 10.5704/moj.2111.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/14/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction We aimed to assess the clinical outcomes in nonagenarians following a hip fracture. We also further investigated the factors that influence these outcomes, such as method of treatment (operative versus conservative), co-morbidities, and pre-morbid function. Materials and methods We studied 65 nonagenarians that were identifiable from our hospital hip fracture database. We reviewed various parameters of these patients admitted after sustaining a hip fracture (neck of femur or intertrochanteric) and investigated how these parameters affected patient outcomes. The main outcomes studied were: inpatient morbidity, and mortality at one year. Results Inpatient morbidity was more likely in patients with an ASA grade of 3 to 5. Urinary tract infection was the most common medical complication. The 1-year mortality was 15.4% and was significantly influenced by advancing age. Surgically managed patients had a 1-year mortality rate (14.3%) slightly less than non-operative patients (17.4%). Post injury mobility was significantly better in those who received operative treatment with 63% of surgical cases regaining ambulatory status versus 7% of conservatively managed patients. Conclusions We presented the outcomes of hip fractures in an extreme age group in the population. In nonagenarians with hip fractures surgery was associated with a 1-year mortality rate of 14.3% which is comparable to the general hip fracture population and less than the mortality rate of conservatively managed patients (17.4%). The primary advantage of surgery would be that two-thirds of patients return to ambulatory status. This information is useful to counsel patients and their families especially since the elderly are often more fearful of surgical intervention.
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Affiliation(s)
- R Malhotra
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
| | - S S Huq
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
| | - M Chong
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
| | - D Murphy
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
| | - Z J Daruwalla
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
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Mason L, Shic F, Falck-Ytter T, Chakrabarti B, Charman T, Loth E, Tillmann J, Banaschewski T, Baron-Cohen S, Bölte S, Buitelaar J, Durston S, Oranje B, Persico AM, Beckmann C, Bougeron T, Dell'Acqua F, Ecker C, Moessnang C, Murphy D, Johnson MH, Jones EJH. Preference for biological motion is reduced in ASD: implications for clinical trials and the search for biomarkers. Mol Autism 2021; 12:74. [PMID: 34911565 PMCID: PMC8672507 DOI: 10.1186/s13229-021-00476-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The neurocognitive mechanisms underlying autism spectrum disorder (ASD) remain unclear. Progress has been largely hampered by small sample sizes, variable age ranges and resulting inconsistent findings. There is a pressing need for large definitive studies to delineate the nature and extent of key case/control differences to direct research towards fruitful areas for future investigation. Here we focus on perception of biological motion, a promising index of social brain function which may be altered in ASD. In a large sample ranging from childhood to adulthood, we assess whether biological motion preference differs in ASD compared to neurotypical participants (NT), how differences are modulated by age and sex and whether they are associated with dimensional variation in concurrent or later symptomatology. METHODS Eye-tracking data were collected from 486 6-to-30-year-old autistic (N = 282) and non-autistic control (N = 204) participants whilst they viewed 28 trials pairing biological (BM) and control (non-biological, CTRL) motion. Preference for the biological motion stimulus was calculated as (1) proportion looking time difference (BM-CTRL) and (2) peak look duration difference (BM-CTRL). RESULTS The ASD group showed a present but weaker preference for biological motion than the NT group. The nature of the control stimulus modulated preference for biological motion in both groups. Biological motion preference did not vary with age, gender, or concurrent or prospective social communicative skill within the ASD group, although a lack of clear preference for either stimulus was associated with higher social-communicative symptoms at baseline. LIMITATIONS The paired visual preference we used may underestimate preference for a stimulus in younger and lower IQ individuals. Our ASD group had a lower average IQ by approximately seven points. 18% of our sample was not analysed for various technical and behavioural reasons. CONCLUSIONS Biological motion preference elicits small-to-medium-sized case-control effects, but individual differences do not strongly relate to core social autism associated symptomatology. We interpret this as an autistic difference (as opposed to a deficit) likely manifest in social brain regions. The extent to which this is an innate difference present from birth and central to the autistic phenotype, or the consequence of a life lived with ASD, is unclear.
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Affiliation(s)
- L Mason
- Centre for Brain and Cognitive Development, Birkbeck, University of London, Malet St, London, WC1E 7HX, UK.
| | - F Shic
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
- Department of General Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Department of Computer Science, University of Washington, Seattle, WA, USA
| | - T Falck-Ytter
- Development and Neurodiversity Lab, Department of Psychology, Uppsala University, Uppsala, Sweden
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet and Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Swedish Collegium for Advanced Study, Uppsala, Sweden
| | - B Chakrabarti
- Centre for Autism, School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK
- Department of Psychology, Ashoka University, Sonipat, India
- India Autism Center, Kolkata, India
| | - T Charman
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, London, UK
| | - E Loth
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, London, UK
| | - J Tillmann
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, London, UK
| | - T Banaschewski
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - S Baron-Cohen
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - S Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet and Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - J Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - S Durston
- NICHE-Lab, Dept. of Psychiatry, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - B Oranje
- NICHE-Lab, Dept. of Psychiatry, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - A M Persico
- Interdepartmental Program "Autism 0-90", University of Messina, Messina, Italy
| | - C Beckmann
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - T Bougeron
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR3571 CNRS, Université de Paris, 75015, Paris, France
| | - F Dell'Acqua
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, London, UK
| | - C Ecker
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, London, UK
- Department of Child and Adolescent Psychiatry, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - C Moessnang
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - D Murphy
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, London, UK
| | - M H Johnson
- Centre for Brain and Cognitive Development, Birkbeck, University of London, Malet St, London, WC1E 7HX, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - E J H Jones
- Centre for Brain and Cognitive Development, Birkbeck, University of London, Malet St, London, WC1E 7HX, UK
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Keane A, Regan SO, Quinn L, Murphy D, Kelly BO, Lynam A, Lyons F, Devitt E. Evaluation of the impact of human immunodeficiency virus pre-exposure prophylaxis on new human immunodeficiency virus diagnoses during the COVID-19 pandemic. Int J STD AIDS 2021; 33:99-102. [PMID: 34852685 DOI: 10.1177/09564624211054587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS The national PrEP programme launched in Ireland in November 2019 with tenofovir/emtricitabine free to those meeting eligibility criteria. We assessed the impact of the first year of the PrEP programme on new HIV diagnoses in the largest sexual health and HIV service in Ireland. METHODS A free PrEP service was established in November 2019. We reviewed the number of new diagnoses of HIV between November 2018-2019, before the introduction of the national PrEP programme and compared this with the number of new HIV diagnosis between November 2019-2020. RESULTS There were 95 new HIV diagnoses (63.3% MSM) between November 2018 and 2019 and 73 new HIV diagnoses (65.7% MSM) between November 2019 and 2020. There was a statistically significant decline in new HIV diagnoses between the 2 years (P = 0.0003). 546 patients were prescribed PrEP as of December 2020.106 patients (19.4%) changed their PrEP dosing regimen due to lockdown. 178 individuals (32.6%) had a rectal infection diagnosed. CONCLUSION There has been a reduction in new HIV diagnoses in our cohort (although this has occurred during a global pandemic). It is too early to say if PrEP reduces late presentations of HIV based on our findings. A significant number of rectal infections were identified in the PrEP clinic suggesting ongoing risk despite pandemic restrictions. Further research into sexual practices during COVID-19 is needed to assess if this had an impact on the lower rates of HIV acquisition.
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Affiliation(s)
- A Keane
- Department of Genitourinary Medicine and Infectious Diseases, 58024GUIDE Clinic, St James Hospital, Dublin, Ireland
| | - S O Regan
- Department of Genitourinary Medicine and Infectious Diseases, 58024GUIDE Clinic, St James Hospital, Dublin, Ireland
| | - L Quinn
- Department of Genitourinary Medicine and Infectious Diseases, 58024GUIDE Clinic, St James Hospital, Dublin, Ireland
| | - D Murphy
- Department of Genitourinary Medicine and Infectious Diseases, 58024GUIDE Clinic, St James Hospital, Dublin, Ireland
| | - B O Kelly
- Department of Genitourinary Medicine and Infectious Diseases, 58024GUIDE Clinic, St James Hospital, Dublin, Ireland
| | - A Lynam
- Department of Genitourinary Medicine and Infectious Diseases, 58024GUIDE Clinic, St James Hospital, Dublin, Ireland
| | - F Lyons
- Department of Genitourinary Medicine and Infectious Diseases, 58024GUIDE Clinic, St James Hospital, Dublin, Ireland
| | - E Devitt
- Department of Genitourinary Medicine and Infectious Diseases, 58024GUIDE Clinic, St James Hospital, Dublin, Ireland
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Burke B, McGurk C, Murphy D, Claffey P, O'Keeffe S, Aherne E. 160 TIME TO BIN ‘NEXT OF KIN’?—JUNIOR DOCTORS DEMONSTRATE POOR UNDERSTANDING OF THE TERM IN IRELAND. Age Ageing 2021. [DOI: 10.1093/ageing/afab216.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
‘Next of kin’ (NOK) is a term widely used in the healthcare setting in Ireland to indicate an individual that can be contacted in the event of an emergency when a patient is in hospital. While it has its origins in Irish inheritance law, the term confers no legal or decision-making authority to any other individuals on behalf of a patient in hospital. However, anecdotally, the term is commonly misunderstood with a false belief among healthcare staff that consent should be sought from the NOK when a patient is unable to do so. In this study we sought to assess current understanding of the term among Irish non-consultant hospital doctors (NCHDs).
Methods
Data was collected via an online survey, completed by NCHDs across a number of medical and surgical disciplines to investigate their understanding of the term. Descriptive analysis of data was performed in Excel.
Results
118 NCHDs completed the survey. While 110 (93.2%) believed a NOK was an emergency contact, 53 (44.9%) believed they assisted in decision making; 58 (49.2%) thought they could provide medical information about the patient. Forty-four doctors (37.3%) believed a NOK was permitted to make medical decisions while 59 (50%) felt they could provide consent on behalf of an incapacitated patient. Sixty-three (53.4%) believed a NOK had legal entitlement to information over and above that of another family member or friend.
Conclusion
This study highlights several misconceptions surrounding the term ‘next of kin’ in the Irish healthcare setting, particularly around the area of decision-making authority and consent. The term is confusing and unhelpful and should not be used in healthcare. ‘Contact person’ or ‘emergency contact’ are appropriate alternatives. Further education to NCHDs around consent and maintenance of patient autonomy is necessary.
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Affiliation(s)
- B Burke
- Department of Geriatric Medicine, Cork University Hospital , Cork, Ireland
| | - C McGurk
- Department of Geriatric Medicine, Cork University Hospital , Cork, Ireland
| | - D Murphy
- Department of Geriatric Medicine, Cork University Hospital , Cork, Ireland
| | - P Claffey
- Department of Geriatric Medicine, Cork University Hospital , Cork, Ireland
| | - S O'Keeffe
- Department of Geriatric Medicine, Galway University Hospital , Galway, Ireland
| | - E Aherne
- Department of Geriatric Medicine, Cork University Hospital , Cork, Ireland
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Pezzetta C, Folli A, Matuszewska O, Murphy D, Davidson RWM, Bonifazi D. Front Cover Picture:
peri
‐Xanthenoxanthene (PXX): a Versatile Organic Photocatalyst in Organic Synthesis (Adv. Synth. Catal. 20/2021). Adv Synth Catal 2021. [DOI: 10.1002/adsc.202101163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- C. Pezzetta
- School of Chemistry Cardiff University Park Place Cardiff CF10 3AT United Kingdom
- Dr. Reddy's Laboratories (EU) 410 Science Park, Milton Road Cambridge CB4 0PE United Kingdom
| | - A. Folli
- School of Chemistry Cardiff University Park Place Cardiff CF10 3AT United Kingdom
| | - O. Matuszewska
- School of Chemistry Cardiff University Park Place Cardiff CF10 3AT United Kingdom
| | - D. Murphy
- School of Chemistry Cardiff University Park Place Cardiff CF10 3AT United Kingdom
| | - R. W. M. Davidson
- Dr. Reddy's Laboratories (EU) 410 Science Park, Milton Road Cambridge CB4 0PE United Kingdom
| | - D. Bonifazi
- School of Chemistry Cardiff University Park Place Cardiff CF10 3AT United Kingdom
- Institute of Organic Chemistry Faculty of Chemistry University of Vienna Währinger Strasse 38 1090 Vienna Austria
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Hosseini F, Gulsin G, Murphy D, Hawkins N, Andrade J, Laksman Z, Bennett M, Yeung-Lai-Wah J, Chakrabarti S, Krahn A, Deyell M. Magnetic resonance imaging in the evaluation of idiopathic frequent premature ventricular complexes with normal ventricular function. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The role of cardiac magnetic resonance (CMR) imaging in the diagnostic evaluation of patients with frequent premature ventricular complexes (PVCs) and normal left ventricular ejection fraction (LVEF) remains unclear. Existing data has been predominantly derived from highly selected populations, that may overestimate the true prevalence of abnormal findings on CMR in this patient population.
Purpose
The aim of this study was 2-fold: 1) to establish the prevalence of CMR imaging abnormalities in a cohort with normal LVEF and high PVC burden; 2) to identify predictors of CMR imaging abnormalities in patients with frequent PVCs and normal LVEF.
Methods
In this cohort study, 211 patients (age 53.2±19 years; 41% male) with frequent PVCs (≥5%/24 h), of normal LVEF (≥50% by echocardiography) and no known underlying structural heart disease were prospectively enrolled from 2016–2020. Of these, 166 (79%) patients were symptomatic from their PVCs in the form of palpitations, fatigue, chest pain, dizziness, and/or dyspnea. Patients underwent CMR imaging (1.5 Tesla) with a late gadolinium enhancement (LGE) protocol at the time of enrollment for the detection of scarring and/or fibrosis.
Results
Patients had a median baseline echocardiographic LVEF of 60% (± 5%) with 195 (92%) of patients having a normal native QRS morphology. Median PVC burden of the study cohort was 16% (± 14%). CMR LGE abnormalities were found in 19 (9%) patients including 17 scans with non-ischemic LGE and 2 with ischemic LGE. Age >60 (odds ratio [OR]: 3.20, 95% confidence interval [CI]: 1.20–8.51, p=0.020), male sex (OR: 4.67, 95% CI: 1.61–13.50, p=0.004), history of hypertension (OR: 3.43, 95% CI: 1.31–8.97, p=0.012), native QRS duration (OR: 1.03, 95% CI: 1.00–1.05, p=0.031), and history of non-sustained ventricular tachycardia (OR: 2.81, 95% CI: 1.03–7.68, p=0.044) were significantly associated with the presence of imaging abnormalities on CMR. Dominant PVC origin from the left ventricle had a positive trend (OR: 2.60, 95% CI: 0.99–7.66, p=0.083) to association with CMR imaging abnormalities. On multivariate analysis, male sex (OR: 4.10, 95% CI: 1.40–12.04, p=0.010) and history of hypertension (OR: 2.89, 95% CI: 1.08–7.75, p=0.035) remained significantly associated with the presence of CMR abnormalities. There was no association between CMR imaging abnormalities and the burden of PVCs or the number of PVC morphologies.
Conclusion
In this cohort, only 9% of patients with apparently idiopathic frequent PVCs and normal LVEF had concealed myocardial abnormalities on CMR imaging. Male sex and history of hypertension were associated with a higher rate of CMR abnormalities.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Hosseini
- University of British Columbia, Division of Internal Medicine, Department of Medicine, Vancouver, Canada
| | - G Gulsin
- University of British Columbia, Department of Radiology, Vancouver, Canada
| | - D Murphy
- University of British Columbia, Department of Radiology, Vancouver, Canada
| | - N Hawkins
- University of British Columbia, Heart Rhythm Services, Centre for Cardiovascular Innovation, Vancouver, Canada
| | - J Andrade
- University of British Columbia, Heart Rhythm Services, Centre for Cardiovascular Innovation, Vancouver, Canada
| | - Z Laksman
- University of British Columbia, Heart Rhythm Services, Centre for Cardiovascular Innovation, Vancouver, Canada
| | - M Bennett
- University of British Columbia, Heart Rhythm Services, Centre for Cardiovascular Innovation, Vancouver, Canada
| | - J Yeung-Lai-Wah
- University of British Columbia, Heart Rhythm Services, Vancouver, Canada
| | - S Chakrabarti
- University of British Columbia, Heart Rhythm Services, Vancouver, Canada
| | - A Krahn
- University of British Columbia, Heart Rhythm Services, Centre for Cardiovascular Innovation, Vancouver, Canada
| | - M Deyell
- University of British Columbia, Heart Rhythm Services, Centre for Cardiovascular Innovation, Vancouver, Canada
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Murphy D, Graby J, McKenzie D, Kandan SR, Carson K, Lowe R, Khavandi A, Hudson B, Rodrigues J. FFRCT and Invasive Coronary Angiography – assessing concordance in an unselected UK real world population. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
CT coronary angiography (CTCA) Fractional Flow Reserve (FFRCT) is a key investigation in chronic coronary syndrome (CCS) guidelines. FFR calculated from CTCA may help improve CTCA specificity for flow limiting disease, preventing unnecessary invasive coronary angiography (ICA).
Purpose
To (1) assess the treatment planning potential of FFRCT by determining the concordance of FFRCT with an ICA +/− invasive physiological assessment for the detection of flow limiting CAD in a real world NHS setting and (2) concordance sub-analysis of concordance of invasive iFR and FFRCT.
Methods
A single-centre retrospective analysis of a prospectively maintained clinical CTCA database. We identified patients with CCS who had CTCA FFRCT and subsequent ICA from August 2018 to January 2021. Concordance was assessed on a per patient and per vessel basis (major epicardial vessels: left main stem [LMS], left anterior descending artery [LAD], circumflex [LCx], right coronary artery [RCA]). Two non-invasive ischaemia thresholds were examined an FFRCT ≤0.8 and <0.75 (2 cm distal to stenosis). This was compared to a clinical ICA assessment where a flow limiting lesion was defined as a stenosis >70% (or >50% in the LMS) and/or an end vessel iFR ≤0.89 / FFR ≤0.8. All vessels that underwent an iFR, at the interventionists discretion, were then assessed relative to their end-vessel FFRCT.
Results
565 patients had a CTCA with FFRCT and 164 patients had a subsequent ICA and were suitable for analysis. On a per patient basis 69% of those referred to ICA with an FFRCT ≤0.8 of at least one major epicardial vessel had any flow limiting CAD at ICA. With an FFRCT <0.75 this was 73%. Table 1 illustrates the per vessel concordance.
A total of 120 vessels were included in the iFR subsection analysis. The mean FFRCT was 0.71 (±0.13) and mean iFR was 0.89 (±0.1). Accuracy was 54% (95% CI 45–63%) with a sensitivity of 89% (95% CI 76–96%), specificity 32% (95% CI 22–44%), positive predictive value 45% (95% CI 40–50%) and negative predictive value of 83% (95% CI 66–92%). A Pearson's correlation coefficient of 0.23 was found.
Conclusion
This study demonstrated that the negative predictive value of FFRCT was excellent, including importantly for LMS analysis. The specificity on a per vessel basis was good with the exception of the LAD assessment. This may have implications for interventional planning with this imaging modality. FFRCT correlated poorly with invasive iFR in this subsection analysis although selection bias may be contributing. There remains a significant proportion of patients referred for an ICA where no flow limiting CAD is found.
Funding Acknowledgement
Type of funding sources: None. Table 1. Per vessel concordance analysis of potential flow limiting FFRCT relative to clinical ICA findings. Analysed with an ischaemia threshold of FFRCT ≤0.80 and <0.75. PPV = Positive Predictive Value. NPV = Negative Predictive Value.
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Affiliation(s)
- D Murphy
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
| | - J Graby
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
| | - D McKenzie
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
| | - S R Kandan
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
| | - K Carson
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
| | - R Lowe
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
| | - A Khavandi
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
| | - B Hudson
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
| | - J Rodrigues
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
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Hosseini F, Gulsin G, Murphy D, Hawkins N, Andrade J, Laksman Z, Bennett M, Yeung-Lai-Wah J, Chakrabarti S, Krahn A, Deyell M. MAGNETIC RESONANCE IMAGING IN THE EVALUATION OF IDIOPATHIC FREQUENT PREMATURE VENTRICULAR COMPLEXES. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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