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Wilkin K, Evans S, Van Niekerk L, Romano D, Fuller-Tyszkiewicz M, Knowles S, Chesterman S, Raven L, Mikocka-Walus A. Moving Towards Acceptance and Values: A Qualitative Study of ACTforIBD Compared to IBD Psychoeducation. J Clin Psychol Med Settings 2024; 31:245-257. [PMID: 38347385 PMCID: PMC11102374 DOI: 10.1007/s10880-023-09999-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 05/20/2024]
Abstract
The current study explored perspectives of those with inflammatory bowel disease (IBD) and comorbid anxiety and/or depression on a hybrid acceptance and committment therapy (ACT) intervention, compared to an active control. This qualitative study was nested within a randomized controlled trial (RCT) where an experimental group received an 8-week blended delivery ACTforIBD intervention (four sessions telehealth, four sessions pre-recorded self-directed), while an active control group received a psychoeducation program of similar intensity. Semi-structured interviews were conducted post-intervention and at a 3-month follow-up. Themes were interpreted using reflexive thematic analysis. Twenty individuals participated; ten in each condition. Seven themes were constructed, including three shared themes between groups: I Am Worth Advocating For, Present Moment Is My Biggest Ally, and Ambivalence About Self-Directed Modules. Two themes were identified for the ACTforIBD group: Symptoms Are Going to Happen and Moving Toward Values while two themes identified from the ActiveControl group were: Reset and Refresh and It's Ok to Say No. Acceptance and values modules from ACTforIBD were perceived as useful in reducing psychological distress for those with IBD, while the ActiveControl group felt their program affirmed existing effective coping strategies. Access to external resources for self-directed modules and networking may increase engagement with content long term.
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Affiliation(s)
- Kathryn Wilkin
- School of Psychology, Deakin University, Geelong, Melbourne, VIC, Australia
| | - Subhadra Evans
- School of Psychology, Deakin University, Geelong, Melbourne, VIC, Australia
| | - Leesa Van Niekerk
- School of Psychological Sciences, University of Tasmania, Churchill Avenue, Sandy Bay, Hobart, TAS, Australia
| | - Daniel Romano
- School of Psychology, Deakin University, Geelong, Melbourne, VIC, Australia
| | | | - Simon Knowles
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Susan Chesterman
- School of Psychology, Deakin University, Geelong, Melbourne, VIC, Australia
| | - Leanne Raven
- Crohn's & Colitis Australia, Melbourne, VIC, Australia
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Romano D, Chesterman S, Fuller-Tyszkiewicz M, Evans S, Dober M, Gearry R, Gibson PR, Knowles S, McCombie A, O E, Olive L, Raven L, Van Niekerk L, Mikocka-Walus A. Feasibility, Acceptability, and Preliminary Efficacy of Acceptance Commitment Therapy for Adults Living With Inflammatory Bowel Disease and Distress. Inflamm Bowel Dis 2023:izad122. [PMID: 37477361 DOI: 10.1093/ibd/izad122] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND The bidirectional relationship between inflammatory bowel disease (IBD) flare-ups and depression/anxiety symptoms has prompted investigations into psychotherapy to improve health-related quality of life (HRQoL) by targeting depression and anxiety. Acceptance commitment therapy (ACT) is effective in improving symptoms of depression and anxiety in people with chronic diseases, yet minimal research has examined ACT's effectiveness for IBD. This study examines the feasibility, acceptability, and preliminary efficacy of the ACTforIBD program, an online program codesigned with consumers to deliver ACT to those with IBD. METHODS Adults with IBD and symptoms of mild-moderate distress were randomized to ACTforIBD or an active control (psychoeducation) condition. Participants completed 8 weekly, 1-hour sessions, 4 of which were therapist facilitated. Feasibility was based on recruitment and retention and acceptability was derived from postprogram satisfaction measures. Preliminary efficacy was determined by group differences in rate of change in study outcomes from baseline to postprogram. RESULTS Of 62 participants (89% women, 11% men; mean age 33 years), 55 completed the program (ACTforIBD: n = 26 [83.9%]; active control: n = 29 [93.5%]). Adherence and acceptability were high in the ACTforIBD group, with 80% of participants completing all self-directed modules and 78% of participants expressing satisfaction with the program. Significant and marginally significant group × time interactions were found for anxiety symptoms (b = -1.89; 95% confidence interval, -3.38 to -0.42) and psychological HRQoL (b = -0.04; 95% confidence interval, -0.07 to 0.01), showing decreased anxiety and increased psychological HRQoL in the intervention group. CONCLUSIONS ACTforIBD is feasible, acceptable, and improved anxiety symptoms, and psychological HRQoL. This highlights the need for a full-scale randomized controlled trial to further examine the program's efficacy.
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Affiliation(s)
- Daniel Romano
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Susan Chesterman
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | | | - Subhadra Evans
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Madeleine Dober
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Richard Gearry
- Department of Medicine, Christchurch School of Medicine and Health Sciences, Univeresity of Otago, Christchurch, New Zealand
| | - Peter R Gibson
- Department of Gastroenterology, Alfred Health, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Simon Knowles
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Andrew McCombie
- Department of General Surgery, Te Whatu Ora Ōtautahi (Health New Zealand Christchurch), Christchurch, New Zealand
| | - Eric O
- Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Lisa Olive
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Leanne Raven
- Crohn's and Colitis Australia, Camberwell, Victoria, Australia
| | - Leesa Van Niekerk
- School of Psychological Sciences, University of Tasmania, Hobart, Tasmania, Australia
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Houlihan E, Corderroura M, Delany L, Twomey A, Knowles S. Vancomycin dosing in neonates and sub-therapeutic levels. Ir Med J 2023; 116:775. [PMID: 37555526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
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Knowles S, Dekow M, Williamson ML. Oral Appliances for OSA Treatment: Meeting the Quadruple Aim. Mil Med 2023; 188:e718-e724. [PMID: 34411239 DOI: 10.1093/milmed/usab316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/28/2021] [Accepted: 08/12/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION In order to better treat obstructive sleep apnea (OSA) in a more efficient and cost-effective way, a joint program between dental clinics and the sleep medicine clinic was piloted at Fort Hood, Texas. Obstructive sleep apnea negatively affects soldier readiness and deployability, leading to the need to establish a successful and proven workflow to treat these patients with oral appliance therapy (OAT). MATERIALS AND METHODS We performed a retrospective review of a de-identified data set which included 288 patients from July 2016 to July 2020. Projected cost data were obtained from routinely collected sleep clinic positive airway pressure (PAP) data. Data were analyzed to determine treatment success and potential cost savings using OAT versus continuous positive airway pressure (CPAP). Patient workflow including successes and challenges with the program is summarized. RESULTS About 85.5% of patients met criteria for successful control of their OSA using OAT as treatment. Five patients did not tolerate OAT and switched back to CPAP. A higher (less severe) O2 nadir on diagnostic polysomnography is moderately correlated with OAT success. Diagnostic Apnea-Hypopnea Index was inversely and weakly correlated with success. Two of the major challenges noted in the program were (1) loss of follow-up and (2) the length of time from oral appliance referral to fitting the oral appliance. If this program was successfully implemented at other Defense Health Agency (DHA) medical treatment facility (MTF) markets nationwide, a potential cost savings of over $500,000/year/MTF could be achieved. CONCLUSIONS Oral appliance therapy has the potential to increase both readiness and deployability for active duty soldiers. Using baseline O2 nadir can help predict success with OAT patients, determining which patients will benefit from this joint program between the dental and medical sleep clinics. Future studies can aim to establish an evidence-based pathway for clinic testing and follow-up. If this patient workflow is implemented properly, there can be significant cost savings army-wide. This all helps The United States Medical Command (MEDCOM) align with the DHA's Quadruple Aim of increased readiness, better health, better care, and lower cost.
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Affiliation(s)
- S Knowles
- Carl R Darnall Army Medical Center, Fort Hood, TX 76544, USA
| | - Matthew Dekow
- Carl R Darnall Army Medical Center, Fort Hood, TX 76544, USA
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Naude C, Skvarc D, Knowles S, Russell L, Evans S, Mikocka-Walus A. The effectiveness of mindfulness-based interventions in inflammatory bowel disease: A Systematic Review & Meta-Analysis. J Psychosom Res 2023; 169:111232. [PMID: 36990003 DOI: 10.1016/j.jpsychores.2023.111232] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/08/2023] [Accepted: 03/12/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Mental health has been identified as contributing to the pathogenesis of Inflammatory Bowel Disease (IBD). Resultingly, psychotherapeutic interventions, such as Mindfulness-Based Interventions (MBI), have been increasingly investigated for improving IBD outcomes. OBJECTIVES To systematically review the current state of evidence of MBI's for individuals living with IBD. METHODS We performed a systematic review searching Medline, PsychINFO, CINAHL, Embase, Cochrane and Scopus, to identify controlled clinical trials, investigating MBI's for various IBD biopsychosocial outcomes. Data was pooled using the inverse-variance random effects model, with restricted maximum likelihood estimation, providing the standardized mean difference (SMD) between control and experimental groups, at both short and long-term follow up. RESULTS We identified 8 studies with 575 participants. Meta-analytic results found that MBI's were more efficacious than control groups in the short-term improvement of stress (SMD = -0.38, 95% CI [-0.65, -0.10], p = 0.007), mindfulness (SMD = 0.59, 95% CI [0.36, 0.83], p = 0.00001), C-Reactive Protein (CRP) (SMD = -0.25, 95% CI [-0.49, -0.01], p = 0.04) and health-related quality of life (HRQoL) (SMD = 0.45, 95% CI [0.24, 0.66], p = 0.0001) (including all emotional, bowel, social and systemic subscales). This was maintained in the long-term for stress (SMD = -0.44, 95% CI [-0.88, -0.01], p < 0.05) and mindfulness (SMD = 0.52, 95% CI [0.14, 0.90], p = 0.008), but not for HRQoL, with no long-term data available for CRP. CONCLUSIONS Given that MBI's appear to be effective in improving several IBD outcomes, they may be a useful adjuvant therapy in wholistic IBD care, with further trials warranted.
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Affiliation(s)
- Colette Naude
- School of Psychology, Deakin University Geelong, Melbourne, VIC, Australia.
| | - David Skvarc
- School of Psychology, Deakin University Geelong, Melbourne, VIC, Australia
| | - Simon Knowles
- Department of Psychology, Swinburne University of Technology, VIC, Australia
| | - Lahiru Russell
- Faculty of Health, Institute for Health Transformation, Deakin University Geelong, Melbourne, Australia
| | - Subhadra Evans
- School of Psychology, Deakin University Geelong, Melbourne, VIC, Australia
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Hall JS, Hofmeister E, Ip HS, Nashold SW, Leon AE, Malavé CM, Falendysz EA, Rocke TE, Carossino M, Balasuriya U, Knowles S. Experimental Infection of Mexican Free-Tailed Bats ( Tadarida brasiliensis) with SARS-CoV-2. mSphere 2023; 8:e0026322. [PMID: 36598226 PMCID: PMC9942575 DOI: 10.1128/msphere.00263-22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/10/2022] [Indexed: 01/05/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus is thought to have originated in wild bats from Asia, and as the resulting pandemic continues into its third year, concerns have been raised that the virus will expand its host range and infect North American wildlife species, including bats. Mexican free-tailed bats (Tadarida brasiliensis) live in large colonies in the southern United States, often in urban areas and, as such, could be exposed to the virus from infected humans. We experimentally challenged wild T. brasiliensis with SARS-CoV-2 to determine the susceptibility, reservoir potential, and population impacts of infection in this species. Of 10 bats oronasally inoculated with SARS-CoV-2, 5 became infected and orally excreted moderate amounts of virus for up to 18 days postinoculation. These five subjects all seroconverted and cleared the virus before the end of the study with no obvious clinical signs of disease. We additionally found no evidence of viral transmission to uninoculated subjects. These results indicate that while T. brasiliensis are susceptible to SARS-CoV-2 infection, infection of wild populations of T. brasiliensis would not likely cause mortality. However, the transmission of SARS-CoV-2 from T. brasiliensis to or from humans, or to other animal species, is a possibility requiring further investigation to better define. IMPORTANCE As the COVID-19 pandemic has continued for 3+ years, there has been increasing concern that the SARS-CoV-2 virus will enter wildlife populations and potentially create new reservoirs where the virus could adapt to a new host and create variants. This is particularly possible with species that reside in man-made structures, in proximity to infected human populations. Mexican free-tailed bats (Tadarida brasiliensis) live in large colonies, often in urban settings and, thus, can be exposed by infected humans and potentially transmit the virus to new hosts. We experimentally challenged T. brasiliensis with SARS-CoV-2 and revealed that they are susceptible to the virus and excrete moderate amounts for up to 18 days postinoculation. This is important information for wildlife biologists, wildlife rehabilitation workers, and the general public that may contact these animals.
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Affiliation(s)
- J. S. Hall
- U.S. Geological Survey, National Wildlife Health Center, Madison, Wisconsin, USA
| | - E. Hofmeister
- U.S. Geological Survey, National Wildlife Health Center, Madison, Wisconsin, USA
| | - H. S. Ip
- U.S. Geological Survey, National Wildlife Health Center, Madison, Wisconsin, USA
| | - S. W. Nashold
- U.S. Geological Survey, National Wildlife Health Center, Madison, Wisconsin, USA
| | - A. E. Leon
- U.S. Geological Survey, National Wildlife Health Center, Madison, Wisconsin, USA
| | - C. M. Malavé
- U.S. Geological Survey, National Wildlife Health Center, Madison, Wisconsin, USA
| | - E. A. Falendysz
- U.S. Geological Survey, National Wildlife Health Center, Madison, Wisconsin, USA
| | - T. E. Rocke
- U.S. Geological Survey, National Wildlife Health Center, Madison, Wisconsin, USA
| | - M. Carossino
- Louisiana Animal Disease Diagnostic Laboratory, School of Veterinary Health Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
- Department of Pathobiological Sciences, School of Veterinary Health Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - U. Balasuriya
- Louisiana Animal Disease Diagnostic Laboratory, School of Veterinary Health Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
- Department of Pathobiological Sciences, School of Veterinary Health Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - S. Knowles
- U.S. Geological Survey, National Wildlife Health Center, Madison, Wisconsin, USA
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Knowles S, Khan ST, Malik H, Helmstetter NB, Engel LS, Kamboj S. Functional weakness incongruent with acute myasthenia crisis. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Van DA, Knowles S, Engel LS, Kamboj S. The link between bananas and rhinitis. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00096-4] [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: 01/28/2023]
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Ramly B, Vavasseur C, Knowles S. Bacteriological Profiles in Early-Onset-Sepsis (EOS) and Late-Onset-Sepsis (LOS) in Neonates. Ir Med J 2022; 115:648. [PMID: 36302268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Aim This audit is performed to see the bacteriology profiles in early-onset sepsis (EOS) and late-onset sepsis (LOS) to compare the microorganisms identified and the antibiotic sensitivity results against hospitals' guidelines for empiric treatment of early and late-onset sepsis. Methods We retrospectively collected the neonate's microbiological data from the laboratory which included the date blood culture (BC) samples were collected, patients' day of life when the samples were collected to determine whether it was EOS or LOS, time to positivity of BC, and antibiotic susceptibility results. Results In EOS, most infection was caused by Gram-positive organisms which were 12 out of 14 isolates (85.7%) with GBS as the most common pathogen identified. In LOS, the number of infections caused by Gram-negative organisms, which were 14 of 25 isolates (56%) was higher than those caused by Gram-positive organisms, which were 11 out of 25 isolates (44%). E. coli was identified as the leading pathogen causing BSI. All organisms were sensitive to the antibiotics used according to the protocol. Conclusion Escherichia coli was the most common organism and was sensitive to the first-line antibiotics used. Group B Streptococcus is still the main pathogen in EOS. The rate of antibiotic resistance is low. The audit showed the importance of analysing the bacteriological and antibiotic susceptibility pattern to ensure optimal treatments are administered to infants.
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Affiliation(s)
- B Ramly
- National Maternity Hospital, Holles Street, Dublin, Ireland
- Children Health Ireland (CHI) Crumlin, Cooley Road, Dublin, Ireland
| | - C Vavasseur
- National Maternity Hospital, Holles Street, Dublin, Ireland
| | - S Knowles
- National Maternity Hospital, Holles Street, Dublin, Ireland
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Hall JS, Hofmeister E, Ip HS, Nashold SW, Leon AE, Malavé CM, Falendysz EA, Rocke TE, Carossino M, Balasuriya U, Knowles S. Experimental infection of Mexican free-tailed bats ( Tadarida brasiliensis) with SARS-CoV-2. bioRxiv 2022:2022.07.18.500430. [PMID: 35898345 PMCID: PMC9327625 DOI: 10.1101/2022.07.18.500430] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus originated in wild bats from Asia, and as the resulting pandemic continues into its third year, concerns have been raised that the virus will expand its host range and infect North American wildlife species, including bats. Mexican free-tailed bats ( Tadarida brasiliensis : TABR) live in large colonies in the southern United States, often in urban areas, and as such, could be exposed to the virus from infected humans. We experimentally challenged wild TABR with SARS-CoV-2 to determine the susceptibility, reservoir potential, and population impacts of infection in this species. Of nine bats oronasally inoculated with SARS-CoV-2, five became infected and orally excreted moderate amounts of virus for up to 18 days post inoculation. These five subjects all seroconverted and cleared the virus before the end of the study with no obvious clinical signs of disease. We additionally found no evidence of viral transmission to uninoculated subjects. These results indicate that while TABR are susceptible to SARS-CoV-2 infection, infection of wild populations of TABR would not likely cause mortality. However, the transmission of SARS-CoV-2 from TABR to or from humans, or to other animal species, is a distinct possibility requiring further investigation to better define.
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Affiliation(s)
- JS Hall
- U.S. Geological Survey, National Wildlife Health Center, Madison, Wisconsin,Corresponding author
| | - E Hofmeister
- U.S. Geological Survey, National Wildlife Health Center, Madison, Wisconsin
| | - HS Ip
- U.S. Geological Survey, National Wildlife Health Center, Madison, Wisconsin
| | - SW Nashold
- U.S. Geological Survey, National Wildlife Health Center, Madison, Wisconsin
| | - AE Leon
- U.S. Geological Survey, National Wildlife Health Center, Madison, Wisconsin
| | - CM Malavé
- U.S. Geological Survey, National Wildlife Health Center, Madison, Wisconsin
| | - EA Falendysz
- U.S. Geological Survey, National Wildlife Health Center, Madison, Wisconsin
| | - TE Rocke
- U.S. Geological Survey, National Wildlife Health Center, Madison, Wisconsin
| | - M Carossino
- Louisiana Animal Disease Diagnostic Laboratory and Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
| | - U Balasuriya
- Louisiana Animal Disease Diagnostic Laboratory and Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
| | - S Knowles
- U.S. Geological Survey, National Wildlife Health Center, Madison, Wisconsin
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Evans S, Olive L, Dober M, Knowles S, Fuller-Tyszkiewicz M, O E, Gibson P, Raven L, Gearry R, McCombie A, van Niekerk L, Chesterman S, Romano D, Mikocka-Walus A. Acceptance commitment therapy (ACT) for psychological distress associated with inflammatory bowel disease (IBD): protocol for a feasibility trial of the ACTforIBD programme. BMJ Open 2022; 12:e060272. [PMID: 35688593 PMCID: PMC9189839 DOI: 10.1136/bmjopen-2021-060272] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Inflammatory bowel disease (IBD) involves an abnormal immune response to healthy gut bacteria. When a person develops IBD, their susceptibility to anxiety and/or depression increases. The ACTforIBD programme, specifically designed for people with IBD and comorbid psychological distress, draws on acceptance and commitment therapy (ACT), which promotes acceptance of situations that cannot be solved such as persistent physical symptoms. There are no ACT trials for IBD using an active control group or a telemedicine approach, which is important to improve accessibility, particularly in the context of the ongoing COVID-19 pandemic. The ACTforIBD programme is administered online with a 4-hour therapist involvement per participant only; if successful it can be widely implemented to improve the well-being of many individuals with IBD. METHODS AND ANALYSIS Our team have codesigned with consumers the ACTforIBD programme, an 8-week intervention of 1-hour sessions, with the first three sessions and the last session delivered one-to-one by a psychologist, and the other sessions self-directed online. This study aims to evaluate the feasibility and preliminary efficacy of ACTforIBD to reduce psychological distress in patients with IBD. Using a randomised controlled trial, 25 participants will be randomised to ACTforIBD, and 25 patients to an active control condition. ETHICS AND DISSEMINATION This protocol has been approved by Deakin University Research Ethics Committee in September 2021 (Ref. 2021-263) and the New Zealand Central Health and Disability Ethics Committee in December 2021 (Ref. 2021 EXP 11384). The results of this research will be published in peer-reviewed journals and shared with various stakeholders, including community members, policy-makers and researchers, through local and international conferences. TRIAL REGISTRATION NUMBER ACTRN12621001316897.
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Affiliation(s)
- Subhadra Evans
- Psychology, Deakin University Faculty of Health, Burwood, Victoria, Australia
| | - Lisa Olive
- School of Pyschology, Deakin, Geelong, Victoria, Australia
| | - Madeleine Dober
- School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Simon Knowles
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | | | - Eric O
- Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Peter Gibson
- Gastroenterology, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Leanne Raven
- Crohn's and Colitis Australia, Camberwell, Victoria, Australia
| | - Richard Gearry
- Department of Medicine, Christchurch School of Medicine and Health Sciences, Medicine, Christchurch, New Zealand
| | - Andrew McCombie
- Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Leesa van Niekerk
- School of Psychological Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Daniel Romano
- School of Pyschology, Deakin, Geelong, Victoria, Australia
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Mikocka‐Walus A, Skvarc D, van Tilburg MAL, Barreiro‐de Acosta M, Bennebroek Evertsz F, Bernstein CN, Burisch J, Ferreira N, Gearry RB, Graff LA, Jedel S, Mokrowiecka A, Stengel A, Knowles S. COVID-19-related personal product shortages are associated with psychological distress in people living with gastrointestinal disorders: A cross-sectional survey. Neurogastroenterol Motil 2022; 34:e14198. [PMID: 34145689 PMCID: PMC8420452 DOI: 10.1111/nmo.14198] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/23/2021] [Accepted: 05/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The mental health response to the coronavirus (COVID-19) pandemic-related product shortages in those living with chronic gastrointestinal (GI) disorders has received little attention. We aimed to explore the association between the pandemic-related product shortages and psychological distress in people with GI disorders. METHODS This online cross-sectional survey was nested within an ongoing, international, prospective study of well-being in people with GI disorders. The study was advertised in multiple countries in May-September 2020 via patient organizations and social media. The primary outcome measure was distress, evaluated by the Depression Anxiety Stress Scale. We utilized linear regressions, adjusting for covariates and testing individual moderation effects. KEY RESULTS Overall, 831 people completed the survey from 27 countries, of whom 82% were female (mean age = 49 years). The most common disorders included inflammatory bowel disease (n = 322), celiac disease (n = 273), and irritable bowel syndrome (n = 260). Significant problems accessing food were reported by 19.8%, non-medical therapies by 16%, toilet paper by 10.8%, and essential medication by 8.9% of the sample (>5% pain medication). There was a positive association between toilet paper and pain medication shortages and distress, and a negative association between food shortages and distress. Significant moderation effects were identified for COVID-19 prevalence and toilet paper and food shortages, and between COVID-19 fear and pain medication shortages. CONCLUSIONS AND INFERENCES The study documented a significant relationship between product shortages and psychological distress, which were associated with COVID-19 prevalence and fear. Strategies addressing COVID-19 fear could potentially modify the relationship between shortages and distress.
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Affiliation(s)
| | - David Skvarc
- School of PsychologyDeakin University GeelongVictoriaAustralia
| | - Miranda A. L. van Tilburg
- College of Pharmacy & Health SciencesCampbell UniversityBuies CreekNCUS,Division of Gastroenterology and HepatologyUniversity of North CarolinaChapel HillNCUS,School of Social WorkUniversity of WashingtonSeattleWAUS
| | - Manuel Barreiro‐de Acosta
- IBD UnitDepartment of GastroenterologyUniversity Hospital of Santiago de CompostelaSantiago de CompostelaSpain
| | | | | | - Johan Burisch
- GastrounitMedical DivisionHvidovre HospitalUniversity of CopenhagenHvidovreDenmark
| | - Nuno Ferreira
- Department of Social SciencesUniversity of NicosiaNicosiaCyprus
| | - Richard B. Gearry
- Department of MedicineUniversity of Otago ChristchurchChristchurchNew Zealand
| | - Lesley A. Graff
- Max Rady College of MedicineUniversity of ManitobaWinnipegMBCanada
| | - Sharon Jedel
- Division of Digestive DiseasesRush University Medical CenterChicagoILUS
| | - Anna Mokrowiecka
- Department of Digestive Tract DiseasesMedical University of LodzLodzPoland
| | - Andreas Stengel
- Charité Center for Internal Medicine and DermatologyDepartment for Psychosomatic MedicineCharité Universitätsmedizin BerlinBerlin Institute of HealthBerlinGermany,Department of Psychosomatic Medicine and PsychotherapyUniversity Hospital TübingenTübingenGermany
| | - Simon Knowles
- Department of Psychological SciencesSwinburne University of TechnologyVictoriaAustralia
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Fitzsimons M, Williams K, Knowles S, Caroll C. Peritonsillar Abscess at a Dedicated Otolaryngology Emergency Department. Ir Med J 2021; 114:489. [PMID: 37669121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Aim Peritonsillar abscess (PTA) is the most common suppurative complication of acute tonsillitis. It requires urgent specialist treatment due to the risk of progression to airway compromise. We aimed to review referral pathways to a dedicated otolaryngology emergency department (ORL-ED), identify causative organisms and discuss COVID-19 implications. Methods A retrospective review of patients presenting to the ORL-ED between January 2018 and December 2019 was undertaken. Data extracted included demographics, referral source, treatment, microbiology results and length of stay. Statistical analysis of seasonal variation of presentation and causative organisms employed Chi-Square and Fisher's Exact Test, respectively. Results There were 53 PTA presentations. 51 were admitted accounting for 44.3% (51/115) of ED admissions. The median patient age was 31 years (IQR 20-40yrs). GP referral accounted for 48/53 (90.6%). There was no statistically significant seasonality (χ2=5.94, p=0.11) in presentation. Microbiology samples were available for 44 patients. Streptococcus was identified in 19/44 (43.2%) patients. 85% (45/53) of patients received Co-amoxiclav. Discussion PTA is a perennial condition with diverse causative organisms. Antibiotic choice should reflect this. The majority of patients are referred from primary care, emphasising the role of the GP in initial diagnosis and the importance of clinical education in this regard.
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Barradell S, Ganderton C, Knowles S, Munro D, Rayner A, Watson L. Experiences of student circus arts performers undertaking a shoulder rehabilitation program via telehealth consultation during the COVID-19 pandemic. J Sci Med Sport 2021. [PMCID: PMC8556766 DOI: 10.1016/j.jsams.2021.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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15
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Hawkins M, Massuger W, Cheng C, Batterham R, Moore GT, Knowles S, Nadarajah RG, Raven L, Osborne RH. Codesign and implementation of an equity-promoting national health literacy programme for people living with inflammatory bowel disease (IBD): a protocol for the application of the Optimising Health Literacy and Access (Ophelia) process. BMJ Open 2021; 11:e045059. [PMID: 34446478 PMCID: PMC8395357 DOI: 10.1136/bmjopen-2020-045059] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Non-government organisations (NGOs) often represent people who are underserved or experiencing vulnerability. Crohn's & Colitis Australia (CCA) is aware that many Australians with inflammatory bowel disease (IBD) are not reached by current communication and engagement activities. The aim of the CCA IBD project is to implement the Optimising Health Literacy and Access (Ophelia) process over 3 years to collaboratively codesign ways to improve delivery of information, services and resources for people with IBD and their carers. METHODS AND ANALYSIS Health literacy and other data for phase 1 will be collected using the Health Literacy Questionnaire, eHealth Literacy Questionnaire, IBD-related questions and qualitative interviews with people with IBD and their carers to ascertain their lived experience. Quantitative data will be analysed using descriptive statistics and cluster analysis. Identified clusters will be combined with qualitative data to develop vignettes (narratives of people's experiences of living with IBD) for stakeholder workshops to generate ideas for useful, accessible and sustainable solutions for identified health literacy needs. Selection and testing of health literacy actions happens in phase 2 and implementation and evaluation in phase 3 (2021-2023). Outcomes of this project include giving voice to people living with IBD, their carers and frontline healthcare practitioners. Genuine codesign informs the development and implementation of what is needed and wanted to improve access to and availability and quality of information and resources that support people to manage their health. There is potential for other NGOs to use the CCA Ophelia model in other health contexts to improve engagement with and understanding of the needs of the people they serve and to reduce health inequalities and improve health outcomes. ETHICS AND DISSEMINATION Ethics approval for Ophelia phase 1 has been obtained from the Human Research Ethics Committee of Swinburne University of Technology (Ref: 20202968-4652) and by the South West Sydney Local Health District Research and Ethics Office for the purposes of questionnaire recruitment at Liverpool Hospital (Ref: 20202968-4652). Dissemination of the study findings will be the national codesign process and ownership development across the CCA community and through the genuine engagement of clinicians and relevant managers across Australia. The model and process will be directly distributed to international IBD associations and to other NGOs. It will also be disseminated through publication in a peer-reviewed journal, conference presentations and public reports on the CCA and Swinburne University of Technology website.
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Affiliation(s)
- Melanie Hawkins
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Wayne Massuger
- Crohn's and Colitis Australia, Camberwell, Victoria, Australia
| | - Christina Cheng
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Roy Batterham
- Faculty of Public Health, Thammasat University - Rangsit Campus, Khlong Nueng, Pathum Thani, Thailand
| | - Gregory T Moore
- Gastroenterology and Hepatology Unit, Monash Health, Clayton, Victoria, Australia
- Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Simon Knowles
- Department of Psychological Sciences and Statistics, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Ranjit G Nadarajah
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Leanne Raven
- Crohn's and Colitis Australia, Camberwell, Victoria, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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16
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Mikocka-Walus A, Druitt M, O'Shea M, Skvarc D, Watts JJ, Esterman A, Tsaltas J, Knowles S, Harris J, Dowding C, Parigi E, Evans S. Yoga, cognitive-behavioural therapy versus education to improve quality of life and reduce healthcare costs in people with endometriosis: a randomised controlled trial. BMJ Open 2021; 11:e046603. [PMID: 34373298 PMCID: PMC8354255 DOI: 10.1136/bmjopen-2020-046603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Endometriosis is a debilitating chronic inflammatory condition highly burdensome to the healthcare system. The present trial will establish the efficacy of (1) yoga and (2) cognitive-behavioural therapy (CBT), above (3) education, on quality of life, biopsychosocial outcomes and cost-effectiveness. METHODS AND ANALYSIS This study is a parallel randomised controlled trial. Participants will be randomly allocated to yoga, CBT or education. Participants will be English-speaking adults, have a diagnosis of endometriosis by a qualified physician, with pain for at least 6 months, and access to internet. Participants will attend 8 weekly group CBT sessions of 120 min; or 8 weekly group yoga sessions of 60 min; or receive weekly educational handouts on endometriosis. The primary outcome measure is quality of life. The analysis will include mixed-effects analysis of variance and linear models, cost-utility analysis from a societal and health system perspective and qualitative thematic analysis. ETHICS AND DISSEMINATION Enrolment in the study is voluntary and participants can withdraw at any time. Participants will be given the option to discuss the study with their next of kin/treating physician. Findings will be disseminated via publications, conferences and briefs to professional organisations. The University's media team will also be used to further disseminate via lay person articles and media releases. TRIAL REGISTRATION NUMBER ACTRN12620000756921p; Pre-results.
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Affiliation(s)
- Antonina Mikocka-Walus
- School of Psychology, Deakin University Geelong, Geelong and Burwood, Victoria, Australia
| | - Marilla Druitt
- Department of Obstetrics and Gynaecology, University Hospital Geelong, Geelong, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Melissa O'Shea
- School of Psychology, Deakin University Geelong, Geelong and Burwood, Victoria, Australia
| | - David Skvarc
- School of Psychology, Deakin University Geelong, Geelong and Burwood, Victoria, Australia
| | - Jennifer J Watts
- School of Health & Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Adrian Esterman
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Jim Tsaltas
- Department of Gynaecology, Epworth Freemasons Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics & Gynaecology, Monash Health, Clayton, Victoria, Australia
| | - Simon Knowles
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Jill Harris
- Kyo Yoga & Healing, Ocean Grove, Victoria, Australia
| | - Charlotte Dowding
- School of Psychology, Deakin University Geelong, Geelong and Burwood, Victoria, Australia
| | - Elesha Parigi
- School of Psychology, Deakin University Geelong, Geelong and Burwood, Victoria, Australia
| | - Subhadra Evans
- School of Psychology, Deakin University Geelong, Geelong and Burwood, Victoria, Australia
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Abstract
Insect damage to, and sub-optimal harvesting practices of the Papaver somniferum poppy are associated with contamination of its seeds with opium alkaloids. Consumption of poppy seeds has been linked to opium-like overdose symptoms, such as reduced consciousness and respiratory depression. However, acute cardiotoxicity secondary to ingestion of contaminated poppy seeds has not been reported previously. We report a case of a 21-year-old man who presented with severe biventricular dysfunction and cardiogenic shock following consumption of homemade poppy seed tea. We highlight the importance of prompt recognition of the myocardial effects of opiates along with the more common respiratory and neurological effects. In this case, the acute cardiotoxicity was fully reversed with high-dose naloxone, milrinone and noradrenaline. In addition, we recommend offering high-level care due to the possibility that specialist cardiac services may be required. Ergo, early transfer to an appropriate centre is recommended.
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Affiliation(s)
- Y. P. A. Tan
- Department of Anaesthesia and Intensive Care MedicineWythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
| | - P. D. G. Alexander
- Department of Anaesthesia and Intensive Care MedicineWythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
- Manchester Academic Critical CareDivision of Infection, Immunity and Respiratory MedicineSchool of Biological SciencesFaculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - S. Knowles
- Department of AnaesthesiaStepping Hill HospitalStockport NHS Foundation TrustStockportUK
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18
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Jagadeesh D, Knowles S, Horwitz SM. FRONTLINE BRENTUXIMAB VEDOTIN AND CHP (A+CHP) IN PATIENTS WITH PERIPHERAL T‐CELL LYMPHOMA WITH LESS THAN 10% CD30 EXPRESSION (SGN35‐032, TRIAL IN PROGRESS). Hematol Oncol 2021. [DOI: 10.1002/hon.131_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: 11/11/2022]
Affiliation(s)
- D. Jagadeesh
- Cleveland Clinic Taussig Cancer Institute and Case Comprehensive Cancer Center Hematology and Medical Oncology Cleveland Ohio USA
| | - S. Knowles
- Seagen Inc. Late Stage Development Bothell Washington USA
| | - S. M. Horwitz
- Memorial Sloan Kettering Cancer Center Lymphoma Service, New York New York USA
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19
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Jenkins ZM, Tan EJ, O'Flaherty E, Knowles S, Thompson DR, Ski CF, Rossell SL, Coco C, Ierino FL, Gock H, Castle DJ. A psychosocial intervention for individuals with advanced chronic kidney disease: A feasibility randomized controlled trial. Nephrology (Carlton) 2021; 26:442-453. [PMID: 33484221 DOI: 10.1111/nep.13850] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/05/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 12/17/2022]
Abstract
AIM The current study evaluated the feasibility and preliminary efficacy of a psychosocial intervention, the Kidney Optimal Health Program, in reducing symptoms of depression and anxiety in individuals with advanced chronic kidney disease. METHODS Patients with stage 4 or 5 chronic kidney disease were randomized to either a nine-session psychosocial intervention programme or usual care. Feasibility was assessed through recruitment and retention rates and programme acceptability. Participants completed assessments of depression, anxiety and psychosocial health at baseline and at 3-, 6- and 12-month follow-up. A repeated-measures analysis of variance was used to compare groups on outcomes over time. RESULTS One hundred and twenty-eight patients were screened for eligibility; 84 consented to participant and were randomized to receive the intervention (N = 42) or usual care (N = 42). 27 (32.1%) participants withdrew prior to baseline assessment. Of those who completed the baseline assessment (N = 57), trial retention was high (75.4% at 3-month, 80.7% at 6-month and 70.2% at 12-month follow-up). Participants reported high levels of programme acceptability. The patients who completed the intervention (N = 17) demonstrated significantly decreased depression at 12-month follow-up compared to the usual care group (N = 13). CONCLUSION The results support the feasibility of the Kidney Optimal Health Program intervention in recruitment, retention and programme acceptability with an improved screening protocol. Preliminary support is provided for improvement in depressive symptoms in patients with advanced chronic kidney disease. Further investigation through a fully powered randomized controlled trial is warranted.
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Affiliation(s)
- Zoe M Jenkins
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Eric J Tan
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia.,Centre for Mental Health, Swinburne University, Melbourne, Australia
| | - Emmet O'Flaherty
- Department of Nephrology, St. Vincent's Hospital, Melbourne, Australia
| | - Simon Knowles
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Department of Psychology, Swinburne University of Technology, Melbourne, Australia
| | - David R Thompson
- Department of Psychiatry, University of Melbourne, Melbourne, Australia.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.,University of Suffolk, Integrated Care Academy, Ipswich, UK
| | - Chantal F Ski
- Department of Psychiatry, University of Melbourne, Melbourne, Australia.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.,University of Suffolk, Integrated Care Academy, Ipswich, UK
| | - Susan L Rossell
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia.,Centre for Mental Health, Swinburne University, Melbourne, Australia
| | - Carolee Coco
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia
| | - Francesco L Ierino
- Department of Nephrology, St. Vincent's Hospital, Melbourne, Australia.,Department of Nephrology, University of Melbourne, Melbourne, Australia
| | - Hilton Gock
- Department of Nephrology, St. Vincent's Hospital, Melbourne, Australia
| | - David J Castle
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Centre for Complex Interventions, Centre for Addictions and Mental Health, Toronto, Canada
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20
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Tse T, Knowles S, Bélec J, Caudrelier JM, Lock M, Brackstone M, Arnaout A. Consensus statement on tumour bed localization for radiation after oncoplastic breast surgery. ACTA ACUST UNITED AC 2020; 27:e326-e331. [PMID: 32669940 DOI: 10.3747/co.27.5977] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Oncoplastic surgery (ops) is becoming the new standard of care for breast-conserving surgery, leading to some challenges with adjuvant radiation, particularly when accurate tumour bed (tbd) delineation is needed for focused radiation (that is, accelerated partial breast irradiation or boost radiation). Currently, no guidelines have been published concerning tbd localization for adjuvant targeted radiation after ops. Methods A modified Delphi method was used to establish consensus by a panel of 20 experts in surgical and radiation oncology at the Canadian Locally Advanced Breast Cancer National Consensus Group and in a subsequent online member survey. Results These are the main recommendations:■ Surgical clips are necessary and should, at a minimum, be placed along the 4 side walls of the cavity, plus 1-4 clips at the posterior margin if necessary.■ Operative reports should include pertinent information to help guide the radiation oncologists.■ Breast surgeons and radiation oncologists should have a basic understanding of ops techniques and work on "speaking a common language."■ Careful consideration is needed when determining the value of targeted radiation, such as boost, in higher-level ops procedures with extensive tissue rearrangement. Conclusions The panel developed a total of 6 recommendations on tbd delineation for more focused radiation therapy after ops, with more than 80% agreement on each statement. All are summarized, together with the corresponding evidence or expert opinion.
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Affiliation(s)
- T Tse
- Department of Surgery, University of Ottawa, Ottawa, ON
| | - S Knowles
- Department of Surgery, Western University, London, ON
| | - J Bélec
- Department of Radiation Oncology, University of Ottawa, Ottawa, ON
| | - J M Caudrelier
- Department of Radiation Oncology, University of Ottawa, Ottawa, ON
| | - M Lock
- Department of Radiation Oncology, Western University, London, ON
| | - M Brackstone
- Department of Surgery, Western University, London, ON
| | - A Arnaout
- Department of Surgery, University of Ottawa, Ottawa, ON
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21
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Loughlin L, Knowles S, Twomey A, Murphy JFA. The Neonatal Early Onset Sepsis Calculator; in Clinical Practice. Ir Med J 2020; 113:57. [PMID: 32268050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Aims To determine the impact of applying the Neonatal Early Onset Sepsis Calculator (NEOSC) to clinical practice. We evaluated this multivariable risk prediction model, used in the assessment of infants >35 weeks GA, at risk of neonatal sepsis. Methods A retrospective, cohort study comparing the rates of blood culture use in a large maternity hospital before and after the introduction of the NEOSC. Cases were ascertained from the records of the Department of Microbiology. The key variables were the number of blood cultures (all gestational ages, <72 hours old), infant antibiotic use and sepsis rates. Data for three years prior to NEOSC use (January 2015 - December 2017) were compared with 15 months (January 2018 - Q1 2019) after it was implemented. Results Pre- and post- NEOSC use, the total blood cultures taken annually were: 1,312 (2015), 1,149 (2016), 1,319 (2017) and 702 (2018), 192 (Q1 2019) respectively, a statistically significant reduction [p < 0.00001, 95% CI]. There was no significant difference in rates of either: culture-confirmed GBS-sepsis [p value 0.18, 95% CI] or other-pathogen sepsis [p value 0.32, 95%CI] in term infants between the two periods. There was a significant reduction in antibiotic use in the first 24 hours of life (average 11.3% pre-NEOSC and 5.9% after NEOSC was implemented) [p < 0.00001, 95% CI]. Conclusion The introduction of the NEOSC has reduced blood culture and antibiotic use. This has been achieved without any increase in infection rates.
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Affiliation(s)
- L Loughlin
- Department of Neonatology, The National Maternity Hospital, Dublin 2
| | - S Knowles
- Department of Microbiology, The National Maternity Hospital, Dublin 2
| | - A Twomey
- Department of Neonatology, The National Maternity Hospital, Dublin 2
| | - J F A Murphy
- Department of Neonatology, The National Maternity Hospital, Dublin 2
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22
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Dowsey M, Castle D, Knowles S, Monshat K, Salzberg M, Nelson E, Dunin A, Dunin J, Spelman T, Choong P. The effect of mindfulness training prior to total joint arthroplasty on post-operative pain and physical function: A randomised controlled trial. Complement Ther Med 2019; 46:195-201. [DOI: 10.1016/j.ctim.2019.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/09/2019] [Accepted: 08/09/2019] [Indexed: 12/27/2022] Open
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23
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Massuger W, Moore GTC, Andrews JM, Kilkenny MF, Reyneke M, Knowles S, Purcell L, Alex G, Buckton S, Page AT, Stocks N, Cameron D, Manglaviti F, Pavli P. Crohn's & Colitis Australia inflammatory bowel disease audit: measuring the quality of care in Australia. Intern Med J 2019; 49:859-866. [DOI: 10.1111/imj.14187] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/06/2018] [Accepted: 11/27/2018] [Indexed: 01/14/2023]
Affiliation(s)
| | - Gregory T. C. Moore
- Crohn's & Colitis AustraliaMelbourneVictoriaAustralia
- Gastroenterology and Hepatology UnitMonash HealthMelbourneVictoriaAustralia
- School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVictoriaAustralia
| | - Jane M. Andrews
- IBD Service, Gastroenterology and HepatologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
- Faculty of Health SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Monique F. Kilkenny
- School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVictoriaAustralia
- Stroke DivisionThe Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia
| | - Megan Reyneke
- School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVictoriaAustralia
| | - Simon Knowles
- Department of Psychological SciencesSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Liz Purcell
- Dietetic DepartmentMetro South Health Logan HospitalLogan CityQueenslandAustralia
| | - George Alex
- Department of Gastroenterology and Clinical NutritionRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Stephanie Buckton
- Department of GastroenterologySunshine Coast University HospitalQueenslandAustralia
| | - Amy T. Page
- School of Medicine and PharmacologyUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Nigel Stocks
- Discipline of General PracticeUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Don Cameron
- Department of Gastroenterology and Clinical NutritionRoyal Children's HospitalMelbourneVictoriaAustralia
| | | | - Paul Pavli
- Gastroenterology and Hepatology UnitThe Canberra HospitalCanberraAustralian Capital TerritoryAustralia
- Medical SchoolAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
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24
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Mikocka‐Walus A, Prady SL, Pollok J, Esterman AJ, Gordon AL, Knowles S, Andrews JM. Adjuvant therapy with antidepressants for the management of inflammatory bowel disease. Cochrane Database Syst Rev 2019; 4:CD012680. [PMID: 30977111 PMCID: PMC6459769 DOI: 10.1002/14651858.cd012680.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Symptoms of anxiety and depression are common in inflammatory bowel disease (IBD). Antidepressants are taken by approximately 30% of people with IBD. However, there are no current guidelines on treating co-morbid anxiety and depression in people with IBD with antidepressants, nor are there clear data on the role of antidepressants in managing physical symptoms of IBD. OBJECTIVES The objectives were to assess the efficacy and safety of antidepressants for treating anxiety and depression in IBD, and to assess the effects of antidepressants on quality of life (QoL) and managing disease activity in IBD. SEARCH METHODS We searched MEDLINE; Embase, CINAHL, PsycINFO, CENTRAL, and the Cochrane IBD Group Specialized Register from inception to 23 August 2018. Reference lists, trials registers, conference proceedings and grey literature were also searched. SELECTION CRITERIA Randomised controlled trials (RCTs) and observational studies comparing any type of antidepressant to placebo, no treatment or an active therapy for IBD were included. DATA COLLECTION AND ANALYSIS Two authors independently screened search results, extracted data and assessed bias using the Cochrane risk of bias tool. We used the Newcastle-Ottawa Scale to assess quality of observational studies. GRADE was used to evaluate the certainty of the evidence supporting the outcomes. Primary outcomes included anxiety and depression. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS) or the Hamilton Anxiety Rating Scale (HARS). Depression was assessed using HADS or the Beck Depression Inventory. Secondary outcomes included adverse events (AEs), serious AEs, withdrawal due to AEs, quality of life (QoL), clinical remission, relapse, pain, hospital admissions, surgery, and need for steroid treatment. QoL was assessed using the WHO-QOL-BREF questionnaire. We calculated the risk ratio (RR) and corresponding 95% confidence intervals (CI) for dichotomous outcomes. For continuous outcomes, we calculated the mean difference (MD) with 95% CI. A fixed-effect model was used for analysis. MAIN RESULTS We included four studies (188 participants). Two studies were double-blind RCTs, one was a non-randomised controlled trial, and one was an observational retrospective case-matched study. The age of participants ranged from 27 to 37.8 years. In three studies participants had quiescent IBD and in one study participants had active or quiescent IBD. Participants in one study had co-morbid anxiety or depression. One study used duloxetine (60 mg daily), one study used fluoxetine (20 mg daily), one study used tianeptine (36 mg daily), and one study used various antidepressants in clinical ranges. Three studies had placebo controls and one study had a no treatment control group. One RCT was rated as low risk of bias and the other was rated as high risk of bias (incomplete outcome data). The non-randomised controlled trial was rated as high risk of bias (random sequence generation, allocation concealment, blinding). The observational study was rated as high methodological quality, but is still considered to be at high risk of bias given its observational design.The effect of antidepressants on anxiety and depression is uncertain. At 12 weeks, the mean anxiety score in antidepressant participants was 6.11 + 3 compared to 8.5 + 3.45 in placebo participants (MD -2.39, 95% -4.30 to -0.48, 44 participants, low certainty evidence). At 12 months, the mean anxiety score in antidepressant participants was 3.8 + 2.5 compared to 4.2 + 4.9 in placebo participants (MD -0.40, 95% -3.47 to 2.67, 26 participants; low certainty evidence). At 12 weeks, the mean depression score in antidepressant participants was 7.47 + 2.42 compared to 10.5 + 3.57 in placebo participants (MD -3.03, 95% CI -4.83 to -1.23, 44 participants; low certainty evidence). At 12 months, the mean depression score in antidepressant participants was 2.9 + 2.8 compared to 3.1 + 3.4 in placebo participants (MD -0.20, 95% -2.62 to 2.22, 26 participants; low certainty evidence).The effect of antidepressants on AEs is uncertain. Fifty-seven per cent (8/14) of antidepressant participants group reported AEs versus 25% (3/12) of placebo participants (RR 2.29, 95% CI 0.78 to 6.73, low certainty evidence). Commonly reported AEs include nausea, headache, dizziness, drowsiness, sexual problems, insomnia, fatigue, low mood/anxiety, dry mouth, muscle spasms and hot flushes. None of the included studies reported any serious AEs. None of the included studies reported on pain.One study (44 participants) reported on QoL at 12 weeks and another study (26 participants) reported on QoL at 12 months. Physical, Psychological, Social and Environmental QoL were improved at 12 weeks compared to placebo (all low certainty evidence). There were no group differences in QoL at 12 months (all low certainty evidence). The effect of antidepressants on maintenance of clinical remission and endoscopic relapse is uncertain. At 12 months, 64% (9/14) of participants in the antidepressant group maintained clinical remission compared to 67% (8/12) of placebo participants (RR 0.96, 95% CI 0.55 to 1.69; low certainty evidence). At 12 months, none (0/30) of participants in the antidepressant group had endoscopic relapse compared to 10% (3/30) of placebo participants (RR 0.14, 95% CI 0.01 to 2.65; very low certainty evidence). AUTHORS' CONCLUSIONS The results for the outcomes assessed in this review are uncertain and no firm conclusions regarding the efficacy and safety of antidepressants in IBD can be drawn. Future studies should employ RCT designs, with a longer follow-up and develop solutions to address attrition. Inclusion of objective markers of disease activity is strongly recommended as is testing antidepressants from different classes, as at present it is unclear if any antidepressant (or class thereof) has differential efficacy.
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Affiliation(s)
- Antonina Mikocka‐Walus
- Deakin University GeelongSchool of Psychology221 Burwood HighwayBurwood, VICVictoriaAustralia3025
| | - Stephanie L Prady
- University of YorkDepartment of Health SciencesSeebohm Rowntree Area 2YorkUKYO10 5DD
| | - Justyna Pollok
- The University of AdelaideFaculty of Health and Medical SciencesNorth TerraceAdelaideSouth AustraliaAustralia5005
| | - Adrian J Esterman
- University of South AustraliaDivision of Health SciencesAdelaideAustralia
- James Cook UniversityAustralian Institute of Tropical Health and MedicineCairnsAustralia
| | - Andrea L Gordon
- University of South AustraliaSchool of Pharmacy and Medical SciencesAdelaideAustralia
| | - Simon Knowles
- Swinburne University of TechnologyDepartment of Psychological SciencesATC1041 Hawthorn campusVictoriaAustralia
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Jackson B, Begun J, Gray K, Churilov L, Liew D, Knowles S, De Cruz P. Clinical decision support improves quality of care in patients with ulcerative colitis. Aliment Pharmacol Ther 2019; 49:1040-1051. [PMID: 30847962 DOI: 10.1111/apt.15209] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/30/2018] [Accepted: 02/09/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Decision support tools may facilitate shared decision-making and improve quality of care. AIM To assess the effectiveness of a decision support tool on improving quality of care in ulcerative colitis. METHODS A prospective quality of care intervention was conducted at two Australian hospitals comparing out-patient-based ulcerative colitis care with, and without, a tablet-based decision support tool. This included questions on disease activity management; psychological well-being; and preventive care, with 13 process indicators relevant to each domain. Participants included adult out-patients with mild-to-moderate ulcerative colitis and their clinicians who were divided into two cohorts. The first cohort were followed up immediately after their clinical review to check whether their clinician had discussed the 13 process indicators during the consultation. The second cohort of patients used the decision support tool immediately prior to their consultation which then generated a suggested management plan for the patient and clinician to discuss during the consultation. Management between the 2 cohorts was compared to assess the effectiveness of the decision support tool in improving the primary outcome, defined as the proportion of quality process indicators used for ulcerative colitis care, with and without the decision support tool. RESULTS Thirteen physicians and 100 patients participated. Fifty patients were managed without the decision support tool using standard care (median age 40; 44% male), and 50 patients used the decision support tool (median age 40; 46% male) over a 20-week period. Increase in the median use of process indicators overall was observed following use of the decision support tool (27% vs 100%; P < 0.001). Improvements were seen in psychological well-being management (30% vs 100%; P < 0.001), preventive care (16% vs 100%; P < 0.001) and process indicators related to disease activity management (50% vs 100%; P < 0.001). The decision support tool was found to be usable and acceptable. Shared decision-making was greater in the post-intervention group (mean decision conflict score of 18.0 vs 33.5; P = 0.002). CONCLUSIONS The decision support tool substantially improved the quality of the delivery of care. Decision support tools have the potential to minimise errors of omission via a standardised approach to care.
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Jackson BD, Con D, Gorelik A, Liew D, Knowles S, De Cruz P. Examination of the relationship between disease activity and patient-reported outcome measures in an inflammatory bowel disease cohort. Intern Med J 2019; 48:1234-1241. [PMID: 29663629 DOI: 10.1111/imj.13937] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/04/2018] [Accepted: 04/09/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The extent to which disease activity impacts patient-reported outcomes (PRO) is unclear. AIMS To examine the relationship between disease activity and PRO. METHODS Adult inflammatory bowel disease (IBD) patients attending a tertiary clinic from May to June 2015 were included. Assessment of disease activity (Simple Clinical Colitis Activity Index (SCCAI), Harvey Bradshaw Index (HBI)), IBD knowledge (CCKNOW), medication adherence (MMAS8), psychological distress (Hospital Anxiety and Depression Scale (HADS)), work productivity (WPAI) and quality of life (IBDQ) was performed to investigate any correlations between disease activity and PRO. RESULTS A total of 81 participants was included: 49% female, 57% Crohn disease (CD), 38% ulcerative colitis (UC) and 5% IBD-unclassified, with a median age of 34 years. At least mild levels of depression were present in 21 of 81 (26%) of patients; 37 of 81 (46%) expressed some level of anxiety. A moderate-to-strong correlation was found between disease activity and depression in UC (r = 0.84, P = 0.002) but not in CD (r = 0.53, P = 0.29). Disease activity correlated with: overall work impairment due to health (r = 0.85, P = 0.001), health-related impairment while working (r = 0.76, P = 0.02) and percentage of activity impaired due to health (r = 0.83, P = 0.002) in UC only. CONCLUSIONS Disease activity significantly affects mood and work productivity in patients with UC. Monitoring patients' ability to function and work, rather than minimising disease activity alone, should become a routine part of IBD care.
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Affiliation(s)
- Belinda D Jackson
- Department of Gastroenterology, The Austin Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Austin Academic Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Danny Con
- Department of Gastroenterology, The Austin Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Austin Academic Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alexandra Gorelik
- Melbourne EpiCentre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Simon Knowles
- Department of Psychology, Swinburne University of Technology, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter De Cruz
- Department of Gastroenterology, The Austin Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Austin Academic Centre, The University of Melbourne, Melbourne, Victoria, Australia
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Cassar GE, Knowles S, Youssef GJ, Moulding R, Uiterwijk D, Waters L, Austin DW. Examining the mediational role of psychological flexibility, pain catastrophizing, and visceral sensitivity in the relationship between psychological distress, irritable bowel symptom frequency, and quality of life. PSYCHOL HEALTH MED 2018; 23:1168-1181. [DOI: 10.1080/13548506.2018.1476722] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- G. E. Cassar
- School of Psychology, Deakin University, Geelong, Australia
| | - S. Knowles
- Faculty Health, Arts, and Design, Department of Psychology, Swinburne University of Technology, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Psychiatry,St Vincent’s Hospital, Melbourne, Australia
- Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Australia
| | - G. J. Youssef
- School of Psychology, Deakin University, Geelong, Australia
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - R. Moulding
- School of Psychology, Deakin University, Geelong, Australia
| | - D. Uiterwijk
- School of Psychology, Deakin University, Geelong, Australia
| | - L. Waters
- School of Psychology, Deakin University, Geelong, Australia
| | - D. W. Austin
- School of Psychology, Deakin University, Geelong, Australia
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Sainsbury K, Halmos EP, Knowles S, Mullan B, Tye-Din JA. Maintenance of a gluten free diet in coeliac disease: The roles of self-regulation, habit, psychological resources, motivation, support, and goal priority. Appetite 2018; 125:356-366. [DOI: 10.1016/j.appet.2018.02.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/19/2018] [Accepted: 02/22/2018] [Indexed: 01/30/2023]
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Knowles S, Slavish D, Cyrus A, Arnetz B. 0036 Sleep, Inflammation and Telomere Length. Sleep 2018. [DOI: 10.1093/sleep/zsy061.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Knowles
- John D. Dingell VAMC, Detroit, MI
- Carl R. Darnall Army Medical Center, Fort Hood, TX
| | - D Slavish
- University of North Texas, Denton, TX
| | - A Cyrus
- John D. Dingell VAMC, Detroit, MI
| | - B Arnetz
- Michigan State University, East Lansing, MI
- Wayne State University, Detroit, MI
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Mikocka-Walus A, Fielder A, Prady SL, Esterman AJ, Knowles S, Andrews JM. Adjuvant therapy with antidepressants for the management of inflammatory bowel disease. Cochrane Database of Systematic Reviews 2017. [DOI: 10.1002/14651858.cd012680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Antonina Mikocka-Walus
- Deakin University; School of Psychology; 221 Burwood Highway Burwood, VIC Victoria Australia 3025
| | - Andrea Fielder
- University of South Australia; School of Nursing and Midwifery; Adelaide Australia
| | | | - Adrian J Esterman
- University of South Australia; Division of Health Sciences; Adelaide Australia
| | - Simon Knowles
- Swinburne University of Technology; Department of Psychological Sciences; ATC1041 Hawthorn campus Victoria Australia
| | - Jane M Andrews
- Royal Adelaide Hospital; Adelaide South Australia Australia
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Farrell S, McElnea E, Moran S, Knowles S, Murphy CC. Fungal keratitis in the Republic of Ireland. Eye (Lond) 2017; 31:1427-1434. [PMID: 28524886 DOI: 10.1038/eye.2017.82] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 03/24/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeFungal keratitis is relatively rare in temperate climates with only one previous population-based study, which reported a minimum annual incidence of 0.32 per million population in the United Kingdom. We performed a nationwide study in the Republic of Ireland of cases over a 6-year period to establish the incidence, risk factors, treatment, and outcomes of fungal keratitis.Patients and methodsAll corneal scraping specimens positive for fungal species over a 6-year period were identified at the microbiology departments of the seven main ophthalmology units in the Republic of Ireland. Census data was used to establish national minimum annual incidence.ResultsForty-two eyes were treated for confirmed fungal keratitis during the 6-year period. This resulted in a minimum incidence of 1.53 cases per million population per year. Twenty-eight of 42 cases (67%) were due to filamentary fungi, with the most common species being Aspergillus. Pre-existing ocular surface disease was the most common risk factor constituting 42.9%; 26.2% underwent keratoplasty. No eyes underwent evisceration. Two eyes resulted in a level of vision of no perception of light. The mean LogMAR acuity in the remainder of cases was 0.89 with a range from -0.10 to 4.00.ConclusionThis study demonstrates a much higher minimum annual incidence than previously reported. The causative organism is highly related to risk factor. The range of visual outcomes remains broad in all subgroups. The wide range of outcomes and treatments used highlights the need for better evidence-based guidelines for fungal keratitis.
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Affiliation(s)
- S Farrell
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - E McElnea
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - S Moran
- Department of Ophthalmology, Cork University Hospital, Cork, Ireland
| | - S Knowles
- Department of Microbiology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - C C Murphy
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
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Isidoro-Ayza M, Afonso CL, Stanton JB, Knowles S, Ip HS, White CL, Fenton H, Ruder MG, Dolinski AC, Lankton J. Natural Infections With Pigeon Paramyxovirus Serotype 1: Pathologic Changes in Eurasian Collared-Doves ( Streptopelia decaocto) and Rock Pigeons ( Columba livia) in the United States. Vet Pathol 2017; 54:695-703. [PMID: 28382855 DOI: 10.1177/0300985817695782] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pigeon paramyxovirus serotype 1 (PPMV-1) is a globally distributed, virulent member of the avian paramyxovirus serotype 1 serogroup that causes mortality in columbiformes and poultry. Following introduction into the United States in the mid-1980s, PPMV-1 rapidly spread causing numerous mortality events in Eurasian collared-doves ( Streptopelia decaocto) (ECDOs) and rock pigeons ( Columba livia) (ROPIs). The investigators reviewed pathological findings of 70 naturally infected, free-ranging columbiforms from 25 different mortality events in the United States. Immunohistochemistry targeting PPMV-1 nucleoprotein was used to determine the tissue distribution of the virus in a subset of 17 birds from 10 of the studied outbreaks. ECDOs (61 birds) and ROPIs (9 birds) were the only species in which PPMV-1-associated disease was confirmed by viral isolation and presence of histologic lesions. Acute to subacute tubulointerstitial nephritis and necrotizing pancreatitis were the most frequent histologic lesions, with immunolabeling of viral antigen in renal tubular epithelial cells and pancreatic acinar epithelium. Lymphoid depletion of bursa of Fabricius and spleen was common, but the presence of viral antigen in these organs was inconsistent among infected birds. Hepatocellular necrosis was occasionally present with immunolabeling of hypertrophic Kupffer cells, and immunopositive eosinophilic intracytoplasmic inclusion bodies were present in hepatocytes of 1 ECDO. Immunopositive lymphocytic choroiditis was present in 1 ECDO, while lymphocytic meningoencephalitis was frequent in ROPIs in absence of immunolabeling. This study demonstrates widespread presence of PPMV-1 antigen in association with histologic lesions, confirming the lethal potential of this virus in these particular bird species.
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Affiliation(s)
- M Isidoro-Ayza
- 1 Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, USA
| | - C L Afonso
- 2 Southeast Poultry Research Laboratory, Agricultural Research Service, US Department of Agriculture, Athens, GA, USA
| | - J B Stanton
- 3 Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - S Knowles
- 4 National Wildlife Health Center-US Geological Survey, Madison, WI, USA
| | - H S Ip
- 4 National Wildlife Health Center-US Geological Survey, Madison, WI, USA
| | - C L White
- 4 National Wildlife Health Center-US Geological Survey, Madison, WI, USA
| | - H Fenton
- 5 Southeastern Cooperative Wildlife Disease Study, Athens, GA, USA
| | - M G Ruder
- 5 Southeastern Cooperative Wildlife Disease Study, Athens, GA, USA
| | - A C Dolinski
- 6 Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI, USA
| | - J Lankton
- 4 National Wildlife Health Center-US Geological Survey, Madison, WI, USA
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Peckham E, Bradshaw TJ, Brabyn S, Knowles S, Gilbody S. Exploring why people with SMI smoke and why they may want to quit: baseline data from the SCIMITAR RCT. J Psychiatr Ment Health Nurs 2016; 23:282-9. [PMID: 26147943 DOI: 10.1111/jpm.12241] [Citation(s) in RCA: 12] [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] [Accepted: 05/06/2015] [Indexed: 11/28/2022]
Abstract
ACCESSIBLE SUMMARY People with severe mental ill health are up to three times more likely to smoke than other members of the general population. Life expectancy in this client group is reduced by up to 30 years, and smoking is the single most important cause of premature death. The aim of this study was to explore why people with severe mental ill health smoked and why they might want to stop smoking or cut down on the amount of cigarettes that they smoked. The study found that people with severe mental ill health are motivated to cut down or stop smoking, and this is mainly due to concerns about their own health. The reasons people gave for smoking were to relieve stress, to help relax and for something to do when they are bored. Health professionals should offer evidence supported smoking cessation therapy to people with severe mental ill health. In addition to standard National Health Service smoking cessation treatments such as pharmacotherapy and behavioural support. Practitioners should help people with serious mental ill health to identify meaningful activities to relieve boredom and challenge any incorrect beliefs they hold that smoking helps relaxation and relieves stress. ABSTRACT Smoking is the single most preventable cause of premature mortality for people with serious mental ill health (SMI). Yet little is known about the reasons why service users smoke or what their motivations for quitting might be. The aim of this paper is to explore smoking behaviours, reasons for smoking and motivations for cutting down/stopping smoking in individuals with SMI who expressed an interest in cutting down or stopping smoking. Prior to randomization, the smoking behaviours and motivations for wanting to cut down or stop smoking of participants in a randomized trial were systematically assessed. Participant's primary reasons for continuing to smoke were that they believed it helped them to cope with stress, to relax and relieve boredom. Participant's main motivations for wanting to cut down or stop smoking were related to concerns for their own health. Previous attempts to stop smoking had often been made alone without access to evidence supported smoking cessation therapy. Future recommendations include helping people with SMI to increase their activity levels to relieve boredom and inspire confidence in their ability to stop smoking and challenging beliefs that smoking aids relaxation and relieves stress.
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Affiliation(s)
| | | | | | - S Knowles
- University of Manchester, Manchester, UK
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Whitla L, Fitzgerald D, Twomey A, Knowles S, Murphy JFA. Gentamicin Dosing in Therapeutic Hypothermia; a Quality Improvement Initiative. Ir Med J 2016; 109:348. [PMID: 26904795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Abstract
Objectives: Very little is known about mechanisms of idiosyncratic sensitivity to the damaging effects of mercury (Hg); however, there is likely a genetic component. The aim of the present study was to search for genetic variation in genes thought to be involved in Hg metabolism and transport in a group of individuals identified as having elevated Hg sensitivity compared to a normal control group. Materials and Methods: Survivors of pink disease (PD; infantile acrodynia) are a population of clinically identifiable individuals who are Hg sensitive. In the present study, single nucleotide polymorphisms in genes thought to be involved in Hg transport and metabolism were compared across two groups: (i) PD survivors (n = 25); and (ii) age- and sex-matched healthy controls (n = 25). Results: Analyses revealed significant differences between groups in genotype frequencies for rs662 in the gene encoding paraoxanase 1 (PON1) and rs1801131 in the gene encoding methylenetetrahydrofolate reductase (MTHFR). Conclusions: We have identified two genetic polymorphisms associated with increased sensitivity to Hg. Genetic variation in MTHFR and PON1 significantly differentiated a group formerly diagnosed with PD (a condition of Hg hypersensitivity) with age- and gender-matched healthy controls.
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Affiliation(s)
| | - Briana Spolding
- Metabolic Research Unit, School of Medicine, Deakin University, Victoria
| | - Shakuntla Gondalia
- School of Psychology, Deakin University, Victoria ; Centre for Human Psychopharmacology, Swinburne University of Technology, Victoria
| | | | - Enzo A Palombo
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Victoria
| | - Simon Knowles
- School of Psychology, Swinburne University of Technology, Victoria
| | - Ken Walder
- Metabolic Research Unit, School of Medicine, Deakin University, Victoria
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Travers CP, Connell J, Thornton L, Keane E, Knowles S, Murphy JFA. Follow up of infants born to women with hepatitis B in the National Maternity Hospital. Ir Med J 2015; 108:147-149. [PMID: 26062242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Infants born to women with hepatitis B virus (HBV) are at risk of vertical transmission. This risk is significantly reduced with correct post-natal treatment After initial perinatal management and neonatal treatment, these infants receive subsequent follow up HBV immunisations at two, four and six months. These infants then require post vaccination serological testing. This review was conducted to determine the number of infants born to mothers with HBV in the National Maternity Hospital who had appropriate post vaccination serological testing. There were seventy-eight HBV infections identified antenatally in the years 2010 and 2011 resulting in seventy live born infants at our institution. Thirteen (18.6%) infants had evidence of post vaccination serological testing. This is below international rates of follow up. There is an urgent need for a centralised national programme to ensure adequate follow up and management of all infants born to women with HBV in Ireland.
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Heelan K, Hitzig SL, Knowles S, Drucker AM, Mittmann N, Walsh S, Shear NH. Loss of Work Productivity and Quality of Life in Patients With Autoimmune Bullous Dermatoses. J Cutan Med Surg 2015; 19:546-54. [DOI: 10.1177/1203475415582317] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Little is known about quality of life and work productivity in autoimmune bullous dermatoses (AIBDs). Objective: To determine the impact of AIBDs on quality of life and work productivity. Methods: An observational cross-sectional study took place between February and May 2013 at an AIBD tertiary referral centre. Ninety-four patients were included. All participants completed the Dermatology Life Quality Index and the Work Productivity and Activity Impairment–Specific Health Problem questionnaires. Results: Responders to treatment had less impairment ( P < .001) than nonresponders. Patients with severe AIBD had significantly more impairment that those with mild ( P < .001) and moderate ( P = .002) AIBD. Greater impairment was associated with higher percentage of work missed. Those with a higher Dermatology Life Quality Index score had greater work impairment and overall activity impairment ( P = .041, P = .024). Nonresponders had increased impairment while working ( P < .001), overall work impairment ( P < .001), and activity impairment ( P < .001). Severely affected patients had worse impairment in all Work Productivity and Activity Impairment Questionnaire domains. Conclusions: AIBD has the potential to be a large burden on ability to work and quality of life. Larger studies are needed to clarify how these domains change over time and whether or not they improve with treatment.
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Affiliation(s)
- K. Heelan
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S. L. Hitzig
- Institute for Life Course and Aging, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - S. Knowles
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - A. M. Drucker
- Division of Dermatology, University Health Network, Toronto, ON, Canada
| | - N. Mittmann
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Health Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S. Walsh
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - N. H. Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Terry C, Rasoulpour R, Knowles S, Billington R. Utilizing relative potency factors (RPF) and threshold of toxicological concern (TTC) concepts to assess hazard and human risk assessment profiles of environmental metabolites: A case study. Regul Toxicol Pharmacol 2015; 71:301-17. [DOI: 10.1016/j.yrtph.2014.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 12/01/2022]
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Heelan K, Knowles S, Walsh S, Shear N. Effect of concomitant statin use on rituximab treatment for pemphigus and pemphigoid disorders: a case-based review. J Eur Acad Dermatol Venereol 2014; 28:520-2. [DOI: 10.1111/jdv.12217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/04/2013] [Accepted: 06/21/2013] [Indexed: 11/29/2022]
Affiliation(s)
- K. Heelan
- Division of Dermatology; Department of Medicine; Sunnybrook Health Sciences Centre; University of Toronto; Canada
| | - S. Knowles
- Division of Clinical Pharmacology and Toxicology at Sunnybrook; Department of Medicine; Sunnybrook Health Sciences Centre; University of Toronto; Canada
- Department of Pharmacology; Sunnybrook Health Sciences Centre; University of Toronto; Canada
| | - S. Walsh
- Division of Dermatology; Department of Medicine; Sunnybrook Health Sciences Centre; University of Toronto; Canada
| | - N.H. Shear
- Division of Dermatology; Department of Medicine; Sunnybrook Health Sciences Centre; University of Toronto; Canada
- Division of Clinical Pharmacology and Toxicology at Sunnybrook; Department of Medicine; Sunnybrook Health Sciences Centre; University of Toronto; Canada
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Freyne B, Stafford A, Knowles S, O'Hora A, Molloy E. Perinatal Treponema pallidum: evidence based guidelines to reduce mother to child transmission. Ir Med J 2014; 107:14-16. [PMID: 24592640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Universal antenatal screening for T. pallidum is standard in Irish maternity units. The prevalence of adult syphilis has increased in Ireland. We audited the neonatal management of infants exposed to T. pallidum in utero. A cross sectional retrospective analysis of all pregnancies with confirmed positive serology for T. pallidum from January 2005 to December 2010 was conducted at the National Maternity Hospital, Holles St. Data were analysed using SPSS 14.0. Ethical approval was obtained. There were 55,058 live births during the study period. Fifty-eight women had positive serology and 41 met inclusion criteria. Infant evaluation and follow up was decided by allocation to an evidence based algorithm. Twenty-one infants (51%) were accurately allocated and assessed, 5 (12%) had a partial assessment and the algorithm was incorrectly applied in 15 (36%) of cases. Failure to adhere to evidence based neonatal guidelines is common and undermines efficacy of the screening program.
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Affiliation(s)
- B Freyne
- National Maternity Hospital, Holles St, Dublin 2.
| | - A Stafford
- National Maternity Hospital, Holles St, Dublin 2
| | - S Knowles
- National Maternity Hospital, Holles St, Dublin 2
| | - A O'Hora
- National Maternity Hospital, Holles St, Dublin 2
| | - E Molloy
- National Maternity Hospital, Holles St, Dublin 2
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Freyne B, Stafford A, Knowles S, Hora AO, Molloy EJ. Universal perinatal screening forTreponema pallidum: the role of a dedicated infectious diseases team for prevention of mother-to-child transmission. Sex Transm Infect 2013; 89:582. [DOI: 10.1136/sextrans-2013-051185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Abstract
This is the first in a series of articles describing the application of Lean management systems to Laboratory Medicine. Lean is the term used to describe a principle-based continuous quality improvement (CQI) management system based on the Toyota production system (TPS) that has been evolving for over 70 years. Its origins go back much further and are heavily influenced by the work of W Edwards Deming and the scientific method that forms the basis of most quality management systems. Lean has two fundamental elements--a systematic approach to process improvement by removing waste in order to maximise value for the end-user of the service and a commitment to respect, challenge and develop the people who work within the service to create a culture of continuous improvement. Lean principles have been applied to a growing number of Healthcare systems throughout the world to improve the quality and cost-effectiveness of services for patients and a number of laboratories from all the pathology disciplines have used Lean to shorten turnaround times, improve quality (reduce errors) and improve productivity. Increasingly, models used to plan and implement large scale change in healthcare systems, including the National Health Service (NHS) change model, have evidence-based improvement methodologies (such as Lean CQI) as a core component. Consequently, a working knowledge of improvement methodology will be a core skill for Pathologists involved in leadership and management.
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Affiliation(s)
- David M Clark
- National Clinical Lead, NHS Improvement Diagnostics, Department of Histopathology, Path Links, Lincoln County Hospital, Lincoln, UK.
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Charlebois P, Stein B, Kaneva P, Carli F, Fried G, Feldman L, Carli F, Charlebois P, Stein B, Liberman A, Kaneva P, Augustin B, Gamsa A, Kim DJ, Vassiliou M, Feldman L, Boushey R, Moloo H, Vu L, Chan S, Phang P, Gown A, Jones S, Wiseman S, Jeong DH, Hur H, Baik SH, Kim NK, Faria J, Min BS, Lumb K, Colquhoun P, Porter G, Johnson P, Baxter N, Schmocker S, Huang H, Victor J, Krzyzanowska MK, Brierley J, McLeod R, Kennedy E, Milot H, Desrosiers E, Lebrun A, Drolet S, Bouchard A, Grégoire R, Vuong T, Loungnarath R, DeBroux E, Liberman A, Charlebois P, Stein B, Richard C, Capretti G, Kaneva P, Neville A, Carli F, Liberman S, Charlebois P, Stein B, Vassiliou M, Fried G, Feldman L, Milot H, Drolet S, Bouchard A, Grégoire R, Powell R, Fowler A, Mathieson A, Martin K, Vogt K, Ott M, Pereira G, Einarsdottir K, Moloo H, Boushey R, Mamazza J, Bouchard A, Gagné J, Grégoire R, Thibault C, Bouchard P, Gomes T, Musselman R, Auer R, Moloo H, Mamdani M, Al-Omran M, Boushey R, AlObeed O, Armstrong J. Canadian Surgery Forum1 Is laparoscopic sleeve gastrectomy a reasonable stand-alone procedure for super morbidly obese patients?2 Postoperative monitoring requirements of patients with obstructive sleep apnea undergoing bariatric surgery3 Role of relaparoscopy in the diagnosis and treatment of bariatric complications in the early postoperative period4 Changes of active and total ghrelin, GLP-1 and PYY following restrictive bariatric surgery and their impact on satiety: comparison of sleeve gastrectomy and adjustable gastric banding5 Prioritization and willingness to pay for bariatric surgery: the patient perspective6 Ventral hernia at the time of laparoscopic gastric bypass surgery: Should it be repaired?7 Linear stapled gastrojejunostomy with transverse handsewn enterotomy closure significantly reduces strictures for laparoscopic Roux-en-Y bypass8 Laparoscopic biliopancreatic diversion with duodenal switch as second stage for super super morbidly obese patients. Do all patients benefit?9 Sleeve gastrectomy in the super super morbidly obese (BMI > 60 kg/m2): a Canadian experience10 Laparoscopic gastric bypass for the treatment of refractory idiopathic gastroparesis: a report of 2 cases11 Duodeno-ileal switch as a primary bariatric and metabolic surgical option for the severely obese patient with comorbidities: review of a single-institution case series of duodeno-ileal intestinal bypass12 Management of large paraesophageal hernias in morbidly obese patients with laparoscopic sleeve gastrectomy: a case series13 Early results of the Ontario bariatric surgical program: using the bariatric registry14 Improving access to bariatric surgical care: Is universal health care the answer?15 Early and liberal postoperative exploration can reduce morbidity and mortality in patients undergoing bariatric surgery16 Withdrawn17 Identification and assessment of technical errors in laparoscopic Roux-en-Y gastric bypass18 A valid and reliable tool for assessment of surgical skill in laparoscopic Roux-en-Y gastric bypass19 Psychiatric predictors of presurgery drop-out following suitability assessment for bariatric surgery20 Predictors of outcomes following Roux-en-Y gastric bypass surgery at The Ottawa Hospital21 Prophylactic management of cholelithiasis in bariatric patients: Is routine cholecystectomy warranted?22 Early outcomes of Roux-en-Y gastric bypass in a publicly funded obesity program23 Similar incidence of gastrojejunal anastomotic stricture formation with hand-sewn and 21 mm circular stapler techniques during Roux-en-Y gastric bypass24 (CAGS Basic Science Award) Exogenous glucagon-like peptide-1 improves clinical, morphological and histological outcomes of intestinal adaptation in a distal-intestinal resection piglet model of short bowel syndrome25 (CAGS Clinical Research Award) Development and validation of a comprehensive curriculum to teach an advanced minimally invasive procedure: a randomized controlled trial26 Negative-pressure wound therapy (iVAC) on closed, high-risk incisions following abdominal wall reconstruction27 The impact of seed granting on research in the University of British Columbia Department of Surgery28 Quality of surgical care is inadequate for elderly patients29 Recurrence of inguinal hernia in general and hernia specialty hospitals in Ontario, Canada30 Oncostatin M receptor deficiency results in increased mortality in an intestinal ischemia reperfusion model in mice31 Laparoscopic repair of large paraesophageal hernias with anterior gastropexy: a multicentre trial32 Response to preoperative medical therapy predicts success of laparoscopic splenectomy for immune thrombocytopenic purpura33 Perioperative sepsis, but not hemorrhagic shock, promotes the development of cancer metastases in a murine model34 Measuring the impact of implementing an acute care surgery service on the management of acute biliary disease35 Patient flow and efficiency in an acute care surgery service36 The relationship between treatment factors and postoperative complications after radical surgery for rectal cancer37 Risk of ventral hernia after laparoscopic colon surgery38 Urinary metabolomics as a tool for early detection of Barrett’s and esophageal cancer39 Construct validity of individual and summary performance metrics associated with a computer-based laparo-scopic simulator40 Impact of a city-wide health system reorganization on emergency department visits in hospitals in surrounding communities41 Transcatheter aortic valve implantation for the nonoperative management of aortic stenosis: a cost-effectiveness analysis42 Breast cancer: racial differences in age of onset. A potential confounder in Canadian screening recommendations43 Risk taking in surgery: in and out of the comfort zone44 A tumour board in the office: Track those cancer patients!45 Increased patient BMI is not associated with advanced colon cancer stage or grade on presentation: a retrospective chart review46 Consensus statements regarding the multidisciplinary care of limb amputation patients in disasters or humanitarian emergencies. Report of the 2011 Humanitarian Action Summit Surgical Working Group on amputations following disasters or conflict47 Learning the CanMEDS role of professional: a pilot project of supervised discussion groups addressing the hidden curriculum48 Assessing the changing scope of training in Canadian general surgery programs: expected versus actual experience49 Predicting need for surgical management for massive gastrointestinal hemorrhage50 International health care experience: using CanMEDS to evaluate learning outcomes following a surgical mission in Mampong, Ghana51 The open abdomen: risk factors for mortality and rates of closure52 How surgeons think: an exploration of mental practice in surgical preparation53 The surgery wiki: a novel method for delivery of under-graduate surgical education54 Understanding surgical residents’ postoperative practices before implementing an enhanced recovery after surgery (ERAS) guideline at the University of Toronto55 From laparoscopic transabdominal to posterior retroperitoneal adrenalectomy: a paradigm shift in operative approach56 A retrospective audit of outcomes in patients over the age of 80 undergoing acute care abdominal surgery57 Canadian general surgery residents’ perspectives on work-hour regulations58 Timing of surgical intervention and its outcomes in acute appendicitis59 Preparing surgical trainees to deal with adverse events. An outline of learning issues60 Acute care surgical service: surgeon agreement at the time of handover61 Predicting discharge of elderly patients to prehospitalization residence following emergency general surgery62 Morbidity and mortality after emergency abdominal surgery in octo- and nonagenarians63 The impact of acute abdominal illness and urgent admission to hospital on the living situation of elderly patients64 A comparison of laparoscopic versus open subtotal gastrectomy for antral gastric adenocarcinoma: a North American perspective65 Minimally invasive excision of ectopic mediastinal parathyroid adenomas66 Perioperative outcomes of laparoscopic hernia repair in a tertiary care centre: a single institution’s experience67 Evaluation of a student-run, practical and didactic curriculum for preclerkship medical students68 Joseph Lister: Father of Modern Surgery69 Comparisons of melanoma sentinel lymph node biopsy prediction nomograms in a cohort of Canadian patients70 Local experience with myocutaneous flaps after extensive pelvic surgery71 The treatment of noncirrhotic splanchnic vein thrombosis: Is anticoagulation enough?72 Implementation of an acute care surgery service does not affect wait-times for elective cancer surgeries: an institutional experience73 Use of human collagen mesh for closure of a large abdominal wall defect, after colon cancer surgery, a case report74 The role of miR-200b in pulmonary hypoplasia associated with congenital diaphragmatic hernia75 Systematic review and meta-analysis of electrocautery versus scalpel for incising epidermis and dermis76 Accuracy of sentinel lymph node biopsy for early breast cancer in the community setting in St. John’s, New-foundland: results of a retrospective review77 Acute surgical outcomes in the 80 plus population78 The liberal use of platelets transfusions in the acute phase of trauma resuscitation: a systematic review79 Implementation of an acute care surgical on call program in a Canadian community hospital80 Short-term outcomes following paraesophageal hernia repair in the elderly patient81 First experience with single incision surgery: feasibility in the pediatric population and cost evaluation82 The impact of the establishment of an acute care surgery unit on the outcomes of appendectomies and cholecystectomies83 Description and preliminary evaluation of a low-cost simulator for training and evaluation of flexible endoscopic skills84 Tumour lysis syndrome in metastatic colon cancer: a case report85 Acute care surgery service model implementation study at a single institution86 Colonic disasters approached by emergent subtotal and total colectomy: lessons learned from 120 consecutive cases87 Acellular collagen matrix stent to protect bowel anastomoses88 Lessons we learned from preoperative MRI-guided wire localization of breast lesions: the University Health Network (UHN) experience89 Interim cost comparison for the use of platinum micro-coils in the operative localization of small peripheral lung nodules90 Routine barium esophagram has minimal impact on the postoperative management of patients undergoing esophagectomy for esophageal cancer91 Iron deficiency anemia is a common presenting issue with giant paraesophageal hernia and resolves following repair92 A randomized comparison of different ventilation strategies during thoracotomy and lung resection93 The Canadian Lung Volume Reduction Surgery study: an 8-year follow-up94 A comparison of minimally invasive versus open Ivor-Lewis esophagectomy95 A new paradigm in the follow-up after curative resection for lung cancer: minimal-dose CT scan allows for early detection of asymptomatic cancer activity96 Predictors of lymph node metastasis in early esophageal adenocarcinoma: Is endoscopic resection worth the risk?97 How well can thoracic surgery residents operate? Comparing resident and program director opinions98 The impact of extremes of age on short- and long-term outcomes following surgical resection of esophageal malignancy99 Epidermal growth factor receptor targeted gold nanoparticles for the enhanced radiation treatment of non–small cell lung cancer100 Laparoscopic Heller myotomy results in excellent outcomes in all subtypes of achalasia as defined by the Chicago classification101 Neoadjuvant chemoradiation versus surgery in managing esophageal cancer102 Quality of life postesophagectomy for cancer!103 The implementation, evolution and translocation of standardized clinical pathways can improve perioperative outcomes following surgical treatment of esophageal cancer104 A tissue-mimicking phantom for applications in thoracic surgical simulation105 Sublobar resection compared with lobectomy for early stage non–small cell lung cancer: a single institution study106 Not all reviews are equal: the quality of systematic reviews and meta-analyses in thoracic surgery107 Do postoperative complications affect health-related quality of life after video-assisted thoracoscopic lobectomy for patients with lung cancer? A cohort study108 Thoracoscopic plication for palliation of dyspnea secondary to unilateral diaphragmatic paralysis: A worthwhile venture?109 Thoracic surgery experience in Canadian general surgery residency programs110 Perioperative morbidity and pathologic response rates following neoadjuvant chemotherapy and chemoradiation for locally advanced esophageal carcinoma111 An enhanced recovery pathway reduces length of stay after esophagectomy112 Predictors of dysplastic and neoplastic progression of Barrett’s esophagus113 Recurrent esophageal cancer complicated by tracheoesophageal fistula: management by means of palliative airway stenting114 Pancreaticopleural fistula-induced empyema thoracis: principles and results of surgical management115 Prognostic factors of early postoperative mortality following right extended hepatectomy116 Optimizing steatotic livers for transplantation using a cell-penetrating peptide CPP-fused heme oxygenase117 Video outlining the technical steps for a robot-assisted laparoscopic pancreaticoduodenectomy118 Establishment of a collaborative group to conduct innovative clinical trials in Canada119 Hepatic resection for metastatic malignant melanoma: a systematic review and meta-analysis120 Acellular normothermic ex vivo liver perfusion for donor liver preservation121 Pancreatic cancer and predictors of survival: comparing the CA 19–9/bilirubin ratio with the McGill Brisbane Scoring System122 Staged liver resections for bilobar hepatic colorectal metastases: a single centre experience123 Economic model of observation versus immediate resection of hepatic adenomas124 Resection of colorectal liver metastasis in the elderly125 Acceptable long-term survival in patients undergoing liver resection for metastases from noncolorectal, non-neuroendocrine, nonsarcoma malignancies126 Patient and clinicopathological features and prognosis of CK19+ hepatocellular carcinomas: a case–control study127 The management of blunt hepatic trauma in the age of angioembolization: a single centre experience128 Liver resections for noncolorectal and non-neuroendocrine metastases: an evaluation of oncologic outcomes129 Developing an evidence-based clinical pathway for patients undergoing pancreaticoduodenectomy130 Hepatitis C infection and hepatocellular carcinoma in liver transplant: a 20 year experience131 The effect of medication on the risk of post-ERCP pancreatitis132 Temporal trends in the use of diagnostic imaging for patients with hepato-pancreato-biliary (HPB) conditions: How much ionizing radiation are we really using?196 A phase II study of aggressive metastasectomy for intra-and extrahepatic metastases from colorectal cancer133 Why do women choose mastectomy for breast cancer treatment? A conceptual framework for understanding surgical decision-making in early-stage breast cancer134 Synoptic operative reporting: documentation of quality of care data for rectal cancer surgery135 Learning curve analysis for cytoreductive surgery: a useful application of the cumulative sum (CUSUM) method136 Pancreatic cancer is strongly associated with a unique urinary metabolomic signature137 Concurrent neoadjuvant chemo/radiation in locally advanced breast cancer138 Impact of positron emission tomography on clinical staging of newly diagnosed rectal cancer: a specialized single centre retrospective study139 An evaluation of intraoperative Faxitron microradiography versus conventional specimen radiography for the excision of nonpalpable breast lesions140 Comparison of breast cancer treatment wait-times in the Southern Interior of British Columbia in 2006 and 2010141 Factors affecting lymph nodes harvest in colorectal carcinoma142 Laparoscopic adrenalectomy for metastases143 You have a message! Social networking as a motivator for fundamentals of laparoscopic surgery (FLS) training144 The evaluation and validation of a rapid diagnostic and support clinic for women assessment for breast cancer145 Oncoplastic breast surgery: oncologic benefits and limitations146 A qualitative study on rectal cancer patients’ preferences for location of surgical care147 The effect of surgery on local recurrence in young women with breast cancer148 Elevated IL-6 and IL-8 levels in tumour microenvironment is not associated with increased serum levels in humans with Pseudomyxoma peritonei and peritoneal mesothelioma149 Conversion from laparoscopic to open approach during gastrectomy: a population-based analysis150 A scoping review of surgical process improvement tools (SPITs) in cancer surgery151 Splenectomy during gastric cancer surgery: a population-based study152 Defining the polo-like kinase 4 (Plk4) interactome in cancer cell protrusions153 Neoadjuvant imatinib mesylate for locally advanced gastrointestinal stromal tumours154 Implementing results from ACOSOG Z0011: Practice-changing or practice-affirming?155 Should lymph node retrieval be a surgical quality indicator in colon cancer?156 Long-term outcomes following resection of retroperitoneal recurrence of colorectal cancer157 Clinical research in surgical oncology: an analysis of clinicaltrials.gov158 Radiation therapy after breast conserving surgery: When are we missing the mark?159 The accuracy of endorectal ultrasound in staging rectal lesions in patients undergoing transanal endoscopic microsurgery160 Quality improvement in gastrointestinal cancer surgery: expert panel recommendations for priority research areas161 Factors influencing the quality of local management of ductal carcinoma in situ: a cohort study162 Papillary thyroid microcarcinoma: Does size matter?163 Hyperthermic isolated limb perfusion for extremity soft tissue sarcomas: systematic review of clinical efficacy and quality assessment of reported trials164 Adherence to antiestrogen therapy in seniors with breast cancer: How well are we doing?165 Parathyroid carcinoma: Challenging the surgical dogma?166 A qualitative assessment of the journey to delayed breast reconstruction195 The role of yoga therapy in breast cancer patients167 Outcomes reported in comparative studies of surgical interventions168 Enhanced recovery pathways decrease length of stay following colorectal surgery, but how quickly do patients actually recover?169 The impact of complications on bed utilization after elective colorectal resection170 Impact of trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study171 Complex fistula-in-ano: Should the plug be abandoned in favour of the LIFT or BioLIFT?172 Prognostic utility of cyclooxygenase-2 expression by colon and rectal cancer173 Laparoscopic right hemicolectomy with complete mesocolic excision provides acceptable perioperative outcomes but is complex and time-consuming: analysis of learning curves for a novice minimally invasive surgeon174 Intraoperative quality assessment following double stapled circular colorectal anastomosis175 Improving patient outcomes through quality assessment of rectal cancer care176 Are physicians willing to accept a decrease in treatment effectiveness for improved functional outcomes for low rectal cancer?177 Turnbull-Cutait delayed coloanal anastomosis for the treatment of distal rectal cancer: a prospective cohort study178 Preoperative high-dose rate brachytherapy in preparation for sphincter preservation surgery for patients with advanced cancer of the lower rectum179 Impact of an enhanced recovery program on short-term outcomes after scheduled laparoscopic colon resection180 The clinical results of the Turnbull-Cutait delayed coloanal anastomosis: a systematic review181 Is a vertical rectus abdominus flap (VRAM) necessary? An analysis of perineal wound complications182 Fistula plug versus endorectal anal advancement flap for the treatment of high transsphincteric cryptoglandular anal fistulas: a systematic review and meta-analysis183 Maternal and neonatal outcomes following colorectal cancer surgery184 Transanal drainage to treat anastomotic leaks after low anterior resection for rectal cancer: a valuable option185 Trends in colon cancer in Ontario: 2002–2009186 Validation of electronically derived short-term outcomes in colorectal surgery187 A population-based assessment of transanal and endoscopic resection for adenocarcinoma of the rectum188 Laparoscopic colorectal surgery in the emergency setting: trends in the province of Ontario from 2002 to 2009189 Prevention of perineal hernia after laparoscopic and robotic abdominoperineal resection: review with case series of internal hernia through pelvic mesh which was placed in attempt to prevent perineal hernia190 Effect of rectal cancer treatments on quality of life191 The use of antibacterial sutures as an adjunctive preventative strategy for surgical site infection in Canada: an economic analysis192 Impact of socioeconomic status on colorectal cancer screening and stage at presentation: preliminary results of a population-based study from an urban Canadian centre193 Initial perioperative results of the first transanal endoscopic microsurgery (TEM) program in the province of Quebec194 Use of negative pressure wound therapy decreases perineal wound infections following abdominal perineal resection. Can J Surg 2012; 55:S63-S135. [DOI: 10.1503/cjs.016712] [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: 11/01/2022] Open
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Molloy EJ, Owoeye C, Knowles S. Is antenatal screening for syphilis still necessary? Ir Med J 2012; 105:37-38. [PMID: 22455234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Shaw D, Knowles S, Siriwardena AN. A3 Identifying barriers and facilitators to improving prehospital care of asthma: views of ambulance clinicians. Arch Emerg Med 2011. [DOI: 10.1136/emermed-2011-200645.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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