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Latham N, Young J, Wilson J, Gray M, George K. Child health nurses' perceptions of the Family Community-based Assistance Resourcing and Education program in contemporary practice: a qualitative study. Aust J Prim Health 2024; 30:PY23072. [PMID: 38354733 DOI: 10.1071/py23072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND The Family Community-based Assistance Resourcing and Education Program (FCP) is a nurse home visiting program that was introduced in Queensland two decades ago to redress health inequalities for infants from families experiencing specific social stressors. Locally adapted versions of this home visiting program are still in use, but have not been evaluated. This study examined child health nurse perceptions of the adapted FCP in one regional Queensland health service. METHODS A qualitative descriptive exploratory study using two focus groups (conducted May 2019) with Child Health Nurses who delivered the FCP was conducted. Transcripts of digital recordings were analysed using Braun and Clarke's (2006) six-step framework for guided thematic analysis. RESULTS A total of 16 Child Health Nurses participated in the study, with a mean of 10years' experience with the program. Data analysis generated 12 themes organised under three domains: 'Establishing the relationship with families', 'What works in practice' and 'We could do it better'. Participants cited flexibility, expert input and in-home delivery as key program benefits. However, narrow eligibility criteria, poor screening for perinatal anxiety and resourcing constraints were identified as limitations. CONCLUSIONS This study is the first to measure Child Health Nurses' perceptions of an adapted FCP. It sheds light on their 'practice wisdom', including the program's ability to meet the needs of families with social vulnerabilities. The study supports prior calls for home visiting programs to be evaluated against clearly stated program intentions. Participant insights have been shared to inform practice and program implementation both locally and as part of Queensland's First 2000Days health service delivery reform agenda.
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Zemanick ET, Emerman I, McCreary M, Mayer-Hamblett N, Warden MN, Odem-Davis K, VanDevanter DR, Ren CL, Young J, Konstan MW. Heterogeneity of CFTR modulator-induced sweat chloride concentrations in people with cystic fibrosis. J Cyst Fibros 2024:S1569-1993(24)00015-8. [PMID: 38360461 DOI: 10.1016/j.jcf.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/03/2024] [Accepted: 02/04/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Sweat chloride (SC) concentrations in people with cystic fibrosis (PwCF) reflect relative CF transmembrane conductance regulator (CFTR) protein function, the primary CF defect. Populations with greater SC concentrations tend to have lesser CFTR function and more severe disease courses. CFTR modulator treatment can improve CFTR function within specific CF genotypes and is commonly associated with reduced SC concentration. However, SC concentrations do not necessarily fall to concentrations seen in the unaffected population, suggesting potential for better CFTR treatment outcomes. We characterized post-modulator SC concentration variability among CHEC-SC study participants by genotype and modulator. METHODS PwCF receiving commercially approved modulators for ≥90 days were enrolled for a single SC measurement. Clinical data were obtained from chart review and the CF Foundation Patient Registry (CFFPR). Variability of post-modulator SC concentrations was assessed by cumulative SC concentration frequencies. RESULTS Post-modulator SC concentrations (n = 3787) were collected from 3131 PwCF; most (n = 1769, 47 %) were collected after elexacaftor/tezacaftor/ivacaftor (ETI) treatment. Modulator use was associated with lower SC distributions, with post-ETI concentrations the lowest on average. Most post-ETI SC concentrations were <60 mmol/L (79 %); 26 % were <30 mmol/L. Post-ETI distributions varied by genotype. All genotypes containing at least one F508del allele had individuals with post-ETI SC ≥60 mmol/L, with the largest proportion being F508del/minimal function (31 %). CONCLUSIONS Post-modulator SC concentration heterogeneity was observed among all genotypes and modulators, including ETI. The presence of PwCF with post-modulator SC concentrations within the CF diagnostic range suggests room for additional treatment-associated CFTR restoration in this population.
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Affiliation(s)
- E T Zemanick
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
| | - I Emerman
- Seattle Children's Hospital, Seattle, WA, United States
| | - M McCreary
- Seattle Children's Hospital, Seattle, WA, United States
| | - N Mayer-Hamblett
- Seattle Children's Hospital, Seattle, WA, United States; University of Washington, Seattle, WA, United States
| | - M N Warden
- Seattle Children's Hospital, Seattle, WA, United States
| | - K Odem-Davis
- Seattle Children's Hospital, Seattle, WA, United States
| | - D R VanDevanter
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - C L Ren
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - J Young
- Seattle Children's Hospital, Seattle, WA, United States
| | - M W Konstan
- Case Western Reserve University School of Medicine, Cleveland, OH, United States; Rainbow Babies and Children's Hospital, Cleveland, OH, United States
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Young J, Seeberg KA, Aakre KM, Borgeraas H, Nordstrand N, Wisløff T, Hjelmesæth J, Omland T, Hertel JK. The liver-heart axis in patients with severe obesity: The association between liver fibrosis and chronic myocardial injury may be explained by shared risk factors of cardiovascular disease. Clin Biochem 2024; 123:110688. [PMID: 37995847 DOI: 10.1016/j.clinbiochem.2023.110688] [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: 07/06/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Severe obesity is associated with increased risk of non-alcoholic fatty liver disease and cardiovascular disease. We hypothesized that liver fibrosis as quantified by the Enhanced Liver Fibrosis (ELF) test would be predictive of myocardial injury and fibrosis, expressed by higher concentrations of cardiac troponin T and I measured by high-sensitivity assays (hs-cTnT and hs-cTnI, respectively). MATERIAL AND METHODS We performed cross-sectional analyses of baseline data from 136 patients (mean age 45 years, 38 % male) with severe obesity participating in the non-randomized clinical trial Prevention of Coronary Heart Disease in Morbidly Obese Patients (ClinicalTrials.gov NCT00626964). Associations between ELF scores, hs-cTnT, and hs-cTnI concentrations were assessed using linear regression analysis. RESULTS ELF scores were associated with hs-cTnT in the unadjusted model (B 0.381, 95 % Confidence Interval [CI] 0.247, 0.514), but the association was attenuated upon adjustment for potential confounders (B -0.031, 95 % CI -0.155, 0.093). Similarly, for hs-cTnI, an observed association with ELF scores in the unadjusted model was attenuated upon adjustment for potential confounders ((B 0.432, 95 % CI 0.179, 0.685) and (B 0.069, 95 % CI -0.230, 0.367), respectively). Age, sex, hypertension, and estimated glomerular filtration rate were amongst the shared predictors of ELF score, hs-cTnT, and hs-cTnI that provided the univariable models with the highest R-squared and lowest Akaike Information Criterion values. CONCLUSIONS Contrary to our hypothesis, ELF score did not predict myocardial injury and fibrosis, but we rather demonstrated an association between liver fibrosis and myocardial injury and fibrosis may be explained by shared risk factors of cardiovascular disease.
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Affiliation(s)
- J Young
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - K A Seeberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Endocrinology, Obesity and Nutrition, Vestfold Hospital Trust, Tønsberg, Norway
| | - K M Aakre
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - H Borgeraas
- Department of Endocrinology, Obesity and Nutrition, Vestfold Hospital Trust, Tønsberg, Norway
| | - N Nordstrand
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - T Wisløff
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - J Hjelmesæth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Endocrinology, Obesity and Nutrition, Vestfold Hospital Trust, Tønsberg, Norway
| | - T Omland
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - J K Hertel
- Department of Endocrinology, Obesity and Nutrition, Vestfold Hospital Trust, Tønsberg, Norway
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Latham N, Young J, Wilson J, Gray M. Measuring success: program fidelity of Queensland's child health home visiting services. A document analysis. Aust J Prim Health 2023; 29:575-586. [PMID: 37468222 DOI: 10.1071/py23002] [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: 01/07/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND The Family CA.R.E. (Community-based Assistance Resourcing and Education) program was introduced in Queensland two decades ago. It aimed to redress health inequalities for infants from families experiencing specific social stressors. The program has been locally adapted over time and has not been evaluated against the original program. This study assessed the extent to which selected hospital and health services in Queensland, Australia have modified the original Family C.A.R.E. PROGRAM METHODS Altheide's model was used to facilitate a critical document analysis of policies and guidelines for adapted Family C.A.R.E. home visiting programs in use by hospital and health services (target n =7). RESULTS Five of seven eligible services provided service model documentation. There was low alignment with the original Family C.A.R.E. program across four of the five participating services. While the program delivered within Service 4 was highly aligned to the structure and intent of the original model, variation to the program was still evident. Importantly, four of the five participating programs were not collecting evaluation measures. CONCLUSIONS Health services have adapted the original Family C.A.R.E program format to 'fit' the local service environment but have largely failed to collect data to facilitate evaluation. Inability to evaluate the program leads to uncertainty about program success and benefits as well as any unintended consequences for families engaging in unevaluated home visiting programs. This study highlights the importance of monitoring program fidelity and evaluating success given the potential ramifications for this vulnerable cohort and for health service delivery.
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Affiliation(s)
- Nicole Latham
- Digital Health, Sunshine Coast Hospital and Health Service, Birtinya, Qld 4575, Australia; and School of Health, University of the Sunshine Coast, Sippy Downs, Qld 4556, Australia
| | - Jeanine Young
- School of Health, University of the Sunshine Coast, Petrie, Qld 4502, Australia; and Sunshine Coast Health Institute, Birtinya, Qld 4575, Australia
| | - Josephine Wilson
- School of Health, University of the Sunshine Coast, Petrie, Qld 4502, Australia
| | - Michelle Gray
- School of Health, University of the Sunshine Coast, Sippy Downs, Qld 4556, Australia; and Edith Cowan University, Joondalup, WA 6027, Australia
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Talbot M, Gear M, Young J, Milner D, Bunting A, Bozzo A. Risk assessment of aviators with a total hip arthroplasty. BMJ Mil Health 2023:e002557. [PMID: 37844962 DOI: 10.1136/military-2023-002557] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/11/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Max Talbot
- Department of National Defence and the Canadian Armed Forces, Montréal, Québec, Canada
- Department of Surgery, McGill University Health Centre, Montréal, Québec, Canada
| | - M Gear
- Department of National Defence and the Canadian Armed Forces, Ottawa, Ontario, Canada
| | - J Young
- Department of National Defence and the Canadian Armed Forces, Ottawa, Ontario, Canada
| | - D Milner
- Department of National Defence and the Canadian Armed Forces, Ottawa, Ontario, Canada
| | - A Bunting
- Department of Surgery, McGill University Health Centre, Montréal, Québec, Canada
| | - A Bozzo
- Department of Surgery, McGill University Health Centre, Montréal, Québec, Canada
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Crowe L, Young J, Smith AC, Haydon HM. Factors that may threaten or protect the wellbeing of staff working in paediatric intensive care environments. Intensive Crit Care Nurs 2023; 78:103476. [PMID: 37379677 DOI: 10.1016/j.iccn.2023.103476] [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: 03/18/2023] [Revised: 04/25/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE This study explored the risk and protective factors for wellbeing from the perspectives of multidisciplinary paediatric intensive care unit staff. DESIGN Using a qualitative, descriptive study design we purposively recruited a sample of nurses, physicians, and allied health professionals to participate in semi-structured interviews which explored staff perceptions of risk and protective factors relating to their daily paediatric intensive care roles. Data was analysed using thematic analysis. SETTING Four paediatric intensive care units in Australia. FINDINGS Twenty staff were recruited. Braun and Clarke's thematic analysis approach identified perceived risks for wellbeing included a lack of preparation for the role, and clinical situations that contributed to psychological distress, including perceived worst shift, moral distress, non-accidental injuries, and isolation. Themes perceived as protective to wellbeing included: finding the work stimulating and meaningful, belonging to the team, and using humour. CONCLUSION Staff perceptions of wellbeing in the paediatric intensive care unit suggested that risk factors often co-existed simultaneously with protective factors. These results are not consistent with the notion that wellbeing as a phenomenon can be considered on a risk-protection continuum. Strategies that enhance this work as meaningful and stimulating, promote a sense of belonging to the team, and support the use of humour, may assist health professionals to achieve a balance between risk and protective factors for wellbeing. IMPLICATIONS FOR CLINICAL PRACTICE Education and training on end-of-life care, and how to have difficult conversations and manage the consistent psychological distress of intensive care work, is essential at orientation and requires regular formal interventions. Experiencing the work as stimulating highlights the need for advanced scope of practice work. Opportunities for individual and team reflection about the meaning and purpose of their work, and ensuring staff feel valued and experience a sense of belonging to the team, are critical to the intensive care context.
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Affiliation(s)
- Liz Crowe
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
| | - Jeanine Young
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia; School of Health, University of the Sunshine Coast, Australia.
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia; School of Health, University of the Sunshine Coast, Australia; Centre for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark.
| | - Helen M Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
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VanDevanter DR, Zemanick ET, Konstan MW, Ren CL, Odem-Davis K, Emerman I, Young J, Mayer-Hamblett N. Willingness of people with cystic fibrosis receiving elexacaftor/tezacaftor/ivacaftor (ETI) to participate in randomized modulator and inhaled antimicrobial clinical trials. J Cyst Fibros 2023; 22:652-655. [PMID: 37100705 PMCID: PMC10523954 DOI: 10.1016/j.jcf.2023.04.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/31/2023] [Accepted: 04/13/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE To assess the feasibility of enrolling people with CF (pwCF) taking the CFTR modulator elexacaftor/tezacaftor/ivacaftor (ETI) in clinical trials of a new modulator. METHODS PwCF receiving ETI at CHEC-SC study (NCT03350828) enrollment were surveyed for interest in 2-week to 6-month placebo- (PC) and active-comparator (AC) modulator studies. Those taking inhaled antimicrobials (inhABX) were surveyed for interest in PC inhABX studies. RESULTS Of 1791 respondents, 75% [95% CI 73, 77] would enroll in a 2-week PC modulator study versus 51% [49, 54] for a 6-month study; 82% [81, 84] and 63% [61, 65] would enroll in 2-week and 6 month AC studies; 77% [74, 80] of 551 taking inhABX would enroll in a 2-week PC inhABX study versus 59% [55, 63] for a 6-month study. Previous clinical trial experience increased willingness. CONCLUSIONS Study designs will affect feasibility of future clinical trials of new modulators and inhABX in people receiving ETI.
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Affiliation(s)
- D R VanDevanter
- Case Western Reserve University School of Medicine, Cleveland, OH United States.
| | - E T Zemanick
- University of Colorado, Anschutz Medical Campus, Aurora CO United States
| | - M W Konstan
- Case Western Reserve University School of Medicine, Cleveland, OH United States; Rainbow Babies and Children's Hospital, Cleveland, OH United States
| | - C L Ren
- Children's Hospital of Philadelphia, Philadelphia, PA United States
| | - K Odem-Davis
- Seattle Children's Hospital, Seattle, WA United States
| | - I Emerman
- Seattle Children's Hospital, Seattle, WA United States
| | - J Young
- Seattle Children's Hospital, Seattle, WA United States
| | - N Mayer-Hamblett
- Seattle Children's Hospital, Seattle, WA United States; University of Washington, Seattle, WA United States
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Mayer-Hamblett N, Zemanick ET, Odem-Davis K, VanDevanter D, Warden M, Rowe SM, Young J, Konstan MW, For-The-Chec-Sc-Study-Group. Characterizing CFTR modulated sweat chloride response across the cf population: Initial results from the CHEC-SC study. J Cyst Fibros 2023; 22:79-88. [PMID: 35871974 PMCID: PMC10103635 DOI: 10.1016/j.jcf.2022.07.008] [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: 05/03/2022] [Revised: 06/24/2022] [Accepted: 07/12/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND CHEC-SC is an ongoing epidemiologic study characterizing modulator-induced sweat chloride (SC) responses across the CF population, with interim results available prior to the availability of triple combination modulator therapy. METHODS Eligible participants had been prescribed a modulator for ≥90 days with re-enrollment allowed upon establishment of a new modulator. Pre-modulator SC values were obtained from chart review; post-modulator sweat was collected and analyzed locally. SC changes were descriptively summarized with biologic sex effects adjusted for age, weight, and CFTR genotype. Heterogeneity in ivacaftor SC response was characterized in relation to published CFTR functional responses. RESULTS 1848 participants provided 2004 SC measurements, 26.2% on ivacaftor, 39.1% on lumacaftor/ivacaftor, and 34.7% on tezacaftor/ivacaftor. Average SC changes for all modulators were consistent with those reported in previous clinical studies, with greater variation in SC response observed among rarer mutations and notable shifts in the proportion with SC <60mmol/L independent of the magnitude of SC change. Ivacaftor induced in vitro CFTR functional change was significantly correlated with ivacaftor-modulated SC response (Pearson correlation= ‒0.52, 95% CI: ‒0.773, ‒0.129). Average SC change from ivacaftor to tezacaftor/ivacaftor was ‒4.9 mmol/L (n=17,95% CI:‒9.3, ‒0.5) and differed from those switching from lumacaftor/ivacaftor (10.0 mmol/L, n=139, 95% CI:7.8,12.3). Sex at birth was not associated with SC response. CONCLUSIONS CHEC-SC is the largest study characterizing modulator-induced SC changes across the CF population. There was a strong association between ivacaftor induced in vitro CFTR function and SC response across a genotypically heterogenous cohort. Biological sex was not associated with SC response.
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Affiliation(s)
- N Mayer-Hamblett
- University of Washington, Seattle, WA, United States; Seattle Children's Hospital, Seattle, WA, United States.
| | - E T Zemanick
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - K Odem-Davis
- Seattle Children's Hospital, Seattle, WA, United States
| | - D VanDevanter
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - M Warden
- Seattle Children's Hospital, Seattle, WA, United States
| | - S M Rowe
- University of Alabama at Birmingham, Birmingham, AL, England
| | - J Young
- Seattle Children's Hospital, Seattle, WA, United States
| | - M W Konstan
- Case Western Reserve University School of Medicine, Cleveland, OH, United States; Rainbow Babies and Children's Hospital, Cleveland, OH, United States
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Peberdy L, Young J, Massey D, Kearney L. Integrated review of the knowledge, attitudes, and practices of maternity health care professionals concerning umbilical cord clamping. Birth 2022; 49:595-615. [PMID: 35582849 PMCID: PMC9790596 DOI: 10.1111/birt.12647] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Umbilical cord clamp timing has implications for newborn health, which include increased iron stores up to 6 months of age. National and International cord clamping guidelines differ as do health professionals' practices. The rationale for differences in cord clamping practice is unclear. AIMS AND OBJECTIVE Studies on the knowledge, attitudes, and practices of maternity health care professionals about cord clamp timing were synthesized. Similarities and differences between professional groups and understanding of the optimal timing of cord clamp timing for term newborns were compared. METHODS An integrative review was undertaken. PubMed, Scopus, MIDIRS, CINAHL, and Google Scholar were searched. Publication date limits were set between January 2007 and December 2020. Quality appraisal was undertaken using the Critical Appraisal Skills Program (CASP) tools. RESULTS Eighteen studies met inclusion criteria, as they included primary research studies that investigated maternity health care professionals' knowledge, attitudes, and practices about umbilical cord clamping, and were written in English. Four main subject areas were identified: a) knowledge of optimal cord clamp timing; b) attitudes and perceptions of early vs deferred cord clamping; c) cord clamping practice; and d) rationale for cord clamping practice. CONCLUSIONS Different attitudes and practices were identified between midwifery and medical professionals in relation to cord clamp timing together with health professional knowledge and practice gaps pertaining to optimal cord clamp timing. Contemporary evidence should inform guidelines for clinical practice and be embedded into maternity health professional curricula and professional development programs.
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Affiliation(s)
- Lisa Peberdy
- University of the Sunshine CoastSunshine CoastQueenslandAustralia
| | - Jeanine Young
- University of the Sunshine CoastSunshine CoastQueenslandAustralia
| | - Debbie Massey
- Southern Cross UniversityLismoreNew South WalesAustralia
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Teuwen LA, Young J, Davies A, Hudson J, Bourlon de los Rios M, Prenen H, Segelov E. 432P Representation of countries and gender in abstracts at the 2022 American Society of Clinical Oncology Annual Scientific Meeting (ASCO ASM). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.463] [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: 12/07/2022] Open
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Flanagan B, Warren-James M, Young J. Evaluation of the CARES Skills Framework as a Peer Support Model in the Paramedic Undergraduate Curriculum: Facilitating Challenging Discussions in a Safe Environment. PREHOSP EMERG CARE 2022; 27:971-977. [PMID: 36103240 DOI: 10.1080/10903127.2022.2125136] [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: 06/22/2022] [Accepted: 09/07/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Infant or child death is reported as being the most distressing type of case paramedics attend. Student paramedics also identify supporting bereaved families as an area associated with low confidence. This study evaluated the CARES skills framework (Connect to emotion, Attention training, Reflective listening, Empathy, Support help seeking) as a peer support model to encourage student paramedics to talk about grief and death related to infants and children. METHOD A convenience sample of first-year paramedic students (target n = 154) was recruited from a single Australian regional university. A modified nominal group technique method was used following a student debriefing session designed to identify problems, generate solutions, and make decisions regarding the efficacy of the CARES skills framework. RESULTS Of 154 eligible participants, 141 participated (92% response rate). Peer social support normalized students' emotions related to death and dying. Although naming emotions was challenging, students reported that the CARES model facilitated a safe environment to talk about death and dying. Students reported feeling heard and connected to their peers during the exercise and an enhanced sense of belonging after the exercise. CONCLUSIONS Findings contribute to evidence that suggests the CARES model is a useful mechanism to enhance peer social support in paramedic students.
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Affiliation(s)
- Belinda Flanagan
- Director of Paramedicine, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Matthew Warren-James
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Jeanine Young
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
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Elks M, Young J, Kearney L, Bernard A. The impact of an autonomous nurse-led high-flow nasal cannula oxygen protocol on clinical outcomes of infants with bronchiolitis. J Clin Nurs 2022. [PMID: 36164265 DOI: 10.1111/jocn.16525] [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: 02/15/2022] [Revised: 08/01/2022] [Accepted: 08/14/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the relationship of the implementation of a nurse-led high-flow nasal cannula oxygen protocol on the clinical outcomes of infants with bronchiolitis in a regional paediatric unit. BACKGROUND Bronchiolitis is a common lower respiratory illness and is the leading cause for hospitalisation of infants globally. Standard care involves the provision of supportive measures. Historically, supplemental oxygen was provided by low-flow nasal cannula. High-flow nasal cannula oxygen has been increasingly adopted despite limited evidence of its efficacy. METHODS This study employed non-equivalent, post-implementation only design to explore clinical outcomes of infants with bronchiolitis admitted for high-flow nasal cannula oxygen therapy. The study compared infants in the 24 months before and after the initiation of a high-flow nasal cannula protocol. The primary clinical outcome was length of stay, secondary outcomes included time on high flow, weaning time, escalation of care and time outside of physiological parameters. Implementation strategy evaluation was measured by compliance with applying the protocol, reported as episodes of variance, and duration of variance. The StaRI checklist was selected as the most appropriate reporting guideline. RESULTS A total of 80 patients were admitted with bronchiolitis and received high-flow nasal cannula oxygen therapy during a 48-month period; 37 patients were prior, and 43 after, the introduction of a nurse-led high-flow nasal cannula protocol. Length of stay was significantly reduced in the post-implementation group compared to the historical control group (83.8 vs. 61.3 h). Time on high flow and weaning time was decreased in the post-implementation group compared to the control group (33.5 vs. 26.7 h and 26 vs.12.25 h, respectively); however, these did not reach statistical significance. There was varied application of the HFNC protocol. CONCLUSIONS The implementation of a nurse-led high-flow nasal cannula protocol was associated with a reduced length of stay. RELEVANCE TO CLINICAL PRACTICE This study demonstrated that infants with bronchiolitis that were treated with a nurse-led high-flow nasal cannula (HFNC) therapy protocol had positive effects on clinical outcomes including a shorter length of stay than compared with those with physician-directed care in a regional paediatric unit. A weight-based (2 L/kg) HFNC therapy was safely administered to infants with bronchiolitis in a regional hospital paediatric ward with no paediatric intensive care unit (PICU).
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Affiliation(s)
- Michelle Elks
- Sunshine Coast Hospital and Health Service, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Jeanine Young
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Lauren Kearney
- School of Nursing, Midwifery & Paramedicine University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Anne Bernard
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
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Young J, Cole R, Thompson JMD, Cruice D, McEniery J. Addressing Caregiver Challenges with Inconsistent and Unrealistic Safe Sleep Messaging: a Safer Sleep Guideline informed by Risk Minimisation. Women Birth 2022. [DOI: 10.1016/j.wombi.2022.07.074] [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: 11/26/2022]
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Barratt J, Dellanna F, Portoles J, Choukroun G, de Nicola L, Reusch M, Young J, Dimković N. Tolérance du roxadustat par rapport aux agents stimulant l’érythropoïèse dans le traitement de l’anémie chez les patients atteints de maladie rénale chronique non dialysés ou incidents en dialyse : analyse groupée de quatre études de phase 3. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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15
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Laidsaar-Powell R, Butow P, Brown B, Mander K, Young J, Stone E, Chin V, Banks E, Lim C, Rankin N. EP10.01-005 Australian Lung Cancer Survivors Experiences of Novel Treatments, Healthcare, and Ongoing Physical and Psychological Needs. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Barratt J, Dellanna F, Portoles J, Choukroun G, De Nicola L, Reusch M, Young J, Jiletcovici A, Dimković N. Bilan martial des patients traités par roxadustat pour anémie liée à leur maladie rénale chronique : analyse post hoc chez les patients non dialysés ou incidents en dialyse inclus dans quatre études de phase 3. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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17
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Chin V, Arora H, Senabouth A, Hernandez JA, McCloy R, Simes J, Boyer M, Hogg P, Young J, Joshua A, Brown B, Watkins N, Powell J. EP16.03-041 Single Cell RNA Sequencing Reveals Phenotypic Predispositions to Developing Lung Cancer in Never-Smokers. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.1102] [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: 12/01/2022]
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18
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Sumankuuro J, Baatiema L, Crockett J, Young J. Women's use of non-conventional herbal uterotonic in pregnancy and labour: evidence from birth attendants. BMC Pregnancy Childbirth 2022; 22:600. [PMID: 35896986 PMCID: PMC9327204 DOI: 10.1186/s12884-022-04934-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/19/2022] [Indexed: 11/14/2022] Open
Abstract
Background Over the years, governments and stakeholders have implemented various policies/programmes to improve maternal health outcomes in low-middle-income countries. In Ghana, Community Health Officers were trained as midwives to increase access to skilled maternal healthcare. The government subsequently banned traditional birth attendants from providing direct maternal healthcare in 2000. Despite these, there is an unprecedented utilisation of TBAs’ services, including herbal uterotonics. This has attempted to defeat stakeholders’ campaigns to improve maternal health outcomes. Thus, we explored and highlighted herbal uterotonic consumption in pregnancy and birth and the implications on maternal and newborn health outcomes in North-Western Ghana. Methods This was an exploratory qualitative study that investigated traditional birth attendants (n = 17) and healthcare providers' (n = 26) perspectives on the intake of herbal uterotonics in pregnancy and childbirth in rural Ghana, using in-depth interviews. A combination of convenience, purposive and snowball sampling procedures were employed in selecting participants. Results Findings were captured in two domains: (1) perceived rationale for herbal uterotonic intake, and (2) potential adverse impacts of herbal uterotonic intake in pregnancy and labour, and nine topics: (i) confidence in unskilled attendance at birth, (ii) cost and a shortage of essential medicines, (iii) herbal uterotonics as a remedy for obstetric problems, (iv) herbal uterotonics facilitate birth, (v) attraction of home birth for cultural reasons, (vi) affordability of herbal uterotonics, (vii) unintended consequences and adverse outcomes, (viii) risks using herbal uterotonics to manage fertility and (ix) risks using herbal uterotonics to facilitate home birth. Conclusion The findings have suggested that the intake of non-conventional herbal uterotonic is widespread in the study area, although the constituents of the herb are unknown. However, complex and multiple factors of healthcare cost, desire for homebirth, unawareness of the negative effects of such substances, perceived way of addressing obstetric problems and cultural undertones, among others, accounted for herbal uterotonics consumption. We also encourage research into the constituents of ‘mansugo’ and the potential benefits and adverse effects. We recommend qualitative studies involving previous users of this herbal uterotonic to inform policy and healthcare provision.
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Affiliation(s)
- Joshua Sumankuuro
- Faculty of Public Policy and Governance, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana. .,Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,School of Community Health, Faculty of Science, Charles Sturt University, Orange, New South Wales, Australia. .,School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa.
| | - Leonard Baatiema
- Department of Health Policy and Management, University of Ghana, Accra, Ghana.,Department of Global Health and Population, Harvard T.H Chan School of Public Health, Harvard University, Boston, USA
| | - Judith Crockett
- School of Community Health, Faculty of Science, Charles Sturt University, Orange, New South Wales, Australia
| | - Jeanine Young
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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Ryan RE, Connolly M, Bradford NK, Henderson S, Herbert A, Schonfeld L, Young J, Bothroyd JI, Henderson A. Interventions for interpersonal communication about end of life care between health practitioners and affected people. Cochrane Database Syst Rev 2022; 7:CD013116. [PMID: 35802350 PMCID: PMC9266997 DOI: 10.1002/14651858.cd013116.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Communication about end of life (EoL) and EoL care is critically important for providing quality care as people approach death. Such communication is often complex and involves many people (patients, family members, carers, health professionals). How best to communicate with people in the period approaching death is not known, but is an important question for quality of care at EoL worldwide. This review fills a gap in the evidence on interpersonal communication (between people and health professionals) in the last year of life, focusing on interventions to improve interpersonal communication and patient, family member and carer outcomes. OBJECTIVES To assess the effects of interventions designed to improve verbal interpersonal communication about EoL care between health practitioners and people affected by EoL. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL from inception to July 2018, without language or date restrictions. We contacted authors of included studies and experts and searched reference lists to identify relevant papers. We searched grey literature sources, conference proceedings, and clinical trials registries in September 2019. Database searches were re-run in June 2021 and potentially relevant studies listed as awaiting classification or ongoing. SELECTION CRITERIA This review assessed the effects of interventions, evaluated in randomised and quasi-randomised trials, intended to enhance interpersonal communication about EoL care between patients expected to die within 12 months, their family members and carers, and health practitioners involved in their care. Patients of any age from birth, in any setting or care context (e.g. acute catastrophic injury, chronic illness), and all health professionals involved in their care were eligible. All communication interventions were eligible, as long as they included interpersonal interaction(s) between patients and family members or carers and health professionals. Interventions could be simple or complex, with one or more communication aims (e.g. to inform, skill, engage, support). Effects were sought on outcomes for patients, family and carers, health professionals and health systems, including adverse (unintended) effects. To ensure this review's focus was maintained on interpersonal communication in the last 12 months of life, we excluded studies that addressed specific decisions, shared or otherwise, and the tools involved in such decision-making. We also excluded studies focused on advance care planning (ACP) reporting ACP uptake or completion as the primary outcome. Finally, we excluded studies of communication skills training for health professionals unless patient outcomes were reported as primary outcomes. DATA COLLECTION AND ANALYSIS Standard Cochrane methods were used, including dual review author study selection, data extraction and quality assessment of the included studies. MAIN RESULTS Eight trials were included. All assessed intervention effects compared with usual care. Certainty of the evidence was low or very low. All outcomes were downgraded for indirectness based on the review's purpose, and many were downgraded for imprecision and/or inconsistency. Certainty was not commonly downgraded for methodological limitations. A summary of the review's findings is as follows. Knowledge and understanding (four studies, low-certainty evidence; one study without usable data): interventions to improve communication (e.g. question prompt list, with or without patient and physician training) may have little or no effect on knowledge of illness and prognosis, or information needs and preferences, although studies were small and measures used varied across trials. Evaluation of the communication (six studies measuring several constructs (communication quality, patient-centredness, involvement preferences, doctor-patient relationship, satisfaction with consultation), most low-certainty evidence): across constructs there may be minimal or no effects of interventions to improve EoL communication, and there is uncertainty about effects of interventions such as a patient-specific feedback sheet on quality of communication. Discussions of EoL or EoL care (six studies measuring selected outcomes, low- or very low-certainty evidence): a family conference intervention may increase duration of EoL discussions in an intensive care unit (ICU) setting, while use of a structured serious illness conversation guide may lead to earlier discussions of EoL and EoL care (each assessed by one study). We are uncertain about effects on occurrence of discussions and question asking in consultations, and there may be little or no effect on content of communication in consultations. Adverse outcomes or unintended effects (limited evidence): there is insufficient evidence to determine whether there are adverse outcomes associated with communication interventions (e.g. question prompt list, family conference, structured discussions) for EoL and EoL care. Patient and/or carer anxiety was reported by three studies, but judged as confounded. No other unintended consequences, or worsening of desired outcomes, were reported. Patient/carer quality of life (four studies, low-certainty evidence; two without useable data): interventions to improve communication may have little or no effect on quality of life. Health practitioner outcomes (three studies, low-certainty evidence; two without usable data): interventions to improve communication may have little or no effect on health practitioner outcomes (satisfaction with communication during consultation; one study); effects on other outcomes (knowledge, preparedness to communicate) are unknown. Health systems impacts: communication interventions (e.g. structured EoL conversations) may have little or no effect on carer or clinician ratings of quality of EoL care (satisfaction with care, symptom management, comfort assessment, quality of care) (three studies, low-certainty evidence), or on patients' self-rated care and illness, or numbers of care goals met (one study, low-certainty evidence). Communication interventions (e.g. question prompt list alone or with nurse-led communication skills training) may slightly increase mean consultation length (two studies), but other health service impacts (e.g. hospital admissions) are unclear. AUTHORS' CONCLUSIONS Findings of this review are inconclusive for practice. Future research might contribute meaningfully by seeking to fill gaps for populations not yet studied in trials; and to develop responsive outcome measures with which to better assess the effects of communication on the range of people involved in EoL communication episodes. Mixed methods and/or qualitative research may contribute usefully to better understand the complex interplay between different parties involved in communication, and to inform development of more effective interventions and appropriate outcome measures. Co-design of such interventions and outcomes, involving the full range of people affected by EoL communication and care, should be a key underpinning principle for future research in this area.
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Affiliation(s)
- Rebecca E Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Michael Connolly
- School of Nursing, Midwifery and Health Systems, University College Dublin and Our Lady's Hospice and Care Services, Dublin, Ireland
| | - Natalie K Bradford
- Centre for Children's Health Research, Cancer and Palliative Care Outcomes at Centre for Children's Health Research, Queensland University of Technology (QUT), South Brisbane, Australia
| | - Simon Henderson
- Department of Aviation, The University of New South Wales, Sydney, Australia
| | - Anthony Herbert
- Paediatric Palliative Care Service, Children's Health Queensland, Hospital and Health Service, South Brisbane, Australia
- Centre for Children's Health Research, Queensland University of Technology, South Brisbane, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Jeanine Young
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Australia
| | | | - Amanda Henderson
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Australia
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Dalgaard F, Fudim M, Al-Khatib S, Friedman D, Abraham WT, Cleland JF, Curtis AB, Gold MR, Kutyifa V, Linde C, Young J, Ali-Ahmad F, Olivas-Martinez A, Inoue LYT, Sanders GD. Cardiac resynchronization therapy in patients with a history of atrial fibrillation: insights from five major clinical trials. Europace 2022. [DOI: 10.1093/europace/euac053.386] [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
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Heart, Lung, and Blood Institute
Background
Many patients with heart failure who are considered for cardiac resynchronization therapy (CRT) have a history of (h/o) atrial fibrillation (AF) but there are doubts about the efficacy of CRT in patients with AF.
Purpose
To investigate the association of CRT on morbidity and mortality among patients with and without a h/o AF.
Methods
Original, patient-level data from five clinical trials of CRT that permitted enrolment of patients with a h/o AF were included: COMPANION, MADIT-CRT, BLOCK HF, REVERSE, and MIRACLE trial. Patients with permanent or persistent AF were excluded from these trials, and therefore from this analysis. The outcomes of interest were the composite endpoint of time to heart failure hospitalization (HFH) or all-cause mortality or all-cause mortality alone. The association of CRT (versus no CRT) with outcomes for patients with and without a h/o AF was assessed using a Bayesian-Weibull survival regression model with random terms for the trial-specific treatment effects and the trial-specific baseline hazard functions including an interaction between history of paroxysmal AF and CRT. All results are presented as hazard ratios (HRs) with 95% posterior credible intervals (CIs) and posterior probabilities of no association, adjusting for baseline characteristics.
Results
A total of 4062 patients were included, 661 (16.3%) of whom had a h/o AF. Patients with a h/o AF were older (mean [SD] age 68 [10] years versus 64 [11] years) and had a higher proportion of ischemic cardiomyopathy (67% versus 53%, p<0.001), a higher baseline serum creatinine (1.3 mg/dl versus 1.2 mg/dl, p<0.001), and a lower left ventricular ejection fraction (25% versus 26%, p<0.001). The HRs for all outcomes and the interaction term are shown in Table 1. For the overall population, CRT delayed the time to HFH or all-cause mortality (HR: 0.74, 95% CI: 0.62 – 0.87, p=0.005); for patients with a h/o AF, it did not (HR: 0.87, 95% CI: 0.64 to 1.19, p=0.37). In this patient-level meta-analysis, CRT was not associated with a reduction in mortality, overall or by h/o AF. Howevber, the interaction (estimate shown as a ratio of HRs) between those with or without a h/o AF and the effects of CRT was not significant for either outcome (Table 1).
Conclusion
In the largest post hoc analysis to date, we confirm the benefits of CRT in patients without a h/o AF in reducing HFH or mortality. There was no statistically significant interaction between CRT and h/o AF for any analysed outcome.
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Affiliation(s)
- F Dalgaard
- Gentofte University Hospital, Gentofte, Denmark
| | - M Fudim
- Duke Clinical Research Institute, Durham, United States of America
| | - S Al-Khatib
- Duke Clinical Research Institute, Durham, United States of America
| | - D Friedman
- Duke Clinical Research Institute, Durham, United States of America
| | - WT Abraham
- The Ohio State University, Division of Cardiovascular Medicine, Columbus, United States of America
| | - JF Cleland
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - AB Curtis
- University At Buffalo, Department of Medicine, Buffalo, United States of America
| | - MR Gold
- Medical University of South Carolina, Charleston, United States of America
| | - V Kutyifa
- University of Rochester Medical Center, Division of Cardiology, Rochester, United States of America
| | - C Linde
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - J Young
- Cleveland Clinic, Cleveland, United States of America
| | - F Ali-Ahmad
- Duke Clinical Research Institute, Durham, United States of America
| | - A Olivas-Martinez
- University of Washington, Department of Biostatistics, Seattle, United States of America
| | - LYT Inoue
- University of Washington, Department of Biostatistics, Seattle, United States of America
| | - GD Sanders
- Duke Clinical Research Institute, Durham, United States of America
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21
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Bruce N, Young J. 347 A Bit of a Headache: Management of Head Injuries in a District General Hospital. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Head Injury is a common presentation in our DGH, which covers a large rural area and is now a regional trauma centre. We audited our management of head injuries against current guidelines and planned a new pathway to ensure patients receive the correct advice and follow up on discharge.
Method
Data was requested from IT for all head injury episodes in 2019, to reflect usual numbers pre-pandemic.
Electronic letters, radiology and notes were used to identify whether imaging criteria was met/carried out, discharge destinations, re-presentations, specialty discussions, and head injury advice on discharge.
Results
307 individual patients identified. 13 re-presentations. 10 required neurosurgical discussions
Destinations
226 (73.6%) discharged direct from ED. Admissions: Surgical - 37 (12%), Medical - 6 (2%), Paeds – 14 (4.5%), ITU 2 (0.7%), Did not wait – 2 (0.7%), Not Recorded – 7 (2.3%)
Imaging
100 patients met NICE criteria for CT, 100% were documented in notes and had CT. 76% reported normal, 18% had a bleed, contusion, or haematoma.
HI advice
90% of ED discharges, 16% of Surgical and 16% of medical discharges had head injury discharge advice documented
Conclusions
Guidelines were met for 100% of patients requiring imaging. Head injury advice was well documented in ED but fell down in ward paperwork. We have written a robust pathway where all inpatients have a proforma completed during admission with prompts for discharge advice and rehab referral where appropriate, this is currently undergoing a re-audit to ensure improvement and if successful will become an established part of the trauma pathway in our hospital.
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Affiliation(s)
- N. Bruce
- NHS Borders, Melrose, United Kingdom
| | - J. Young
- NHS Borders, Melrose, United Kingdom
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22
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Hobbs J, Marks B, Young J. 238 The Use of MRCP in the Assessment of Choledocholithiasis in Patients Presenting with Symptomatic Gallstone Disease. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.153] [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: 11/14/2022]
Abstract
Abstract
Aim
Magnetic Resonance Cholangiopancreatography (MRCP) is the investigation of choice for choledocholithiasis; however, use is varied and guidelines vague. The National Institute for Health and Care (NICE) recommend MRCP when common bile duct (CBD) dilatation ≥ 8mm or liver function tests (LFTs) are abnormal but do not quantify this further. The Sunflower Study classifies patients as “high-risk” for choledocholithiasis if alanine aminotransferase (ALT) ≥ 80 IU/L, alkaline phosphatase (ALP) ≥ 200 IU/L or CBD ≥ 8mm. We aimed to assess compliance with NICE criteria and determine what biochemical abnormalities are most associated with choledocholithiasis.
Method
A retrospective analysis of inpatient MRCPs performed at QEH between March and May 2021 was performed (n = 72). Pre-MRCP bloods and imaging were used to assess concordance with NICE guidelines. We compared LFTs between patients with and without choledocholithiasis, looking for significant differences.
Results
84.7% of MRCPs were performed in accordance with NICE guidance, of which 31.1% demonstrated choledocholithiasis. No cases of choledocholithiasis were identified if NICE criteria were not fulfilled. A significant difference between the mean values of gamma glutamyltransferase (GGT) and ALP was noted between patients with and without choledocholithiasis.
Conclusions
We identified that the majority of MRCPs were performed in accordance with guidance. Significantly, no cases of choledocholithiasis were identified if these criteria were not met. Although our sample size was small, we found the most specific biochemical markers were ALP and GGT and propose that further research with larger cohorts may help develop a risk stratification tool to aid decision making.
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Affiliation(s)
- J. Hobbs
- Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
| | - B. Marks
- County Durham and Darlington NHS Foundation Trust, Darlington, United Kingdom
| | - J. Young
- Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
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23
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Young J, Mercieca L, Ceci M, Pisani D, Betts A, Boffa M. A case of bullous pemphigoid after the SARS-CoV-2 mRNA vaccine. J Eur Acad Dermatol Venereol 2022; 36:e13-e16. [PMID: 34547137 PMCID: PMC8661451 DOI: 10.1111/jdv.17676] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/16/2021] [Indexed: 12/16/2022]
Affiliation(s)
- J. Young
- Department of DermatologyMater Dei HospitalMsidaMalta
| | - L. Mercieca
- Department of DermatologyMater Dei HospitalMsidaMalta
| | - M. Ceci
- Department of PathologyMater Dei HospitalMsidaMalta
| | - D. Pisani
- Department of PathologyMater Dei HospitalMsidaMalta
| | - A. Betts
- Department of PathologyMater Dei HospitalMsidaMalta
| | - M.J. Boffa
- Department of DermatologyMater Dei HospitalMsidaMalta
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Lin R, Ritter E, Flynn J, Ho C, Ruiz J, Jakubowski A, Papadopoulos E, Shaffer B, Castro-Malaspina H, Cho C, Ponce D, Barker J, Tamari R, Sauter C, Gyurkocza B, van den Brink M, Young J, Perales M, Devlin S, Wong P, Giralt S. Aging-related, Senescence-associated Secretory Phenotype and Allogeneic Hematopoietic Cell Transplantation Outcomes in Older Adults. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00355-6] [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: 10/19/2022]
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25
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Mao AW, Barck H, Young J, Paley A, Mao JH, Chang H. Identification of a novel cancer microbiome signature for predicting prognosis of human breast cancer patients. Clin Transl Oncol 2021; 24:597-604. [PMID: 34741726 DOI: 10.1007/s12094-021-02725-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/16/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Prognosis of breast cancer (BC) patients differs considerably and identifying reliable prognostic biomarker(s) is imperative. With evidence that the microbiome plays a critical role in the response to cancer therapies, we aimed to identify a cancer microbiome signature for predicting the prognosis of BC patients. METHODS The TCGA BC microbiome data (TCGA-BRCA-microbiome) was downloaded from cBioPortal. Univariate and multivariate Cox regression analyses were used to examine association of microbial abundance with overall survival (OS) and to identify a microbial signature for creating a prognostic scoring model. The performance of the scoring model was assessed by the area under the ROC curve (AUC). Nomograms using the microbial signature, clinical factors, and molecular subtypes were established to predict OS and progression-free survival (PFS). RESULTS Among 1406 genera, the abundances of 94 genera were significantly associated with BC patient OS in TCGA-BRCA-microbiome dataset. From that set we identified a 15-microbe prognostic signature and developed a 15-microbial abundance prognostic scoring (MAPS) model. Patients in low-risk group significantly prolong OS and PFS as compared to those in high-risk group. The time-dependent ROC curves with MAPS showed good predictive efficacy both in OS and PFS. Moreover, MAPS is an independent prognostic factor for OS and PFS over clinical factors and PAM50-based molecular subtypes and superior to the previously published 12-gene signature. The integration of MAPS into nomograms significantly improved prognosis prediction. CONCLUSION MAPS was successfully established to have independent prognostic value, and our study provides a new avenue for developing prognostic biomarkers by microbiome profiling.
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Affiliation(s)
- A W Mao
- Berkeley Biomedical Data Science Center, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - H Barck
- Berkeley Biomedical Data Science Center, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - J Young
- Berkeley Biomedical Data Science Center, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - A Paley
- Berkeley Biomedical Data Science Center, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - J -H Mao
- Berkeley Biomedical Data Science Center, Lawrence Berkeley National Laboratory, Berkeley, CA, USA. .,Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA.
| | - H Chang
- Berkeley Biomedical Data Science Center, Lawrence Berkeley National Laboratory, Berkeley, CA, USA. .,Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA.
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Cole R, Young J, Kearney L, Thompson JMD. Challenges parents encounter when implementing infant safe sleep advice. Acta Paediatr 2021; 110:3083-3093. [PMID: 34297875 DOI: 10.1111/apa.16040] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/21/2021] [Indexed: 01/21/2023]
Abstract
AIM To understand which safe sleep recommendations parents find most challenging to implement, identifying common barriers encountered; and investigate whether challenges are associated with practices employed. METHODS A cross-sectional survey of 3341 Australian families with young infants who birthed a live baby during April-May 2017. Caregivers were asked about infant care practices and family characteristics. Qualitative free-text items explored challenges faced with current safe sleep recommendations. RESULTS Nearly one-third (n = 1033, 31%) of caregivers reported difficulty with at least one safe sleep recommendation. Infant sleep position and avoiding bed-sharing were identified as the most challenging recommendations. Caregivers described barriers which influenced consistency in uptake of advice. Families who described difficulty with a recommendation were significantly less likely to consistently employ that advice compared to those who did not report difficulty (sleep position: 198/473,42% vs 2548/2837,90% [p < 0.0001]; own sleep space: (269/344,78% vs 1331/2884,46% [p < 0.0001]). When families encountered challenges, they often proposed alternate strategies with an inference their substitute action compensated potential increased risk. CONCLUSION Many families encounter difficulties implementing safe sleep advice; these challenges negatively impact care practices. Effective interventions meeting individual family needs, to provide safe sleep environments consistently, are necessary to improve sleep-related infant care and further reduce infant mortality.
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Affiliation(s)
- Roni Cole
- School of Nursing, Midwifery and Paramedicine University of the Sunshine Coast Sippy Downs Australia
- Sunshine Coast Health Institute Sunshine Coast Hospital and Health Service Birtinya Australia
| | - Jeanine Young
- School of Nursing, Midwifery and Paramedicine University of the Sunshine Coast Sippy Downs Australia
- Sunshine Coast Health Institute Sunshine Coast Hospital and Health Service Birtinya Australia
| | - Lauren Kearney
- School of Nursing, Midwifery and Paramedicine University of the Sunshine Coast Sippy Downs Australia
- Sunshine Coast Health Institute Sunshine Coast Hospital and Health Service Birtinya Australia
| | - John M. D. Thompson
- School of Nursing, Midwifery and Paramedicine University of the Sunshine Coast Sippy Downs Australia
- Paediatrics: Child and Youth Health School of Medicine University of Auckland Auckland New Zealand
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Maselli D, Carstens D, Yang D, Mu F, Young J, Cook E, Betts K, Chung Y. P061 BENRALIZUMAB IS EFFECTIVE IN REDUCING ASTHMA EXACERBATIONS: RESULTS FROM THE ZEPHYR 2 STUDY. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Qiu Y, McEwen C, Bhagirath V, Chan N, Eikelboom J, Eikelboom R, Young J, Whitlock R, Belley-Cote E. Evaluating direct oral anticoagulants versus vitamin K antagonists for treatment of left ventricular thrombus: a systematic review and meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2981] [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: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Left ventricular thrombi are associated with high rates of stroke and systemic embolism (1). While vitamin K antagonists (VKAs) have historically been the anticoagulant of choice, they have a narrow therapeutic window and require frequent monitoring. Direct oral anticoagulants (DOACs) offer more predictable anticoagulation but the use of DOACs to treat left ventricular thrombus has not been well studied (1,2). Guideline recommendations around the topic are based on expert consensus and very low-quality evidence.
Purpose
This systematic review and meta-analysis compares DOACs or VKAs in the treatment of left ventricular thrombus. Outcomes of interest were stroke and systemic embolism, thrombus resolution, any bleeding, major bleeding, and mortality.
Methods
We searched CENTRAL, MEDLINE, EMBASE, CINAHL, ACPJC, and Web of Science for studies comparing DOACs and VKAs in the treatment of left ventricular thrombus. We also searched reference lists from included studies and relevant conferences' proceedings. Two reviewers independently screened titles and abstracts and then the full-text of potentially relevant citations in duplicate. They then extracted data and evaluated risk of bias in duplicate. The data was analyzed using Revman 5.3. We used the DerSimonian and Laird random-effects model to pool the weighted effect of estimates across all studies. The pooled relative risks (RRs) were calculated with corresponding 95% confidence intervals (CIs). We assessed the quality of evidence for each outcome using the Grading of Recommendations, Assessment, Development, and Evaluation approach.
Results
Of 443 citations screened, 12 observational studies (n=2,225) were included. We found no randomized controlled trial addressing the question. Most included studies were at high risk of bias due to unmatched baseline variables. We found no significant difference in any of our outcomes with DOACs versus VKAs: stroke and systemic embolism (RR 1.14, 95% CI [0.82, 1.58], p=0.43), thrombus resolution (RR 1.02, 95% CI [0.91, 1.15], p=0.69), any bleeding (RR 1.47, 95% CI [0.65, 3.33], p=0.36), major bleeding (RR 0.22, 95% CI [0.01, 4.21], p=0.32), and mortality (RR 0.99, 95% CI [0.67, 1.45], p=0.95). Evidence for each of these outcomes was of very low-quality due to risk of bias, inconsistency, and imprecision of the studies.
Conclusions
Very low quality evidence suggests no difference in outcomes with DOACs versus VKAs in the treatment of left ventricular thrombus. More robust data are needed to guide clinicians.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Qiu
- Michael G. DeGroote School of Medicine, Hamilton, Canada
| | - C McEwen
- Michael G. DeGroote School of Medicine, Hamilton, Canada
| | - V Bhagirath
- Division of Hematology and Thromboembolism, Department of Medicine, Hamilton, Canada
| | - N Chan
- Division of Hematology and Thromboembolism, Department of Medicine, Hamilton, Canada
| | - J Eikelboom
- Population Health Research Institute, Hamilton, Canada
| | - R Eikelboom
- Max Rady College of Medicine, Department of Cardiac Surgery, Winnipeg, Canada
| | - J Young
- McMaster University, Health Sciences Library, Hamilton, Canada
| | - R Whitlock
- Population Health Research Institute, Hamilton, Canada
| | - E Belley-Cote
- Population Health Research Institute, Hamilton, Canada
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29
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Boyle C, Young J. 219 Have New National Guidelines Changed Practice in Referrals with Suspected Ureteric Colic? Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1073] [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: 11/14/2022]
Abstract
Abstract
Aim
To assess how many patients had a non-contrast CT as first-line investigation for suspected renal colic, and how this was affected by the release of the 2019 NICE guidelines. A secondary aim was to assess the proportion of patients who had CT KUBs that demonstrated a ureteric calculus.
Method
CT KUB scans performed over two separate 3 month periods were identified. These reflected periods of time before and after the new NICE guidelines. Electronic records were used to assess if the patients had an ultrasound performed as the initial diagnostic investigation, instead of a CT scan. The results of the scans were reviewed to identify if a ureteric or renal calculus had been positively identified.
Results
In the period before the new guidelines, 61 patients were scanned. 4 had an ultrasound to assess for a stone prior to a CT. All of these patients were medical inpatients. None of the ultrasounds diagnosed a stone. 22/61 patients had CT-proven stones (36%) In the period after the new guidelines, 79 patients were scanned. 12 had an ultrasound to assess for a stone prior to a CT. 8 were medical patients, 3 were surgical and 1 was gynaecological. 1 ultrasound diagnosed a stone. 28/79 patients had CT-proven stones (35.4%)
Conclusions
The release of new guidelines did not improved compliance with suggested imaging pathways. This clearly demonstrates an area for improvement. It is also worth noting that only 1/3 of referrals with suspected renal colic did actually have a stone, which has implications for specialty referral pathways.
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Affiliation(s)
- C Boyle
- Borders General Hospital, Melrose, United Kingdom
| | - J Young
- Borders General Hospital, Melrose, United Kingdom
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30
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Qiu Y, McEwen C, Bhagirath V, Chan N, Eikelboom J, Eikelboom R, Young J, Whitlock R, Belley-Cote E. EVALUATING DIRECT ORAL ANTICOAGULANTS VERSUS VITAMIN K ANTAGONISTS FOR TREATMENT OF LEFT VENTRICULAR THROMBUS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.036] [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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31
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Flaender M, Young J, Duchemin-Pelletier E, Lorintiu O, Compere L, Champetier T, Ventre E. MYOTONIC DYSTROPHY. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.259] [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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Crowe L, Young J, Turner MJ. What is the prevalence and risk factors of burnout among pediatric intensive care staff (PICU)? A review. Transl Pediatr 2021; 10:2825-2835. [PMID: 34765504 PMCID: PMC8578753 DOI: 10.21037/tp-20-400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/29/2021] [Indexed: 12/03/2022] Open
Abstract
Staff in the paediatric intensive care unit work with children and their families in an area of high acuity, mortality, and morbidity. There is complexity due to technological advancements and confronting psychosocial situations. With increasing reports of the threat of burnout to healthcare professionals it is imperative to understand the prevalence of burnout and the determinants of risk factors for staff to work in the paediatric intensive care unit (PICU) in order to inform interventions that reduce risk and support growth and wellbeing of this specialised workforce. We conducted electronic searches of PUBMED, Medline, CINAHL and PsychINFO. Studies meeting eligibility inclusion criteria comprised English text, publication dates 1995 to 2019, use of standardized measures to assess prevalence and risk factors for burnout where the PICU staff data was reported separately and contained sample sizes ≥10 PICU staff. Two reviewers independently identified and extracted citations and assessed the quality of papers using two standardised reporting tools. Twenty studies were included in the final review. Due to the heterogeneity of the included studies a descriptive account of the studies was developed. Outcomes reported included prevalence and levels of burnout reported across professional disciplines, reported scoring criteria for burnout, risk and protective factors for burnout, comparative populations, systems and social context associated with burnout and study strengths and limitations. Most studies were cross-sectional, used a single measure of burnout and focussed on either physicians or nurses. Of the 20 studies reported 62% reported high burnout, 19% moderate burnout, and 19% reported low levels of burnout. Inconsistency was identified in adherence to recommended cut-off scores or reporting for the categorisation of burnout, which contributed to a lack of clarity in the interpretation of prevalence and severity. Reports of factors associated with increased risk and likely protective factors for burnout were often contradictory suggesting that burnout may be situational; dependent upon personal, environmental, leadership, cultural and patient factors within the PICU. This review revealed that determining levels and risk of burnout in PICU staff remains problematic. Further research which examines the experiences of all members of the multidisciplinary team and identification of factors that affect the development of burnout, including those which are protective, is required.
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Affiliation(s)
- Liz Crowe
- School of Medicine, The University of Queensland, Brisbane, Australia.,School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Jeanine Young
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Queensland, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - M Jane Turner
- Discipline of Psychiatry, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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33
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Cohen S, Singh R, Khalid N, Young J, Aldiwani M, Roy D, Edwards I. 468 IMPROVING ADVANCE CARE PLANNING SKILLS IN JUNIOR DOCTORS. Age Ageing 2021. [DOI: 10.1093/ageing/afab116.07] [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
Introduction
Junior doctors are increasingly encountering Advance Care Planning (ACP) when they look after frail, older or multi-morbid patients during their hospital rotations. However, there remains a lack of formal training and resources, particularly with DNACPR discussions and when engaging patients and their loved ones with Emergency Health Care Planning (EHCP). We aimed to assess the need for ACP, improve the infrastructure by which ACP is delivered, and better support junior doctors to have these difficult conversations.
Method
Discharges from the Geriatrics Department at Kettering General Hospital were reviewed initially in May 2019 and again in January 2020 following intervention. We introduced a focused communication skills training session delivered at departmental teaching, which included a combination of simulation training and lectures. We additionally designed and implemented an EHCP template to aid junior doctors’ discussions. This could also be copied to the discharge letter, to facilitate safe transfer of care to primary care.
Results
In May 2019 of 32 patients, 100% met at least one SPICTTM criterion, with median of 4 criteria, thus indicating a high need for ACP in this cohort. Despite this, only one discharge letter included an EHCP and two had a request for GP colleagues to complete one. Evaluation of discharges again in January of 2020 reconfirmed a similar need for ACP, but following our interventions, the number of EHCP’s performed had increased. Of 22 identified patients 4 had a completed EHCP and 3 were requested for completion by their GP. Qualitative questionnaires demonstrated an improvement in both knowledge and confidence amongst junior doctors following the training session.
Conclusion
We have shown that there is a necessity for ACP to be considered for Geriatrics inpatients, and that providing structure and training in this challenging area offers benefit to both patients and junior doctors.
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Affiliation(s)
| | | | | | | | | | - D Roy
- Kettering General Hospital
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34
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Desai S, Laplant B, Macon W, Young J, King R, Wang Y, Inwards D, Micallef I, Johnston PB, Porrata LF, Ansell SM, Habermann TM, Witzig TE, Nowakowski GS. INTERIM PET/CT PREDICTS OUTCOMES OF DIFFUSE LARGE B‐CELL LYMPHOMA (DLBCL) TREATED WITH FRONTLINE LENALIDOMIDE/RCHOP (R2CHOP): LONG‐TERM ANALYSIS OF MC078E. Hematol Oncol 2021. [DOI: 10.1002/hon.83_2880] [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)
- S. Desai
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - B. Laplant
- Mayo Clinic Department of Quantitative Health Sciences Rochester Minnesota USA
| | - W. Macon
- Mayo Clinic Department of Laboratory Medicine and Pathology Rochester Minnesota USA
| | - J. Young
- Mayo Clinic Division of Nuclear Medicine Department of Radiology Rochester Minnesota USA
| | - R. King
- Mayo Clinic Department of Laboratory Medicine and Pathology Rochester Minnesota USA
| | - Y. Wang
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - D. Inwards
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - I. Micallef
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - P. B. Johnston
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - L. F. Porrata
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - S. M. Ansell
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - T. M. Habermann
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - T. E. Witzig
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - G. S. Nowakowski
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
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35
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Bakshy K, Heimeier D, Schwartz JC, Glass EJ, Wilkinson S, Skuce RA, Allen AR, Young J, McClure JC, Cole JB, Null DJ, Hammond JA, Smith TPL, Bickhart DM. Development of polymorphic markers in the immune gene complex loci of cattle. J Dairy Sci 2021; 104:6897-6908. [PMID: 33685702 DOI: 10.3168/jds.2020-19809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/18/2021] [Indexed: 11/19/2022]
Abstract
The addition of cattle health and immunity traits to genomic selection indices holds promise to increase individual animal longevity and productivity, and decrease economic losses from disease. However, highly variable genomic loci that contain multiple immune-related genes were poorly assembled in the first iterations of the cattle reference genome assembly and underrepresented during the development of most commercial genotyping platforms. As a consequence, there is a paucity of genetic markers within these loci that may track haplotypes related to disease susceptibility. By using hierarchical assembly of bacterial artificial chromosome inserts spanning 3 of these immune-related gene regions, we were able to assemble multiple full-length haplotypes of the major histocompatibility complex, the leukocyte receptor complex, and the natural killer cell complex. Using these new assemblies and the recently released ARS-UCD1.2 reference, we aligned whole-genome shotgun reads from 125 sequenced Holstein bulls to discover candidate variants for genetic marker development. We selected 124 SNPs, using heuristic and statistical models to develop a custom genotyping panel. In a proof-of-principle study, we used this custom panel to genotype 1,797 Holstein cows exposed to bovine tuberculosis (bTB) that were the subject of a previous GWAS study using the Illumina BovineHD array. Although we did not identify any significant association of bTB phenotypes with these new genetic markers, 2 markers exhibited substantial effects on bTB phenotypic prediction. The models and parameters trained in this study serve as a guide for future marker discovery surveys particularly in previously unassembled regions of the cattle genome.
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Affiliation(s)
- K Bakshy
- Dairy Forage Research Center, USDA-ARS, Madison, WI 53706
| | - D Heimeier
- The Pirbright Institute, Ash Road, Pirbright, Surrey GU24 0NF, UK
| | - J C Schwartz
- The Pirbright Institute, Ash Road, Pirbright, Surrey GU24 0NF, UK
| | - E J Glass
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush EH25 9RG, Edinburgh, UK
| | - S Wilkinson
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush EH25 9RG, Edinburgh, UK
| | - R A Skuce
- Agri-Food and Biosciences Institute, Stormont, Belfast, Northern Ireland BT4 3SD, UK
| | - A R Allen
- Agri-Food and Biosciences Institute, Stormont, Belfast, Northern Ireland BT4 3SD, UK
| | - J Young
- Dairy Forage Research Center, USDA-ARS, Madison, WI 53706
| | - J C McClure
- Dairy Forage Research Center, USDA-ARS, Madison, WI 53706
| | - J B Cole
- Animal Genomics and Improvement Laboratory, USDA-ARS, Beltsville, MD 20705
| | - D J Null
- Animal Genomics and Improvement Laboratory, USDA-ARS, Beltsville, MD 20705
| | - J A Hammond
- The Pirbright Institute, Ash Road, Pirbright, Surrey GU24 0NF, UK
| | - T P L Smith
- Meat Animal Research Center, USDA-ARS, Clay Center, NE 68933
| | - D M Bickhart
- Dairy Forage Research Center, USDA-ARS, Madison, WI 53706.
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36
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Young J, Mizzi S, Mercieca L, Boffa MJ. A non-healing ulcer caused by a retained fish spine. J Eur Acad Dermatol Venereol 2021; 35:e693-e695. [PMID: 34050999 DOI: 10.1111/jdv.17416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J Young
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - S Mizzi
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - L Mercieca
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - M J Boffa
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
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37
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McLean R, Young J, Musbahi A, Lee JX, Hidayat H, Abdalla N, Chowdhury S, Baker E, Etherson K. 94 An Observational Cohort Study to Evaluate Volume and Severity of Emergency General Surgery Admissions During The COVID-19 Pandemic: Is There A “Lockdown” Effect? Br J Surg 2021. [PMCID: PMC8135742 DOI: 10.1093/bjs/znab134.036] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction The COVID-19 pandemic has led to changes in NHS surgical service provision. This, combined with the government-imposed lockdown, may have impacted on patient attendance, severity of surgical disease, and outcomes. This study aimed to investigate a possible ‘lockdown’ effect on the volume and severity of surgical admissions and outcomes. Method Two cohorts of adult emergency general surgery admissions 30 days immediately before (16/2/2020 to 15/3/2020), and after UK government advice (16/3/2020 to 15/4/2020). Data were collected relating to patient characteristics, disease severity, clinical outcomes, and compared between these groups. Results Following lockdown, a significant reduction in median daily admissions from 7 to 3 (p < 0.001) was observed. Post-lockdown patients were significantly older, frailer with higher inflammatory indices and rates of AKI, and more likely to present with gastrointestinal cancer, obstruction, and perforation. Patients had significantly higher rates of Clavien-Dindo Grade ≥3 complications (p = 0.001), all-cause 30-day mortality (8.5% vs. 2.9%, p = 0.028), but no significant difference was observed in operative 30-day mortality. Conclusions There appears to be a “lockdown” effect on general surgical admissions with fewer admissions, more acutely unwell patients, and an increase in all-cause 30-day mortality. Patients should be advised to present promptly, and this should be reinforced for future lockdowns during the pandemic.
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Affiliation(s)
- R McLean
- University Hospital of North Tees, Stockton, United Kingdom
| | - J Young
- University Hospital of North Tees, Stockton, United Kingdom
| | - A Musbahi
- University Hospital of North Tees, Stockton, United Kingdom
| | - J X Lee
- University Hospital of North Tees, Stockton, United Kingdom
| | - H Hidayat
- University Hospital of North Tees, Stockton, United Kingdom
| | - N Abdalla
- University Hospital of North Tees, Stockton, United Kingdom
| | - S Chowdhury
- University Hospital of North Tees, Stockton, United Kingdom
| | - E Baker
- University Hospital of North Tees, Stockton, United Kingdom
| | - K Etherson
- University Hospital of North Tees, Stockton, United Kingdom
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38
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Rickard CM, Marsh NM, Larsen EN, McGrail MR, Graves N, Runnegar N, Webster J, Corley A, McMillan D, Gowardman JR, Long DA, Fraser JF, Gill FJ, Young J, Murgo M, Alexandrou E, Choudhury MA, Chan RJ, Gavin NC, Daud A, Palermo A, Regli A, Playford EG. Effect of infusion set replacement intervals on catheter-related bloodstream infections (RSVP): a randomised, controlled, equivalence (central venous access device)-non-inferiority (peripheral arterial catheter) trial. Lancet 2021; 397:1447-1458. [PMID: 33865494 DOI: 10.1016/s0140-6736(21)00351-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 11/03/2020] [Revised: 01/11/2021] [Accepted: 02/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The optimal duration of infusion set use to prevent life-threatening catheter-related bloodstream infection (CRBSI) is unclear. We aimed to compare the effectiveness and costs of 7-day (intervention) versus 4-day (control) infusion set replacement to prevent CRBSI in patients with central venous access devices (tunnelled cuffed, non-tunnelled, peripherally inserted, and totally implanted) and peripheral arterial catheters. METHODS We did a randomised, controlled, assessor-masked trial at ten Australian hospitals. Our hypothesis was CRBSI equivalence for central venous access devices and non-inferiority for peripheral arterial catheters (both 2% margin). Adults and children with expected greater than 24 h central venous access device-peripheral arterial catheter use were randomly assigned (1:1; stratified by hospital, catheter type, and intensive care unit or ward) by a centralised, web-based service (concealed before allocation) to infusion set replacement every 7 days, or 4 days. This included crystalloids, non-lipid parenteral nutrition, and medication infusions. Patients and clinicians were not masked, but the primary outcome (CRBSI) was adjudicated by masked infectious diseases physicians. The analysis was modified intention to treat (mITT). This study is registered with the Australian New Zealand Clinical Trials Registry ACTRN12610000505000 and is complete. FINDINGS Between May 30, 2011, and Dec, 9, 2016, from 6007 patients assessed, we assigned 2944 patients to 7-day (n=1463) or 4-day (n=1481) infusion set replacement, with 2941 in the mITT analysis. For central venous access devices, 20 (1·78%) of 1124 patients (7-day group) and 16 (1·46%) of 1097 patients (4-day group) had CRBSI (absolute risk difference [ARD] 0·32%, 95% CI -0·73 to 1·37). For peripheral arterial catheters, one (0·28%) of 357 patients in the 7-day group and none of 363 patients in the 4-day group had CRBSI (ARD 0·28%, -0·27% to 0·83%). There were no treatment-related adverse events. INTERPRETATION Infusion set use can be safely extended to 7 days with resultant cost and workload reductions. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Claire M Rickard
- School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, School of Medicine, The University of Queensland, QLD, Australia; School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; Herston Infectious Diseases Institute, Nursing and Midwifery Research Centre, Cancer Care Services, and Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Infection Management Services, Nursing Practice Development Unit, and Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia; Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia.
| | - Nicole M Marsh
- School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, School of Medicine, The University of Queensland, QLD, Australia; School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; Herston Infectious Diseases Institute, Nursing and Midwifery Research Centre, Cancer Care Services, and Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Emily N Larsen
- School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; Herston Infectious Diseases Institute, Nursing and Midwifery Research Centre, Cancer Care Services, and Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Matthew R McGrail
- School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, School of Medicine, The University of Queensland, QLD, Australia
| | - Nicholas Graves
- Health Services and Systems Research, Duke-National University of Singapore, Medical School, Singapore
| | - Naomi Runnegar
- School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, School of Medicine, The University of Queensland, QLD, Australia; Infection Management Services, Nursing Practice Development Unit, and Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Joan Webster
- School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; Herston Infectious Diseases Institute, Nursing and Midwifery Research Centre, Cancer Care Services, and Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Amanda Corley
- School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, School of Medicine, The University of Queensland, QLD, Australia; School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; Herston Infectious Diseases Institute, Nursing and Midwifery Research Centre, Cancer Care Services, and Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia
| | - David McMillan
- School of Health and Sports Sciences, School of Nursing, Midwifery and Paramedicine, and INFLAME Biomedical Research Cluster, The University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - John R Gowardman
- School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, School of Medicine, The University of Queensland, QLD, Australia; Herston Infectious Diseases Institute, Nursing and Midwifery Research Centre, Cancer Care Services, and Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Debbie A Long
- School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; School of Nursing, and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Kelvin Grove, QLD, Australia; Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - John F Fraser
- School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, School of Medicine, The University of Queensland, QLD, Australia; School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia
| | - Fenella J Gill
- School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Bentley, WA, Australia; Perth Children's Hospital, Child and Adolescent Health Service, Nedlands, WA, Australia
| | - Jeanine Young
- School of Health and Sports Sciences, School of Nursing, Midwifery and Paramedicine, and INFLAME Biomedical Research Cluster, The University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Marghie Murgo
- Partnering with Consumers, Australian Commission on Safety and Quality in Healthcare, Sydney, NSW, Australia
| | - Evan Alexandrou
- School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia; Centre for Applied Nursing Research and Ingham Institute for Applied Medical Research, South Western Sydney LHD, Liverpool, NSW, Australia; Department of Intensive Care, Liverpool Hospital, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia
| | - Md Abu Choudhury
- School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Raymond J Chan
- School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; Infection Management Services, Nursing Practice Development Unit, and Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia; School of Nursing, and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Nicole C Gavin
- School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, School of Medicine, The University of Queensland, QLD, Australia; School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; Herston Infectious Diseases Institute, Nursing and Midwifery Research Centre, Cancer Care Services, and Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; School of Nursing, and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Azlina Daud
- Faculty of Nursing, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Kuantan Campus, Kuantan, Pahang, Malaysia
| | - Annamaria Palermo
- Intensive Care Unit, St John of God Murdoch Hospital, Murdoch, WA, Australia
| | - Adrian Regli
- Intensive Care Unit, St John of God Murdoch Hospital, Murdoch, WA, Australia; Medical School, The University of Western Australia, Sterling Highway, Crawley, WA, Australia; Medical School, The Notre Dame University, Henry Road, Fremantle, WA, Australia
| | - E Geoffrey Playford
- School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, School of Medicine, The University of Queensland, QLD, Australia; Infection Management Services, Nursing Practice Development Unit, and Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
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Cole R, Young J, Kearney L, Thompson JM. Priority setting: Consensus for Australia's infant safe sleeping public health promotion programme. J Paediatr Child Health 2021; 57:219-226. [PMID: 32918511 DOI: 10.1111/jpc.15178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/10/2020] [Accepted: 08/23/2020] [Indexed: 12/22/2022]
Abstract
AIM To develop focused priorities to inform the revision of Australia's Sudden Unexpected Death in Infancy (SUDI) risk reduction public health programme. METHODS A content expert consensus research activity was designed using two consensus techniques. The two-phase study employed a Delphi process (phase 1) and a Nominal Group workshop technique (phase 2). The Delphi invited 56 national and international content experts. The Nominal Group comprised 17 Australasian experts and stakeholders to ensure priority setting was relevant to the Australian context. RESULTS Phase 1 established a ranked thematic list of 10 key SUDI risk reduction themes. Phase 2 addressed three nominal questions producing prioritised lists for: key-message wording; contextual information and strategies to support caregiver implementation of key messages; and considerations in redesigning and dissemination of a safe sleep campaign. The top four priority themes were: sleep position, sleep space, smoking and surface-sharing. CONCLUSION This two-phase priority setting was successful in establishing clearly defined infant safe sleep priorities. International content expert participation in phase 1 strengthened priority setting outcomes while phase 2 ensured final outcomes provided a strong national focus reflective of identified needs of Australian families. Findings provide a foundation from which important components can be considered when revising and developing future SUDI risk reduction programmes.
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Affiliation(s)
- Roni Cole
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia.,Women's and Families Service Group, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia
| | - Jeanine Young
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Lauren Kearney
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - John Md Thompson
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia.,Paediatrics, Child and Youth Health, School of Medicine, University of Auckland, Auckland, New Zealand
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James GD, Symeonides S, Marshall J, Young J, Clack G. Assessment of various continual reassessment method models for dose-escalation phase 1 oncology clinical trials: using real clinical data and simulation studies. BMC Cancer 2021; 21:7. [PMID: 33402104 PMCID: PMC7786936 DOI: 10.1186/s12885-020-07703-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background The continual reassessment method (CRM) identifies the maximum tolerated dose (MTD) more efficiently and identifies the true MTD more frequently compared to standard methods such as the 3 + 3 method. An initial estimate of the dose-toxicity relationship (prior skeleton) is required, and there is limited guidance on how to select this. Previously, we compared the CRM with six different skeletons to the 3 + 3 method by conducting post-hoc analysis on a phase 1 oncology study (AZD3514), each CRM model reduced the number of patients allocated to suboptimal and toxic doses. This manuscript extends this work by assessing the ability of the 3 + 3 method and the CRM with different skeletons in determining the true MTD of various “true” dose-toxicity relationships. Methods One thousand studies were simulated for each “true” dose toxicity relationship considered, four were based on clinical trial data (AZD3514, AZD1208, AZD1480, AZD4877), and four were theoretical. The 3 + 3 method and 2-stage extended CRM with six skeletons were applied to identify the MTD, where the true MTD was considered as the largest dose where the probability of experiencing a dose limiting toxicity (DLT) is ≤33%. Results For every true dose-toxicity relationship, the CRM selected the MTD that matched the true MTD in a higher proportion of studies compared to the 3 + 3 method. The CRM overestimated the MTD in a higher proportion of simulations compared to the 3 + 3 method. The proportion of studies where the correct MTD was selected varied considerably between skeletons. For some true dose-toxicity relationships, some skeletons identified the true MTD in a higher proportion of scenarios compared to the skeleton that matched the true dose-toxicity relationship. Conclusion Through simulation, the CRM generally outperformed the 3 + 3 method for the clinical and theoretical true dose-toxicity relationships. It was observed that accurate estimates of the true skeleton do not always outperform a generic skeleton, therefore the application of wide confidence intervals may enable a generic skeleton to be used. Further work is needed to determine the optimum skeleton.
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Affiliation(s)
- G D James
- Medical Statistics Consultancy Ltd, London, W4 5XF, UK.
| | - S Symeonides
- Edinburgh Cancer Research Centre, IGMM, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - J Marshall
- Oncology Biometrics, Oncology R&D, AstraZeneca, Cambridge, UK
| | - J Young
- Aptus Clinical Ltd, Alderley Park, Macclesfield, Cheshire, SK10 4TF, UK
| | - G Clack
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Cole R, Young J, Kearney L, Thompson JMD. Awareness of infant safe sleep messages and associated care practices: findings from an Australian cohort of families with young infants. BMJ Paediatr Open 2021; 5:e000972. [PMID: 33718628 PMCID: PMC7908297 DOI: 10.1136/bmjpo-2020-000972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate primary infant caregiver awareness of the current national public health safe sleep messages and the associations of awareness with care practices. DESIGN AND SETTING A cross-sectional survey in Queensland, Australia. All families with live babies birthed during April-May 2017 were eligible. Questionnaires were distributed when infants were approximately 3 months old. PARTICIPANTS Of the 10 200 eligible families, 3341 (33%) primary caregivers participated. MAIN OUTCOME MEASURES Participants were asked: to recall key safe sleeping messages they were aware of (unprompted); questions about their infant care practices; and to select the current, national six safe sleeping messages (prompted multi-choice). RESULTS Overall, the majority of families are aware of sleep-related infant mortality and sudden infant death (3178/3317, 96%); however, approximately one in four caregivers (867/3292, 26%) could not identify the current six messages to promote safer infant sleep in a multi-choice question. Despite being aware of the six key messages, some caregiver practices did not always align with advice (336/2423, 14% were not smoke-free; 349/2423, 14% were not usually supine for sleep; 649/2339, 28% employed practices which may increase risk of head or face covering; 426/2423, 18% were not receiving breastmilk). CONCLUSIONS There is considerable scope for improvement in parent awareness and ability to recall key safe sleep messages. Awareness of advice does not always translate into safe infant care. Health promotion messaging to encourage safer infant sleep, ultimately aimed at reducing sudden unexpected infant deaths, needs more effective supportive strategies and dissemination if future campaigns are to be successful.
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Affiliation(s)
- Roni Cole
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia.,Women's and Families Service Group, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia
| | - Jeanine Young
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
| | - Lauren Kearney
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
| | - John M D Thompson
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia.,Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
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Peberdy L, Young J, Massey D, Kearney L. Australian maternity healthcare professionals' knowledge, attitudes and practices relevant to cord blood banking, donation and clamp timing: A cross-sectional survey. Women Birth 2020; 34:e584-e591. [PMID: 33309477 DOI: 10.1016/j.wombi.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/31/2020] [Accepted: 11/20/2020] [Indexed: 11/26/2022]
Abstract
PROBLEM Australian health professionals' knowledge and attitudes towards third stage labour options of cord clamp timing, cord blood banking and donation and their practice of informing parents of these options is unknown. BACKGROUND Parents have several options for the management of their infant' cord blood during the third stage of labour. Early or deferred cord clamping practices may affect parent choices about physiological transfusion to the neonate and/or cord blood collection for private or public banking or donation. AIM To identify health professionals' knowledge and attitudes towards third stage labour options of cord clamp timing, cord blood banking and donation and their practice of informing parents of these options. METHODS A total of 129 Australian maternity healthcare professionals responded to the self-administered survey between December 2017 and June 2018. FINDINGS Occupational differences were revealed in regard to cord clamp timing, cord blood banking and donation knowledge, attitudes and practices. Midwives were more likely to discuss cord clamp timing with parents and to clamp the cord later than obstetricians. Obstetricians were more knowledgeable of cord blood banking and donation options than midwives. Cord blood banking and donation options were discussed by both groups if parents asked. DISCUSSION Identification of gaps in knowledge should guide future maternity health professional education that is inclusive of all third stage labour options to ensure that open discussion and informing parents of options is consistent, contemporary and evidence-based. CONCLUSION To make informed decisions, parents need evidence-based information on all third stage labour options.
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Affiliation(s)
- Lisa Peberdy
- The University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia.
| | - Jeanine Young
- The University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia.
| | - Debbie Massey
- Southern Cross University, Gold Coast Airport, Terminal Dr, Bilinga, Queensland, 4225, Australia.
| | - Lauren Kearney
- The University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia.
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Shipstone RA, Young J, Kearney L, Thompson JMD. Prevalence of risk factors for sudden infant death among Indigenous and non-Indigenous people in Australia. Acta Paediatr 2020; 109:2614-2626. [PMID: 32239524 DOI: 10.1111/apa.15274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/08/2020] [Accepted: 03/24/2020] [Indexed: 11/30/2022]
Abstract
AIM To examine differences in the prevalence of risk factors for sudden unexpected death in infancy (SUDI) between Aboriginal and Torres Strait Islander and non-Indigenous infants. METHODS A retrospective cohort study of SUDI in Queensland during 2010-2014 examined exposure to SUDI risk factors, to identify factors accounting for higher SUDI mortality among Indigenous infants. A multistage algorithm was applied to linked data to determine Indigenous status. RESULTS There were 228 SUDI, of which Indigenous infants comprised 26.8%. The Indigenous SUDI rate was 2.13/1000 live births compared to 0.72/1000 for non-Indigenous. The disparity between Indigenous and non-Indigenous SUDI was accounted for by surface sharing (OR = 2.93 95% CI = 1.41, 6.07), smoking (OR = 2.49, 95% CI = 1.13, 5.52), and a combination of background antenatal and sociodemographic factors (inadequate antenatal care [OR = 6.93, 95% CI = 2.20, 21.86], young maternal age at first birth [OR = 4.02, 95% CI = 1.49, 10.80] and outer regional [OR = 3.03, 95% CI = 1.37, 6.72] and remote locations [OR = 11.31, 95% CI = 3.47, 36.83]). CONCLUSION Culturally responsive prevention efforts, including wrap-around maternity care and strategies that reduce maternal smoking and promote safer yet culturally acceptable ways of surface sharing, may reduce Indigenous SUDI mortality.
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Affiliation(s)
- Rebecca A. Shipstone
- School of Nursing, Midwifery, and Paramedicine University of the Sunshine Coast Sippy Downs Queensland Australia
| | - Jeanine Young
- School of Nursing, Midwifery, and Paramedicine University of the Sunshine Coast Sippy Downs Queensland Australia
| | - Lauren Kearney
- School of Nursing, Midwifery, and Paramedicine University of the Sunshine Coast Sippy Downs Queensland Australia
| | - John M. D. Thompson
- School of Nursing, Midwifery, and Paramedicine University of the Sunshine Coast Sippy Downs Queensland Australia
- Departments of Paediatrics, Child and Youth Health, and Obstetrics and Gynaecology Faculty of Medical and Health Science University of Auckland Auckland New Zealand
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Shipstone RA, Young J, Kearney L, Thompson JMD. Applying a Social Exclusion Framework to Explore the Relationship Between Sudden Unexpected Deaths in Infancy (SUDI) and Social Vulnerability. Front Public Health 2020; 8:563573. [PMID: 33194965 PMCID: PMC7606531 DOI: 10.3389/fpubh.2020.563573] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 05/19/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Sudden Unexpected Death in Infancy (SUDI) is a leading cause of preventable infant mortality and strongly associated with social adversity. While this has been noted over many decades, most previous studies have used single economic markers in social disadvantage analyses. To date there have been no previous attempts to analyze the cumulative effect of multiple adversities in combination on SUDI risk. Methods: Based on sociological theories of social exclusion, a multidimensional framework capable of producing an overall measure of family-level social vulnerability was developed, accounting for both increasing disadvantage with increasing prevalence among family members and effect of family structures. This framework was applied retrospectively to all cases of SUDI that occurred in Queensland between 2010 and 2014. Additionally, an exploratory factor analysis was performed to investigate whether differing “types” of vulnerability could be identified. Results: Increased family vulnerability was associated with four major known risk factors for sudden infant death: smoking, surface sharing, not-breastfeeding and use of excess bedding. However, families with lower levels of social vulnerability were more likely to display two major risk factors: prone infant sleep position and not room-sharing. There was a significant positive relationship between family vulnerability and the cumulative total of risk factors. Exploratory factor analysis identified three distinct vulnerability types (chaotic lifestyle, socioeconomic and psychosocial); the first two were associated with presence of major SUDI risk factors. Indigenous infants had significantly higher family vulnerability scores than non-Indigenous families. Conclusion: A multidimensional measure that captures adversity across a range of indicators highlights the need for proportionate universalism to reduce the stalled rates of sudden infant death. In addition to information campaigns continuing to promote the importance of the back-sleeping position and close infant-caregiver proximity, socially vulnerable families should be a priority population for individually tailored or community based multi-model approaches.
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Affiliation(s)
- Rebecca A Shipstone
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Jeanine Young
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Lauren Kearney
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - John M D Thompson
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia.,Departments of Paediatrics, Child and Youth Health, and Obstetrics and Gynaecology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
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Lorintiu O, Young J, Chapuis V, Compere L, Duchemin-Pelletier E, Anselmo S, Ventre E. MUSCLE FUNCTION & HOMEOSTASIS / MOLECULAR THERAPEUTIC APPROACHES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.076] [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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Young J, Mdanat F, Dharmasena A, Cannon P, Leatherbarrow B, Hammerbeck-Ward C, Rutherford S, Ataullah S. Combined neurosurgical and orbital intervention for spheno-orbital meningiomas - the Manchester experience. Orbit 2020; 39:251-257. [PMID: 31658848 DOI: 10.1080/01676830.2019.1673782] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/21/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE Surgical resection of spheno-orbital meningioma (SOM) is challenging, requiring a multidisciplinary surgical approach. We present our experience of the surgical management of patients with SOM. METHODS A retrospective analysis of patients with SOM who underwent joint neurosurgical and orbital surgical procedures between January 2000 and June 2017. Pre-operative clinical signs, indication for surgery, surgical complications and post-operative outcomes were recorded. RESULTS Twenty-four operations were performed. Mean age was 49.5 years. Ninety-two percent of patients were female. Pre-operatively mean Snellen acuity vision was 6/12; 13 (54%) had an RAPD; 12 (50%) had reduced colour vision; 16 (67%) had a visual field defect. The majority (21 patients, 88%) had proptosis (average 4.5 mm ± 2.8 mm). The indication for surgery was evidence of visual dysfunction in 17 (71%), the remaining 7 (29%) had high risk of visual loss clinically or radiologically. Three-months post operatively, vision was stable in 13 (58%), improved in 6 (21%) and worse in 5 (17%). Average long-term follow-up was 82 months (1-220). Fourteen (58%) maintain improved or stable visual function. Four (17%) had reduced vision due to regrowth of the tumour at an average of 24 months. CONCLUSION SOMs are very challenging to treat surgically. In this cohort the patients were predominantly young females with aggressive disease. Visual function was improved or stabilised in 79% of the patients.
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Affiliation(s)
- J Young
- Oculoplastic Department, Manchester Royal Eye Hospital , Manchester, UK
| | - F Mdanat
- School of Medical Sciences, The University of Manchester , Manchester, UK
| | - A Dharmasena
- Oculoplastic Department, Manchester Royal Eye Hospital , Manchester, UK
| | - P Cannon
- Oculoplastic Department, Manchester Royal Eye Hospital , Manchester, UK
| | - B Leatherbarrow
- Oculoplastic Department, Manchester Royal Eye Hospital , Manchester, UK
| | - C Hammerbeck-Ward
- Neurosurgical Department, Salford Royal Foundation Trust , Salford, UK
| | - S Rutherford
- Neurosurgical Department, Salford Royal Foundation Trust , Salford, UK
| | - S Ataullah
- Oculoplastic Department, Manchester Royal Eye Hospital , Manchester, UK
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Peberdy L, Young J, Massey D, Kearney L. Maternity health professionals' perspectives of cord clamp timing, cord blood banking and cord blood donation: a qualitative study. BMC Pregnancy Childbirth 2020; 20:410. [PMID: 32677904 PMCID: PMC7364524 DOI: 10.1186/s12884-020-03102-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background Parents today have several options for the management of their infant’s cord blood during the third stage of labour. Parents can choose to have their infant’s cord clamped early or to have deferred cord clamping. If the cord is clamped early, cord blood can be collected for private cord blood banking or public cord blood donation for use later if needed. If cord clamping is deferred, the placental blood physiologically transfuses to the neonate and there are physiological advantages to this. These benefits include a smoother cardiovascular transition and increased haemoglobin levels while not interfering with the practice of collecting cord blood for gases if needed. The aim of this study is to explore Australian maternity health professionals’ perspectives towards cord clamp timing, cord blood banking and cord blood donation. Methods Fourteen maternity health professionals (midwives and obstetricians) from both private and public practice settings in Australia participated in semi-structured interviews either in person or by telephone. Interviews were transcribed and data analysed using thematic analysis. Results Overall there was strong support for deferred cord clamping, and this was seen as important and routinely discussed with parents as part of antenatal care. However, support did not extend to the options of cord blood banking and donation and to routinely informing parents of these options even when these were available at their birthing location. Conclusion Formalised education for maternity health professionals is needed about the benefits and implications of cord blood banking and cord blood donation so that they have the confidence to openly discuss all options of cord clamp timing, cord blood banking and cord blood donation to facilitate informed decision-making by parents.
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Affiliation(s)
- Lisa Peberdy
- Clinical Nursing - Maternal, Child and Family Health, The University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia.
| | - Jeanine Young
- The University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia
| | - Debbie Massey
- Southern Cross University, Gold Coast Airport, Terminal Dr, Bilinga, Queensland, 4225, Australia
| | - Lauren Kearney
- The University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia
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Shipstone R, Thompson JM, Young J, Byard RW. The use of post-mortem lividity to determine sleep position in sudden unexpected deaths in infancy. Acta Paediatr 2020; 109:1162-1165. [PMID: 31050841 DOI: 10.1111/apa.14834] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/21/2019] [Accepted: 04/29/2019] [Indexed: 12/16/2022]
Abstract
AIM To compare parental reports of position found in sudden unexpected deaths in infancy (SUDI) to autopsy reports of lividity and to more accurately classify infant sleep position. METHODS Cases of SUDI in Queensland between 2010 and 2014 were reviewed to determine the position in which infants were reported to have been placed and found. This was compared to the distribution of post-mortem lividity at autopsy. Evidence of lividity present during early death scene investigation was also recorded. RESULTS There was a discordance between the position an infant was reported to have been found and the position of lividity at autopsy in 22/228 SUDI (9.6%). All infants had anterior lividity despite 13 reportedly found supine, three on their side and six in an unknown position. Using anterior lividity at autopsy to change the position found increased the proportion of prone infants from 37.7% to 47.4%. In 47.8% cases, anterior or lateral lividity reported at the scene was no longer present at autopsy. CONCLUSION Previously published odds ratios may have underestimated the risk of sudden infant death associated with prone sleep position. SUDI death scene investigation protocols should require photographic documentation of lividity prior to transporting an infant.
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Affiliation(s)
- Rebecca Shipstone
- School of Nursing, Midwifery, and Paramedicine University of the Sunshine Coast Sippy Downs Queensland Australia
| | - John M.D. Thompson
- School of Nursing, Midwifery, and Paramedicine University of the Sunshine Coast Sippy Downs Queensland Australia
- Faculty of Medical and Health Science Departments of Paediatrics, Child and Youth Health, and Obstetrics and Gynaecology University of Auckland Auckland New Zealand
| | - Jeanine Young
- School of Nursing, Midwifery, and Paramedicine University of the Sunshine Coast Sippy Downs Queensland Australia
| | - Roger W. Byard
- Forensic Science South Australia (FSSA) and the School of Medicine The University of Adelaide Adelaide South Australia Australia
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Bauer D, Young J, Norman K. A Rapid Alternative to Culture Based Mycoplasma Detection. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cambos S, Mohammedi K, Castinetti F, Saie C, Young J, Chanson P, Tabarin A. Persistent cortisol response to desmopressin predicts recurrence of Cushing's disease in patients with post-operative corticotropic insufficiency. Eur J Endocrinol 2020; 182:489-498. [PMID: 32187576 DOI: 10.1530/eje-19-0770] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/18/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cushing's disease (CD) may recur despite corticotropic insufficiency (COI) following pituitary surgery. The predictive value of the desmopressin test (DT) for recurrence in this setting remains controversial. We have evaluated whether the disappearance of the response to DT predicts a low probability recurrence in a large cohort of patients with post-operative COI. DESIGN Multicentre retrospective study. METHODS Ninety-five patients with CD (women 82%, age 41 ± 14 years), responding preoperatively to DT and with early post-operative COI (08 00 am cortisol: <138 nmol/L), underwent a DT within 3 months post-surgery. Association between DT findings and the prediction of recurrence was tested using regression and ROC analyses. RESULTS Recurrence occurred in 17/95 patients within 29 to 91 months. The cortisol peak (327, 95% CI (237-417) vs 121 (79-164) nmol/L, P = 0.0001) and absolute increment during DT (208 (136-280) vs 56 (22-90) nmol/L, P = 0.005) were greater in the recurrence vs remission group. Cortisol peak (AUC: 0.786 (0.670-0.902)) and increment (0.793 (0.672-0.914)) yielded a higher prognostic performance for recurrence than did the early post-operative 08 00 am cortisol (0.655 (0.505-0.804)). In the context of COI, cortisol peak >100 nmol/L and increment >30 nmol/L had a high negative predictive value (94, 95% CI (88-100) and 94, (88-100), respectively). Patients with a cortisol peak ≤100 nmol/L (vs >100) or an increment ≤30 nmol/L (vs >30) were less likely to have CD recurrence (odds ratios: 0.12, 95% CI (0.03-0.41) and 0.11 (0.02-0.36), respectively). CONCLUSION The disappearance of the response to the post-operative DT was independently associated with a lower odds of CD recurrence and offers an incremental prognostic value, which may help to stratify patients with COI and refine their follow-up according to the risk of recurrence.
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Affiliation(s)
- S Cambos
- CHU Bordeaux, Hôpital Haut-Lévêque, Service d'Endocrinologie, Diabétologie et Nutrition, Pessac, France
| | - K Mohammedi
- CHU Bordeaux, Hôpital Haut-Lévêque, Service d'Endocrinologie, Diabétologie et Nutrition, Pessac, France
| | - F Castinetti
- Department of Endocrinology, Aix Marseille University, Marseille Medical Genetics, INSERM, and Assistance Publique-Hopitaux de Marseille, French Reference Center for Rare Pituitary Diseases, Marseille, France
| | - C Saie
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, France
| | - J Young
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, France
- Université Paris Saclay, Univ Paris-Sud, Faculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, France
- INSERM 1185, Fac Med Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - P Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, France
- Université Paris Saclay, Univ Paris-Sud, Faculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, France
- INSERM 1185, Fac Med Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - A Tabarin
- CHU Bordeaux, Hôpital Haut-Lévêque, Service d'Endocrinologie, Diabétologie et Nutrition, Pessac, France
- INSERM and University of Bordeaux Neurocentre Magendie, Bordeaux, France
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