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Phillips A, Jiang Y, Walsh D, Andrews N, Artama M, Clothier H, Cullen L, Deng L, Escolano S, Gentile A, Gidding G, Giglio N, Junker T, Huang W, Janjua N, Kwong J, Li J, Nasreen S, Naus M, Naveed Z, Pillsbury A, Stowe J, Vo T, Buttery J, Petousis-Harris H, Black S, Hviid A. Background rates of adverse events of special interest for COVID-19 vaccines: A multinational Global Vaccine Data Network (GVDN) analysis. Vaccine 2023; 41:6227-6238. [PMID: 37673715 DOI: 10.1016/j.vaccine.2023.08.079] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 07/23/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The Global COVID Vaccine Safety (GCoVS) project was established in 2021 under the multinational Global Vaccine Data Network (GVDN) consortium to facilitate the rapid assessment of the safety of newly introduced vaccines. This study analyzed data from GVDN member sites on the background incidence rates of conditions designated as adverse events of special interest (AESI) for COVID-19 vaccine safety monitoring. METHODS Eleven GVDN global sites obtained data from national or regional healthcare databases using standardized methods. Incident events of 13 pre-defined AESI were included for a pre-pandemic period (2015-19) and the first pandemic year (2020). Background incidence rates (IR) and 95% confidence intervals (CI) were calculated for inpatient and emergency department encounters, stratified by age and sex, and compared between pre-pandemic and pandemic periods using incidence rate ratios. RESULTS An estimated 197 million people contributed 1,189,652,926 person-years of follow-up time. Among inpatients in the pre-pandemic period (2015-19), generalized seizures were the most common neurological AESI (IR ranged from 22.15 [95% CI 19.01-25.65] to 278.82 [278.20-279.44] per 100,000 person-years); acute disseminated encephalomyelitis was the least common (<0.5 per 100,000 person-years at most sites). Pulmonary embolism was the most common thrombotic event (IR 45.34 [95% CI 44.85-45.84] to 93.77 [95% CI 93.46-94.08] per 100,000 person-years). The IR of myocarditis ranged from 1.60 [(95% CI 1.45-1.76) to 7.76 (95% CI 7.46-8.08) per 100,000 person-years. The IR of several AESI varied by site, healthcare setting, age and sex. The IR of some AESI were notably different in 2020 compared to 2015-19. CONCLUSION Background incidence of AESIs exhibited some variability across study sites and between pre-pandemic and pandemic periods. These findings will contribute to global vaccine safety surveillance and research.
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Affiliation(s)
- A Phillips
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - Y Jiang
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - D Walsh
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - N Andrews
- UK Health Security Agency, London, UK
| | - M Artama
- Faculty of Social Sciences, Tampere University, Finland
| | - H Clothier
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - L Cullen
- Public Health Scotland, Edinburgh, Scotland, UK
| | - L Deng
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - S Escolano
- Université Paris-Saclay, UVSQ, Inserm, CESP, High Dimensional Biostatistics for Drug Safety and Genomics, Villejuif, France
| | - A Gentile
- Hospital de Niños Ricardo Gutierrez Epidemiology Department Buenos Aires City, Argentina
| | - G Gidding
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia; The University of Sydney Northern Clinical School, Australia
| | - N Giglio
- Hospital de Niños Ricardo Gutierrez Epidemiology Department Buenos Aires City, Argentina
| | - T Junker
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - W Huang
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan; National Taiwan University Children's Hospital, Taipei, Taiwan
| | - N Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada
| | - J Kwong
- ICES, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - J Li
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - S Nasreen
- ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - M Naus
- British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Z Naveed
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - A Pillsbury
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - J Stowe
- UK Health Security Agency, London, UK
| | - T Vo
- Faculty of Social Sciences, Tampere University, Finland; Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - J Buttery
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - H Petousis-Harris
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; Associate Professor, School of Population Health, University of Auckland, New Zealand
| | - S Black
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - A Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Kusk MW, Stowe J, Hess S, Gerke O, Foley S. Low-cost 3D-printed anthropomorphic cardiac phantom, for computed tomography automatic left ventricle segmentation and volumetry - A pilot study. Radiography (Lond) 2023; 29:131-138. [PMID: 36368249 DOI: 10.1016/j.radi.2022.10.015] [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: 08/22/2022] [Revised: 10/04/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Accurate cardiac left ventricle (LV) delineation is essential to CT-derived left ventricular ejection fraction (LVEF). To evaluate dose-reduction potential, an anatomically accurate heart phantom, with realistic X-ray attenuation is required. We demonstrated and tested a custom-made phantom using 3D-printing, and examined the influence of image noise on automatically measured LV volumes METHODS: A single coronary CT angiography (CCTA) dataset was segmented and converted to Standard Tessellation Language (STL) mesh, using open-source software. A 3D-printed model, with hollow left heart chambers, was printed and cavities filled with gelatinized contrast media. This was CT-scanned in an anthropomorphic chest phantom, at different exposure conditions. LV and "myocardium" noise and attenuation was measured. LV volume was automatically measured using two different methods. We calculated Spearmans' correlation of LV volume with noise and contrast-noise ratio respectively om 486 scans of the phantom. Source images were compared to one phantom series with similar parameters. This was done using Dice coefficient on LV short-axis segmentations. RESULTS Phantom "Myocardium" and LV attenuation was comparable to measurements on source images. Automatic volume measurement succeeded, with mean volume deviation to patient images less than 2 ml. There was a moderate correlation of volume with CNR, and strong correlation of volume with image noise. With papillary muscles included in LV volume, the correlation was positive, but negative when excluded. Variation of volumes was lowest at 90-100 kVp for both methods in the 486 repeat scans. The Dice coefficient was 0.87, indicating high overlap between the single phantom series and source scan. Cost of 3D-printer and materials was 400 and 30 Euro respectively. CONCLUSION Both anatomically and radiologically the phantom mimicked the source scans closely. LV volumetry was reliably performed with automatic algorithms. IMPLICATIONS FOR PRACTICE Patient-specific cardiac phantoms may be produced at minimal cost and can potentially be used for other anatomies and pathologies. This enables radiographic phantom studies without need for dedicated 3D-labs or expensive commercial phantoms.
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Affiliation(s)
- M W Kusk
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Ireland; Department of Radiology and Nuclear Medicine, University Hospital of Southern Denmark, Hospital South West Jutland Esbjerg, Denmark; IRIS - Imaging Research Initiative Southwest, Esbjerg, Denmark.
| | - J Stowe
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Ireland
| | - S Hess
- Department of Radiology and Nuclear Medicine, University Hospital of Southern Denmark, Hospital South West Jutland Esbjerg, Denmark; IRIS - Imaging Research Initiative Southwest, Esbjerg, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - O Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - S Foley
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Ireland
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Mørup SD, Stowe J, Precht H, Gervig MH, Foley S. Design of a 3D printed coronary artery model for CT optimization. Radiography (Lond) 2021; 28:426-432. [PMID: 34556417 DOI: 10.1016/j.radi.2021.09.001] [Citation(s) in RCA: 6] [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: 05/12/2021] [Revised: 08/26/2021] [Accepted: 09/06/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION To design a custom phantom of the coronary arteries to optimize CT coronary angiography (CCTA) protocols. METHODS Characteristics of the left and right coronary arteries (mean Hounsfield Unit (HU) values and diameters) were collected from consecutive CCTA examinations (n = 43). Four different materials (two mixtures of glycerine, gelatine and water, pig hearts, Ecoflex™ silicone) were scanned inside a Lungman phantom using the CCTA protocol to find the closest model to in vivo data. A 3D printed model of the coronary artery tree was created using CCTA data by exporting a CT volume rendering into Autodesk Meshmixer™ software. The model was placed in an acid bath for 5 h, then covered in Ecoflex™, which was removed after drying. Both the Ecoflex™ and pig heart were later filled with a mixture of contrast (Visipaque 320 mg I/ml), NaCl and gelatin and scanned with different levels of tube current and iterative reconstruction (ASiR-V). Objective (HU, noise and size (vessel diameter) and subjective analysis were performed on all scans. RESULTS The gelatine mixtures had HU values of 130 and 129, Ecoflex™ 65 and the pig heart 56. At the different mA/ASiR-V levels the contrast filled Ecoflex™ had a mean HU 318 ± 4, noise 47±7HU and diameter of 4.4 mm. The pig heart had a mean HU of 209 ± 5, noise 38±4HU and a diameter of 4.4 mm. With increasing iterative reconstruction level the visualisation of the pig heart arteries decreased so no measurements could be performed. CONCLUSION The use of a 3D printed model of the arteries and casting with the Ecoflex™ silicone is the most suitable solution for a custom-designed phantom. IMPLICATIONS FOR PRACTICE Custom designed phantoms using 3D printing technology enable cost effective optimisation of CT protocols.
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Affiliation(s)
- S D Mørup
- Health Sciences Research Centre, UCL University College, Niels Bohrs Alle 1, 5230, Odense M, Denmark; Cardiology Research Department, Odense University Hospital, Baagøes Alle 15, 5700, Svendborg, Denmark; Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Ireland.
| | - J Stowe
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Ireland
| | - H Precht
- Health Sciences Research Centre, UCL University College, Niels Bohrs Alle 1, 5230, Odense M, Denmark; Department of Clinical Research, University of Southern Denmark, Winsløwsparken, 5000, Odense C, Denmark; Department of Radiology, Hospital Little Belt Kolding, Denmark
| | - M H Gervig
- Health Sciences Research Centre, UCL University College, Niels Bohrs Alle 1, 5230, Odense M, Denmark
| | - S Foley
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Ireland
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Stowe J, O Halloran C, Photopoulos G, Lia AD, Quinn M, Tschan F, Verwoolde R, Buissink C. CTSim: Changing teaching practice in radiography with simulation. Radiography (Lond) 2020; 27:490-498. [PMID: 33250357 DOI: 10.1016/j.radi.2020.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Simulation offers radiography students the possibility to experiment with Computed Tomography (CT) in a way not possible in clinical practice. The aim of this work was to test a newly developed simulator 'CTSim' for effectiveness in teaching and learning. METHODS The simulator was tested in two phases. The first phase used a test-retest methodology with two groups, a group that experienced a Simulation based learning intervention and one which did not. The second phase subsequently tested for changes when the same intervention was introduced as part of an existing CT training module. RESULTS Phase 1 demonstrated statistically significant improvement of mean scores from 58% to 68% (P < .05) for students who experienced the intervention against no change in scores for the control group. Phase 2 saw mean scores improve statistically significantly in a teaching module from 66% to 73% (P < .05) following the application of the intervention as an active learning component. CONCLUSION The use of the CTSim simulator had a demonstrable effect on student learning when used as an active learning component in CT teaching. IMPLICATIONS FOR PRACTICE Simulation tools have a place in enhancing teaching and learning in terms of effectiveness and also introduce variety in the medium by which this is done.
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Affiliation(s)
- J Stowe
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland.
| | - C O Halloran
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - G Photopoulos
- Radiological Technology Program, School of Health Sciences, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - A D Lia
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - M Quinn
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - F Tschan
- Haute École de Santé Vaud, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - R Verwoolde
- Department of Medical Imaging and Radiation Therapy, Hanze University of Applied, Sciences, Groningen, Netherlands
| | - C Buissink
- Department of Medical Imaging and Radiation Therapy, Hanze University of Applied, Sciences, Groningen, Netherlands
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O'Connor M, Stowe J, Potocnik J, Giannotti N, Murphy S, Rainford L. 3D virtual reality simulation in radiography education: The students' experience. Radiography (Lond) 2020; 27:208-214. [PMID: 32800641 PMCID: PMC7424334 DOI: 10.1016/j.radi.2020.07.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 06/25/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 12/16/2022]
Abstract
Introduction Simulation forms a key element of undergraduate Radiography education as it enables students to develop their clinical skills in a safe environment. In this study, an immersive three-dimensional (3D) virtual radiography simulation tool was piloted in an undergraduate Radiography curriculum and user feedback retrieved. Methods The 3D virtual simulation tool by Virtual Medical Coaching Ltd was introduced to first year radiography students (n = 105). This technology guided students through a comprehensive process of learning anatomy, radiographic positioning and pathology. Students then X-rayed a virtual patient in the VR suite using HTC Vive Pro™ headsets and hand controllers. Instant feedback was provided. An online survey was later disseminated to students to gather user feedback. Thematic and descriptive statistical analyses were applied. Results A response rate of 79% (n = 83) was achieved. Most respondents (58%) reported enjoying VR simulation, whilst some felt indifferent towards it (27%). Ninety-four percent would recommend this tool to other students. The mean length of time it took for students to feel comfortable using the technology was 60 min (10–240 min). Most respondents (58%) desired more VR access. Students attributed enhanced confidence in the areas of beam collimation (75%), anatomical marker placement (63%), centring of the X-ray tube (64%) and exposure parameter selection (56%) to their VR practice. Many students (55%) advocated the use of VR in formative or low stakes assessments. Issues flagged included technical glitches, inability to palpate patient and lack of constructive feedback. Conclusion Student feedback indicates that 3D virtual radiography simulation is a valuable pedagogical tool in radiography education Implications for practice 3D immersive VR simulation is perceived by radiography students to be a valuable learning resource. VR needs to be strategically implemented into curricula to maximise its benefits.
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Affiliation(s)
- M O'Connor
- School of Medicine, University College Dublin, Ireland.
| | - J Stowe
- School of Medicine, University College Dublin, Ireland.
| | - J Potocnik
- School of Medicine, University College Dublin, Ireland.
| | - N Giannotti
- School of Medicine, University College Dublin, Ireland.
| | - S Murphy
- School of Medicine, University College Dublin, Ireland.
| | - L Rainford
- School of Medicine, University College Dublin, Ireland.
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Stowe J, Andrews NJ, Turner PJ, Miller E. The risk of Kawasaki disease after pneumococcal conjugate & meningococcal B vaccine in England: A self-controlled case-series analysis. Vaccine 2020; 38:4935-4939. [PMID: 32536544 DOI: 10.1016/j.vaccine.2020.05.089] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
Abstract
Kawasaki disease (KD) is an uncommon condition occasionally reported after childhood vaccination. Admissions with a KD-compatible diagnosis identified from a national database in England were linked to immunisation records to investigate the risk after pneumococcal conjugate (PCV) or meningococcal B (MenB) vaccines. Both are given at 2/4/12 months of age but were introduced sequentially, allowing their effects to be separately assessed. A total of 553 linked admissions in 512 individuals were validated as KD. The relative incidence (RI) within 28 days of PCV doses 1 or 2 measured by the self-controlled case-series method was 0.62 (95% confidence interval (CI) 0.38-1.00) with a significantly decreased risk after dose 3 (RI 0.30 (95% CI 0.11-0.77)). For MenB vaccine, the RI after doses 1 or 2 was 1.03 (95% CI 0.51-2.05) and 0.64 (95% CI 0.08-5.26) after dose 3. This study shows no evidence of an increased risk of KD after either vaccine.
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Affiliation(s)
- J Stowe
- Immunisation & Countermeasures, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
| | - N J Andrews
- Statistics and Modelling Economics Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
| | - P J Turner
- Section of Inflammation, Repair & Development, National Heart & Lung Institute, Imperial College London, United Kingdom.
| | - E Miller
- Prof. Elizabeth Miller, Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
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Burke M, Alexy T, Kamioka N, Shafi T, Turbyfield C, Stowe J, Porter J, Iturbe J, Kim D, Wittersheim K, Nguyen D, Laskar S, Gupta D, Bhatt K, Smith A, Cole R, Morris A, Vega J, Babaliaros V. Outflow Graft Obstruction Causing Recurrent Heart Failure after Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.947] [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: 10/24/2022] Open
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Stowe J, Niewoehner P. ONLINE TRAINING OF LICENSE OFFICE PROFESSIONALS TO SCREEN APPLICANTS FOR MEDICAL IMPAIRMENT. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J. Stowe
- Mid-America Regional Council, Kansas City, Missouri,
- Missouri Coalition for Roadway Safety, Jefferson City, Missouri
| | - P. Niewoehner
- VA Medical Center, St. Louis, Missouri,
- Missouri Coalition for Roadway Safety, Jefferson City, Missouri
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Abstract
Allocation of organs for transplant has created medical, ethical, and economic concerns at a time when availability of all organs is extremely limited. Although transplantation is the final treatment for many diseases, it is not available to everyone. Patients' use of alcohol and other drugs has become a controversial and debated issue in the transplant community. Compliance is important for all transplant recipients, but it becomes even more important in patients whose drug or alcohol use has caused their organ disease. The issue of addiction appears to be more critical with transplant patients because of the potential for noncompliance, which may lead to graft loss. Local, regional, and national regulations have also affected the allocation of organs. At The Cleveland Clinic Foundation, a chemical dependency transplant team was formed in response to criteria of the Ohio Solid Organ Transplantation Consortium for transplant patients with addictive disorders. The assessment, treatment, and monitoring of these patients requires specific expertise; a prominent role on transplant teams for specialists in addiction has resulted. The purpose of this article is to describe the responsibilities of the chemical dependency transplant team, the scope of the referral and evaluation process, and the team's appropriate roles with patients and transplant professionals.
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Affiliation(s)
- J Stowe
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Verity C, Stellitano L, Winstone AM, Stowe J, Andrews N, Miller E. Pandemic A/H1N1 2009 influenza vaccination, preceding infections and clinical findings in UK children with Guillain-Barré syndrome. Arch Dis Child 2014; 99:532-8. [PMID: 24585755 DOI: 10.1136/archdischild-2013-304475] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 11/03/2022]
Abstract
OBJECTIVE To record clinical findings in all new cases of Guillain-Barré syndrome (GBS) or Fisher syndrome (FS) in UK children in the 2 years following September 2009 and determine the proportion temporally associated with recent infections, pandemic H1N1 (2009) strain influenza vaccination or seasonal influenza vaccination. DESIGN A prospective UK-wide epidemiological study using the British Paediatric Surveillance Unit system. PATIENTS Children aged 16 years or less meeting the Brighton Collaboration criteria for GBS or FS. RESULTS 112 children with GBS (66 boys and 46 girls) and 3 boys with FS were identified in 2 years. All but one recovered sufficiently to go home. The annual UK incidence rate of GBS in patients less than 15 years old was 0.45/100 000, similar to other countries. There was evidence of infection in the 3 months preceding onset in 92/112 GBS and 3/3 FS cases. Of those living in England, 7 cases received pandemic A/H1N1 2009 influenza vaccination before GBS symptom onset (3/7 were within 6 months including 1 within 3 months); 2 children received 2010/2011 seasonal influenza vaccination within 6 months of GBS onset. The numbers vaccinated were not significantly greater than expected by chance. CONCLUSIONS The outcome for childhood GBS and FS after 6 months was better than reported in adults. Most UK GBS and FS cases had infections in the preceding 3 months. When considering the children living in England, there was no significantly increased risk of GBS after pandemic A/H1N1 2009 influenza vaccination or 2010/2011 seasonal influenza vaccination.
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Affiliation(s)
- C Verity
- PIND Research Group, Addenbrooke's Hospital, Cambridge, UK
| | - L Stellitano
- PIND Research Group, Addenbrooke's Hospital, Cambridge, UK
| | - A M Winstone
- PIND Research Group, Addenbrooke's Hospital, Cambridge, UK
| | - J Stowe
- General and Adolescent Paediatric Unit, Institute of Child Health, University College, London, UK
| | - N Andrews
- Statistics, Modelling and Economics Department, Public Health England, Colindale, London, UK
| | - E Miller
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, Colindale, London, UK
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Squires E, Hughes S, Ball B, Troedsson M, Stowe J. Effect of season and reproductive status on the incidence of equine dystocia. J Equine Vet Sci 2013. [DOI: 10.1016/j.jevs.2013.03.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Miller E, Andrews N, Stowe J, Grant A, Waight P, Taylor B. Risks of convulsion and aseptic meningitis following measles-mumps-rubella vaccination in the United Kingdom. Am J Epidemiol 2007; 165:704-9. [PMID: 17204517 DOI: 10.1093/aje/kwk045] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Measles-mumps-rubella (MMR) vaccines containing the Urabe strain of mumps were withdrawn in the United Kingdom in 1992 following demonstration of an increased risk of aseptic meningitis 15-35 days after vaccination. Following introduction of a replacement MMR vaccine (Priorix; GlaxoSmithKline, London, United Kingdom) in 1998, active surveillance of aseptic meningitis and convulsion was established to evaluate the risk associated with the new vaccine. No laboratory-confirmed cases of mumps meningitis were detected among children aged 12-23 months after administration of 1.6 million doses of Priorix (upper 95% confidence limit of risk: 1:437,000) in England and Wales. The upper 95% confidence limit excluded the risk found for mumps meningitis with Urabe vaccines (1:143,000 doses). No cases of aseptic meningitis were detected among children aged 12-23 months, who had received over 99,000 doses of Priorix (upper 95% confidence limit of risk: 1:27,000), in a regional database of hospital-admitted cases. This compares with an observed risk of 1:12,400 for Urabe vaccines. An elevated relative incidence of convulsion was found in the 6- to 11-day period after receipt of Priorix (relative incidence = 6.26, 95% confidence interval: 3.85, 10.18)-consistent with the known effects of the measles component of MMR vaccine-but not in the 15- to 35-day period (relative incidence = 1.48, 95% confidence interval: 0.88, 2.50) as occurred with Urabe-containing vaccines. This study demonstrates the power of active postmarketing surveillance to identify or exclude events too rare to be detected in prelicensure trials.
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Affiliation(s)
- E Miller
- Immunisation Department, Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London, UK.
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Abstract
BACKGROUND MMR vaccine has been reported to cause gait disturbance, and this possible association has been claimed to support the MMR-causes-autism theory. AIMS To determine whether any association between gait disturbance and MMR vaccination exceeds the age related background rate of gait disturbance, using record linkage and self control case series analyses. METHODS MMR vaccination records were linked to hospital admission and general practitioner attendance data. An increased rate of gait problems with onset in various intervals in the 60 day period after MMR vaccination was looked for in children aged 12 to <24 months. RESULTS No evidence of an increased rate of hospital admission or general practice consultations for gait disturbance was found in the putative post-vaccination risk periods. CONCLUSIONS This study provides no evidence for a causal association between MMR and gait disturbance.
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Affiliation(s)
- E Miller
- Immunisation Division, Public Health Laboratory Service, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK.
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Abstract
BACKGROUND The recorded prevalence of autistic spectrum disorders has risen over recent decades. Measles, mumps and rubella (MMR) vaccine has been blamed, by causing a "new variant" form of "regressive autism" associated with "autistic enterocolitis". AIMS To estimate the prevalence of autism and to assess any changes in parental perception regarding the onset or causes of autism. METHODS AND RESULTS A total of 567 children with autistic spectrum disorder in five districts in north east London were identified, born 1979-98. Reported autism, excluding the 94 cases of Asperger's syndrome, increased by year of birth until 1992, since when prevalence has plateaued. This flattening off persisted after allowing for expected delay in diagnosis in more recent birth cohorts. The age at diagnosis of autistic spectrum disorder was estimated to have decreased per five year period since 1983, by 8.7% for childhood autism and by 11.0% for atypical autism. There was some evidence that MMR was more likely to be mentioned as a trigger after August 1997 than before. CONCLUSIONS The prevalence of autism, which was apparently rising from 1979 to 1992, reached a plateau from 1992 to 1996 at a rate of some 2.6 per 1000 live births. This levelling off, together with the reducing age at diagnosis, suggests that the earlier recorded rise in prevalence was not a real increase but was likely due to factors such as increased recognition, a greater willingness on the part of educationalists and families to accept the diagnostic label, and better recording systems. The proportion of parents attributing their child's autism to MMR appears to have increased since August 1997.
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Affiliation(s)
- R Lingam
- Centre for Community Child Health, Royal Free and University College Medical School, Royal Free Campus, University College London, London NW3 2PF
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16
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Affiliation(s)
- B Taylor
- Centre for Community Child Health, Medical School, University College London Royal Free Campus, London NW3 2PF, UK.
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17
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Andrews N, Miller E, Waight P, Farrington P, Crowcroft N, Stowe J, Taylor B. Does oral polio vaccine cause intussusception in infants? Evidence from a sequence of three self-controlled cases series studies in the United Kingdom. Eur J Epidemiol 2002; 17:701-6. [PMID: 12086086 DOI: 10.1023/a:1015691619745] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The use of live oral poliomyelitis vaccine (OPV) has led to the elimination of poliomyelitis disease in many countries since licensure in 1960. The discovery of an increased risk of an intestinal obstruction known as intussusception following live rotavirus vaccination raised questions about the possibility of a link between live OPV and intussusception. METHODS Three self-controlled case-series studies were carried out. The first was exploratory and included 218 intussusception episodes from hospital admissions data linked to vaccination records in the Thames region. The two subsequent studies, which used further hospital admissions data and the General Practice Research Database (GPRD) included 107 and 198 episodes respectively and were used to test hypotheses generated in the first study. RESULTS In the exploratory study risk periods of up to 6 weeks after each dose were examined. The only period with some evidence of an increased risk was the 14-27-day period after the third dose (relative incidence (RI) = 1.97, p = 0.011). The second hospital admissions study and the GPRD study showed no evidence of an increased relative incidence in any putative risk period and did not confirm the increased risk in the 14-27-day period after dose 3 with a combined RI of 1.03. CONCLUSIONS The sequence of studies does not support the hypothesis that OPV causes intussusception. The increased RI in the first study may be explained as a chance finding due to the number of risk periods examined and highlights the need for caution when looking at many risk periods without an a priori hypothesis.
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Affiliation(s)
- N Andrews
- Public Health Laboratory Service Statistics Unit, London, UK.
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18
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Abstract
Parents of autistic children with regressive symptoms who were diagnosed after the publicity alleging a link with measles, mumps, and rubella (MMR) vaccine tended to recall the onset as shortly after MMR more often than parents of similar children who were diagnosed prior to the publicity. This is consistent with the recall bias expected under such circumstances.
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Affiliation(s)
- N Andrews
- Statistics Unit, Public Health Laboratory Service, 61 Colindale Avenue, London NW9 5EQ, UK
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19
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Abstract
Allocation of organs for transplant has created medical, ethical, and economic concerns at a time when availability of all organs is extremely limited. Although transplantation is the final treatment for many diseases, it is not available to everyone. Patients' use of alcohol and other drugs has become a controversial and debated issue in the transplant community. Compliance is important for all transplant recipients, but it becomes even more important in patients whose drug or alcohol use has caused their organ disease. The issue of addiction appears to be more critical with transplant patients because of the potential for noncompliance, which may lead to graft loss. Local, regional, and national regulations have also affected the allocation of organs. At The Cleveland Clinic Foundation, a chemical dependency transplant team was formed in response to criteria of the Ohio Solid Organ Transplantation Consortium for transplant patients with addictive disorders. The assessment, treatment, and monitoring of these patients requires specific expertise; a prominent role on transplant teams for specialists in addiction has resulted. The purpose of this article is to describe the responsibilities of the chemical dependency transplant team, the scope of the referral and evaluation process, and the team's appropriate roles with patients and transplant professionals.
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Affiliation(s)
- J Stowe
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
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20
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Abstract
A CAUSAL ASSOCIATION BETWEEN MEASLES: mumps-rubella (MMR) vaccine and idiopathic thrombocytopenic purpura (ITP) was confirmed using immunisation/hospital admission record linkage. The absolute risk within six weeks of immunisation was 1 in 22 300 doses, with two of every three cases occurring in the six week post-immunisation period being caused by MMR. Children with ITP before MMR had no vaccine associated recurrences.
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Affiliation(s)
- E Miller
- Immunisation Division, Public Health Laboratory Service Communicable Disease Surveillance Centre, Colindale, London NW9 5EQ, UK.
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21
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Tolley K, Leese B, Wright K, Hennessy S, Rowley C, Stowe J, Chamberlain A. Communication aids for the speech impaired. Cost and quality-of-life outcomes of assessment programs provided by specialist Communication Aids Centers in the United Kingdom. Int J Technol Assess Health Care 1995; 11:196-213. [PMID: 7790165 DOI: 10.1017/s0266462300006838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
An evaluation was conducted of the approaches, costs, and quality-of-life outcomes associated with communication aid assessment programs for the speech-impaired provided by specialist Communication Aids Centres (CACs) in the United Kingdom. The average costs of CAC assessment programs was 410 pounds per client, which is not excessive. There was evidence of moderate quality-of-life benefits from clients' use of the recommended aids.
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Leese B, Wright K, Hennessy S, Tolley K, Chamberlain MA, Stowe J, Rowley C. How do communication aid centres provide services to their clients? Eur J Disord Commun 1993; 28:263-272. [PMID: 8241581 DOI: 10.3109/13682829309060040] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A survey of the functioning of the six communication aid centres (CACs) in England and Wales was undertaken. All CACs are specialist units drawing clients from a wide area of the country which means that referrals are more likely to come from outside, rather than from within the districts in which the CACs are located. All CACs have developed individual assessment procedures, with some CACs undertaking continuous assessment of clients, and others recommending an aid after a single session. Funding of aids was often a problem because CACs were only able to recommend aid provision and did not supply them; their stocks of aids were used in assessment sessions or for interim loan to clients until a definitive aid had been acquired. CAC staff engaged in a variety of other functions including the organisation of courses, acting as an advice and information service, and undertaking research.
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Affiliation(s)
- B Leese
- Centre for Health Economics, University of York, UK
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23
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Chamberlain A, Rowley C, Stowe J, Hennessy S, Leese B, Tolley K, Wright K. Evaluation of Communication Aid Centres in England and Wales. Health Trends 1992; 25:75-9. [PMID: 10130813] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
This paper reports the findings of an evaluation (funded by the Department of Health) of six Communication Aid Centres established in 1983. The evaluation was undertaken to assess the effectiveness of these Centres in meeting their set objectives, and to examine service costs and client satisfaction. The findings show that the work of each Centre was effective in meeting its stated objectives, but that the work of individual Centres reflected its own specialised interests. Two problems with current funding arrangements were highlighted. First, the need to replace the original funding by locally based finance, and second, the funding of communication aids for clients. The findings also show that the specialist service provided by these Centres can be managed at costs per person assessed at, or below, non-specialist services in health districts. Client satisfaction with the services provided by the Centres was high.
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Affiliation(s)
- A Chamberlain
- Rheumatology and Rehabilitation Research Unit, University of Leeds
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24
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Affiliation(s)
- J Stowe
- Rheumatology and Rehabilitation Research Unit, School of Medicine, Leeds
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25
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Maxie G, Stowe J, Bonnett B. Electronic communication with veterinarians: An update on VetNet and Exten. Can Vet J 1990; 31:84-5. [PMID: 17423522 PMCID: PMC1480646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Lissemore K, Stowe J. Farm practice in a cross-fire. Can Vet J 1989; 30:857-62. [PMID: 17423452 PMCID: PMC1681311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Stowe J. Disabled living centres. J R Coll Gen Pract 1988; 38:34-5. [PMID: 3204557 PMCID: PMC1711409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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28
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Stowe J, Chamberlain MA. Evaluation of rehabilitation bicycles. Physiotherapy 1983; 69:47-9. [PMID: 6867160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Ellis MI, Stowe J. The hip. Clin Rheum Dis 1982; 8:655-75. [PMID: 7184691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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31
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Bird HA, Stowe J. The wrist. Clin Rheum Dis 1982; 8:559-69. [PMID: 7184688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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32
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Chamberlain MA, Thornley G, Stowe J, Wright V. Evaluation of aids and equipment for the bath: II. A possible solution to the problem. Rheumatol Rehabil 1981; 20:38-43. [PMID: 7221401 DOI: 10.1093/rheumatology/20.1.38] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
One hundred patients needing bath aids is leaving Leeds hospitals in 1978 were randomly allocated into control and treated groups. The former 50 patients received aids through the usual channels, the latter obtained bath aids immediately on discharge and were instructed in their use at home by the peripatetic occupational therapist. All were assessed independently at three to six months. Prompt, correct prescription of aids and supervision of their use in bathing shortly after discharge by a hospital-based occupational therapist resulted in safe bathing by all treated subjects. In contrast, only 82% of controls bathed, 50% of these from the seated position (compared with 90% of the treated group) and only 39% of controls received their aids within two weeks of discharge (compared with 74% of the treated group).
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Abstract
A postal survey was mounted to investigate the use of the British Rheumatism and Arthritis Association's (B.R.A.A.) postal aids service. Of the 288 persons who ordered aids between B.R.A.A. and 446 from other sources. Many simple aids were valuable and well used; several had faults, which in many cases could easily have been rectified if the manufacturers been aware of them. Respondents appreciated the speedy provision of aids but many had problems which would have been better solved by attendance at an Aids Centre or Occupational Therapy Department. A quarter of the subjects were unaware that departments of social services provided aids.
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