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Molaei M, Teneralli R, Yang F, Fitzgerald T, Yang Y, DeKlotz C, Lucas J, Wallinger H, Piercy J, Wu D. 131 Patient Characteristics, Disease Profile and Treatment Patterns in Mild and Moderate PsO Patients in European Real World Practices. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.141] [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: 11/19/2022]
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MEADE T, Côté J, Lyons L, Twomey P, O'Riordan A, Watson A, O'Regan J, Fitzgerald T, Malik F, Clince M, Teh J, Holian J, Murray P. POS-072 A PROSPECTIVE AUDIT OF THE CLINICAL IMPLEMENTATION OF URINE NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (uNGAL) AS A BIOMARKER OF ACUTE KIDNEY INJURY IN HOSPITALISED PATIENTS. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Michalski J, Li Y, Northcott P, Vezina G, Billups C, Burger P, Cullen P, Gajjar A, Fouladi M, Perkins S, Pomeroy S, Smith K, Merchant T, Fitzgerald T, Booth T, Hadley J, Kumar R, Tarbell N, Packer R, Janss A. Impact of Molecular Subgroups on Outcomes Following Radiation Treatment Randomizations for Average Risk Medulloblastoma: A Planned Analysis of Children’s Oncology Group (COG) ACNS0331. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gierten J, Fitzgerald T, Loosli F, Gorenflo M, Birney E, Wittbrodt J. Genome-Wide Analysis of Polygenic Cardiac Traits in Medaka Inbred Strains. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705539] [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: 10/24/2022]
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5
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Li N, Teeple A, Muser E, Lucas J, Hetherington J, Fitzgerald T. Use of the Dermatology Life Quality Index work/study domain to estimate overall work productivity loss among patients with psoriasis: an analysis based on real‐world data. Clin Exp Dermatol 2019; 45:572-575. [DOI: 10.1111/ced.14142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- N. Li
- Janssen Global Services LLC Horsham PA USA
| | - A. Teeple
- Janssen Scientific Affairs LLC Horsham PA USA
| | - E. Muser
- Janssen Scientific Affairs LLC Horsham PA USA
| | - J. Lucas
- Adelphi Real World Bollington Cheshire UK
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Fitzgerald T, Nailon R, Tyner K, Beach S, Drake M, Micheels T, Rupp ME, Schwedhelm M, Tierney M, Ashraf MS. 1236. Infection Control Risk Mitigation and Implementation of Best Practice Recommendations in Long-Term Care Facilities. Open Forum Infect Dis 2018. [PMCID: PMC6254387 DOI: 10.1093/ofid/ofy210.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) is a quality improvement initiative supported by the NE Department of Health and Human Services. This initiative utilizes subject matter experts (SMEs) including infectious diseases physicians and certified infection preventionists (IP) to assess and improve infection prevention and control programs (IPCP) in various healthcare settings. NE ICAP conducted on-site surveys and observations of IPCP in many volunteer facilities to include long-term care facilities (LTCF) between November 2015 and July 2017. SMEs provided on-site coaching and made best practice recommendations (BPR) for priority implementation. Impact of this intervention on LTCF IPCP was examined. Methods Using a standardized questionnaire, follow-up phone calls were made with LTCF to evaluate implementation of the BPR one-year post-assessment. Descriptive analyses were performed to examine BPR implementation in LTCF that had follow-up between 4/4/17 to 4/17/18 and to identify factors that promoted or impeded BPR implementation. Results Overall, 45 LTCF were assessed. The top 5 IC categories requiring improvement were audit and feedback practices (28 of 45, 62%), PPE supplies at point of use (62%), IC risk assessments (58%), TB risk assessments (56%), and supply and linen storage practices (56%). Follow-up assessments were completed for 270 recommendations in 25 LTCF. Recommendations reviewed ranged from three to 26 per LTCF (median = 15). The majority of the 270 recommendations (n = 162, 60%) had been either completely (35%) or partially (25%) implemented by the time of the follow-up calls. The ICAP visit itself was reported as the most helpful resource for BPR implementation (77 of 162). Lack of staffing was the most commonly mentioned barrier to implementation when LTCF implemented BPR partially or implementation was not planned (37 of 85). BPR Implementation most frequently involved additional staff training (64 of 162), review of policies and procedures (38 of 162), and implementing audit (34 of 162) and/or feedback (23 of 162) programs. Conclusion Numerous IC gaps exist in LTCF. Peer-to-peer feedback and coaching by SMEs facilitated implementation of many BPR directed toward mitigating identified IC gaps. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Teresa Fitzgerald
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Regina Nailon
- Nursing Research and Quality Outcomes, Nebraska Medicine, Omaha, Nebraska
| | - Kate Tyner
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Sue Beach
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Margaret Drake
- Division of Epidemiology, Nebraska Department of Public Health, Lincoln, Nebraska
| | - Teresa Micheels
- Infection Control and Epidemiology, Nebraska Medicine, Omaha, Nebraska
| | - Mark E Rupp
- Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Michelle Schwedhelm
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Maureen Tierney
- Public Health, Division of Epidemiology, Nebraska Department of Public Health, Lincoln, Nebraska
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Tyner K, Nailon R, Drake M, Fitzgerald T, Beach S, Lyden E, Rupp ME, Schwedhelm M, Tierney M, Ashraf MS. 1239. Frequently Identified Infection Control Gaps in Outpatient Hemodialysis Centers. Open Forum Infect Dis 2018. [PMCID: PMC6253288 DOI: 10.1093/ofid/ofy210.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Little is known about infection control (IC) practice gaps in outpatient hemodialysis centers (OHDC). Hence, we examined the frequency of IC gaps and the factors associated with them. Methods The Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) in collaboration with NE Department of Health and Human Services conducted on-site visits to assess infection prevention and control programs (IPCP) in 15 OHDC between June 2016 and March 2018. The CDC Infection Prevention and Control Assessment Tool for Hemodialysis Facilities was used for IPCP evaluation. A total of 124 questions, 76 of which represented best practice recommendations (BPR) were analyzed in 10 IC domains. Gap frequencies were calculated for each BPR. Fisher’s exact test was used to study the association of the identified gaps with typical patient census of the facilities and chain affiliation (CA). Results Of the 15 OHDC, seven were large centers (typically following >50 patients) and 11 were part of national chains. Important IC gaps exist in all OHDC. A median of 64 (range 57–70) of 76 BPR were being followed by OHDC or were nonapplicable to them. The IC Program and Infrastructure domain had the highest frequency of IC gaps (Figure 1). Figure 2 describes the top 5 IC gaps. Smaller OHDC (sODHC) and those without CA performed better in a few areas. For example, a higher proportion of sODHC had work exclusion policies that encourage reporting of illness without any penalty when compared with larger OHDC (75% vs. 0, P = 0.01). Similarly, a higher proportion of sOHDC provided space and encouraged persons with symptoms of respiratory infection to sit as far away from others as possible in nonclinical areas (63% vs. 0, P < 0.05). None of the nonchain OHDC had shared computer charting terminals when compared with 64% of OHDC with CA (P = 0.08) and a majority of nonchain OHDC provided space and encouraged persons to maintain distance with others when having respiratory symptoms as opposed to a minority of OHDC with CA (75% vs. 18%, 0.08). Conclusion Important IC gaps exist in OHDC and require mitigation. Informing OHDC of existing IC gaps may help in BPR implementation. Larger scale studies should focus on identifying factors promoting certain BPR implementation in smaller and nonchain OHDC. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Kate Tyner
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Regina Nailon
- Nursing Research and Quality Outcomes, Nebraska Medicine, Omaha, Nebraska
| | - Margaret Drake
- Division of Epidemiology, Nebraska Department of Public Health, Lincoln, Nebraska
| | - Teresa Fitzgerald
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Sue Beach
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Elizabeth Lyden
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mark E Rupp
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Michelle Schwedhelm
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Maureen Tierney
- Department of Public Health, Division of Epidemiology, Nebraska Department of Public Health, Lincoln, Nebraska
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Uy K, Voland R, Varlotto J, Decamp M, Mckie K, Maddox D, Rava P, Fitzgerald T, Toth J, Oliveira P, Reed M, Belani C, Baima J, Zhang J, Walsh W, Patel M, Rosen M, Mcintosh L, Rassaei N, Flickinger J. MA23.05 Post-Operative Radiation Improves Overall Survival in Patients with Node-Positive Non-Small Cell Lung Cancer Undergoing Sublobar Resections. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Drake M, Nailon RE, Tyner K, Beach S, Fitzgerald T, Lyden E, Rupp M, Schwedhelm M, Tierney M, Ashraf MS. Frequently Identified Infection Prevention and Control Gaps in Critical Access Hospitals. Am J Infect Control 2018. [DOI: 10.1016/j.ajic.2018.04.029] [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: 11/30/2022]
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10
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Fitzgerald T. Commentary on: Non-interpretive radiology: an Irish perspective. Clin Radiol 2018; 73:499-500. [DOI: 10.1016/j.crad.2017.12.017] [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] [Received: 11/27/2017] [Accepted: 12/15/2017] [Indexed: 10/17/2022]
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11
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Gierten J, Loosli F, Gehrig J, Pylatiuk C, Fitzgerald T, Birney E, Wittbrodt J, Gorenflo M. Systems Genetics Approach to Study Congenital Heart Disease in a Fish Model. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628326] [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: 10/28/2022]
Affiliation(s)
- J. Gierten
- Department of Pediatric Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - F. Loosli
- Karlsruhe Institute of Technology (KIT), Institute of Toxicology and Genetics (ITG), Eggenstein-Leopoldshafen, Germany
| | - J. Gehrig
- ACQUIFER is a division of DITABIS, Digital Biomedical Imaging Systems AG, Pforzheim, Germany
| | - C. Pylatiuk
- Karlsruhe Institute of Technology (KIT), Institute for Applied Computer Science (IAI), Eggenstein-Leopoldshafen, Germany
| | - T. Fitzgerald
- European Bioinformatics Institute (EMBL-EBI), Hinxton, United Kingdom
| | - E. Birney
- European Bioinformatics Institute (EMBL-EBI), Hinxton, United Kingdom
| | - J. Wittbrodt
- Centre for Organismal Studies (COS), Heidelberg University, Heidelberg, Germany
| | - M. Gorenflo
- Department of Pediatric Cardiology, University Hospital Heidelberg, Heidelberg, Germany
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Tyner K, Nailon R, Beach S, Drake M, Fitzgerald T, Lyden E, Rupp ME, Schwedhelm M, Tierney M, Ashraf MS. Frequently Identified Infection Control Gaps Related to Hand Hygiene in Long-Term Care Facilities. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Little is known about hand hygiene (HH) policies and practices in long-term care facilities (LTCF). Hence, we decided to study the frequency of HH-related infection control (IC) gaps and the factors associated with it.
Methods
The Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) in collaboration with NE Department of Health and Human Services conducted in-person surveys and on-site observations to assess infection prevention and control programs (IPCP) in 30 LTCF from 11/2015 to 3/2017. The Centers for Disease Control and Prevention (CDC) Infection Prevention and Control Assessment tool for LTCF was used for on-site interviews and the Centers for Medicare and Medicaid (CMS) Hospital IC Worksheet was used for observations. Gap frequencies were calculated for questions (6 on CDC survey and 8 on CMS worksheet) representing best practice recommendations (BPR). The factors studied for the association with the gaps included LTCF bed size (BS), hospital affiliation (HA), having trained infection preventionists (IP), and weekly hours (WH)/ 100 bed spent by IP on IPCP. Fisher’s exact test and Mann Whitney test were used for statistical analyses.
Results
HH-related IC gap frequencies from on-site interviews are displayed in Figure 1. Only 6 (20%) LTCF reported having all 6 BPR in place and 10 (33%) having 5 BPR. LTCF with fewer gaps (5 to 6 BPR in place) appear more likely to have HA as compared with the LTCF with more gaps but the difference didn’t reach statistical significance (37.5% vs. 7.1%, P = 0.09). When analyzed separately for each gap, it was found that LTCF with HA are more likely to have a policy on preferential use of alcohol based hand rubs than the ones without HA. (85.7%, vs. 26.1% P = 0.008). Several IC gaps were also identified during observations (Figure 2) with one of them being overall HH compliance of <80%. LTCF that have over 90% HH compliance are more likely to have higher median IP WH/100 beds dedicated towards IPCP as compared with the LTCFs with less than 90% compliance (16.4 vs. 4.4, P < 0.05).
Conclusion
Many HH-related IC gaps still exist in LTCF and require mitigation. Mitigation strategies may include encouraging LTCF to collaborate with IP at local acute care hospitals for guidance on IC activities and to increase dedicated IP times towards IPCP in LTCF.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Kate Tyner
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Regina Nailon
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Sue Beach
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Margaret Drake
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Teresa Fitzgerald
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Elizabeth Lyden
- Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mark E Rupp
- Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Michelle Schwedhelm
- Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, Nebraska
| | - Maureen Tierney
- Division of Epidemiology, Nebraska Department of Public Health, Lincoln, Nebraska
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Tyner K, Nailon R, Beach S, Drake M, Fitzgerald T, Lyden E, Rupp ME, Schwedhelm M, Tierney M, Ashraf MS. Environmental Cleaning and Disinfection in Long-Term Care Facilities: Opportunities for Improvement. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.342] [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: 11/13/2022] Open
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Fitzgerald T, Nailon R, Tyner K, Beach S, Drake M, Lyden E, Rupp ME, Schwedhelm M, Tierney M, Ashraf MS. Infection Control in Long-Term Care Facilities: Frequently Identified Gaps in Infrastructure, Surveillance and Safety. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.270] [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: 11/13/2022] Open
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15
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Rupp ME, Crosara SLR, Van Schooneveld TC, Fitzgerald T, Goetschkes K. Factitious Catheter-Associated Urinary Tract Infections in a Neuroscience Intensive Care Unit. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.266] [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: 11/12/2022] Open
Affiliation(s)
- Mark E. Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
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Bourke M, Fitzgerald T, Donlon N, Flynn S, Creedon S, Sparrow P, Brady A, McEneaney P, O'Brien G, McGreal G. Complications Arising Following Endovascular Repair of Aorto-iliac Aneurysms that Require Open Management: Ten Years’ Experience at a Single Centre. Eur J Vasc Endovasc Surg 2016. [DOI: 10.1016/j.ejvs.2016.08.042] [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: 11/30/2022]
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17
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Rupp ME, Fitzgerald T, Van Schooneveld T, Hewlett A, Clevenger R, Lyden E. Cessation of Contact Isolation for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus Is Not Associated With Increased Infections. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.143] [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: 11/15/2022] Open
Affiliation(s)
- Mark E. Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | - Angela Hewlett
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ryan Clevenger
- Infection Control and Epidemiology, Nebraska Medicine, Omaha, Nebraska
| | - Elizabeth Lyden
- Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
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Kalapurakal J, Gopalakrishnan M, Jung J, Peterson S, Leisenring W, Laurie F, Rigsby C, Lee C, Fitzgerald T, Lee C. Accuracy of a Computational Human Phantom Model for Retrospective 3-Dimensional Target-Organ Dosimetry for Late Effects Study of Patients on National Wilms Tumor Study Protocols. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Wang T, Carraway R, LaRoche D, Babineau A, Fitzgerald T. Differential Roles Between ERK1 and ERK2 on Sensitivity of Radiation Resistance Prostate Cancer Cells in Response to Ionizing Radiation. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Parzuchowski A, Friedman D, Fitzgerald T, Wolden S, Dharmarajan K, Constine L, Laurie F, Kessel S, Appel B, Fernandez K, Punnett A, Terezakis S. Patterns of IFRT Protocol Deviations in Pediatric Versus Adolescent and Young Adults With Hodgkin Lymphoma Treated With a Pediatric Approach. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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21
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Mayo C, Moran J, Xiao Y, Bosch W, Matuszak M, Marks L, Miller R, Wu Q, Yock T, Popple R, McNutt T, Brown N, Molineu A, Purdie T, Yorke E, Santanam L, Gabriel P, Michalski J, Moore J, Richardson S, Siochi R, Napolitano M, Feng M, Fitzgerald T, Ulin K, Verbakel W, Siddiqui M, Martel M, Archambault Y, Morgas T, Purcy J, Adams J, Ladra M, Lansing B, Ruo R, Fogliata A, Hurkmans C. AAPM Task Group 263: Tackling Standardization of Nomenclature for Radiation Therapy. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1525] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Hugh SMM, Tracey M, Gilmartin M, Fitzgerald T, Kearney PM. OP33 Attendance and frequency of health service use among older people with diabetes: results from the irish longitudinal study of ageing (TILDA). Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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23
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Matuszak M, Moran J, Xiao Y, Mayo C, Bosch W, Popple R, Marks L, Wu Q, Molineu A, Miller R, Yock T, McNutt T, Brown N, Purdie T, Yorke E, Santanam L, Gabriel P, Michalski J, Moore J, Richardson S, Siochi R, Napalitano M, Ulin K, Fitzgerald T, Feng M, Verbakel W, Siddiqui S, Morgas T, Martel M, Archambault Y, Ladra M, Lansing B, Ruo R, Fogliata-Cozzi A, Hurkmans C. SU-E-P-22: AAPM Task Group 263 Tackling Standardization of Nomenclature for Radiation Therapy. Med Phys 2015. [DOI: 10.1118/1.4923956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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24
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Hedrick K, Fitzgerald T, Miller R. SU-E-T-257: Output Constancy: Reducing Measurement Variations in a Large Practice Group. Med Phys 2014. [DOI: 10.1118/1.4888588] [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: 11/07/2022] Open
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25
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Kachare S, Sanders C, Myatt K, Fitzgerald T, Zervos E. Ground Zero in the War Against Hospital Acquired Infection: Towards Making Catheter Associated Urinary Tract Infections a Never Event in an Academic Medical Center. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Reid C, Fitzgerald T, Fabre A, Kirby B. Atypical melanocytic naevi following melanotan injection. Ir Med J 2013; 106:148-149. [PMID: 23914578] [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: 06/02/2023]
Abstract
Melanotan is a synthetic analogue of alpha melanocyte stimulating hormone (a-MSH) that stimulates melanogenesis. It is sold on the internet and tanning salons as a quick 'tanning jab'. We report a patient who developed multiple new onset atypical naevi within one week of receiving two Melanotan injections. This case highlights the potential risk of Melanotan in stimulating dysplastic naevi or possibly malignant melanoma.
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Affiliation(s)
- C Reid
- Dermatology Department, St Vincent's University Hospital, Elm Park, Dublin 4.
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Rupp ME, Adler A, Schellen M, Cassling K, Fitzgerald T, Sholtz L, Lyden E, Carling P. The time spent cleaning a hospital room does not correlate with the thoroughness of cleaning. Infect Control Hosp Epidemiol 2012; 34:100-2. [PMID: 23221202 DOI: 10.1086/668779] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Environmental surfaces in hospital rooms often become contaminated with microbes, and evidence has linked the patient care environment to transmission of potential pathogens. Despite attempts at standardization of training and cleaning techniques, there is great variation between housekeepers with regard to room cleaning practices. Environmental cleanliness can be assessed by direct observation, surface cultures, detection of adenosine triphosphate, or use of a fluorescent marking solution. Each monitoring technique has limitations.We participated in a multicenter study that demonstrated improved cleaning of high-touch surfaces through the use of a fluorescent marking solution and rapid-cycle performance feedback. As part of an earlier study, housekeepers were instructed about the importance of environmental cleanliness and appropriate cleaning of high-touch surfaces, and a room cleaning checklist was introduced. In this study, we sought to examine the relationship between the amount of time that a housekeeper spent cleaning a hospital room and the thoroughness of surface cleaning.
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Affiliation(s)
- Mark E Rupp
- University of Nebraska Medical Center, Omaha, Nebraska 68198, USA.
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Bonavitacola P, Sioshansi S, Rava P, Fitzgerald T. Incidental Axillary Coverage Comparison Between 3DCRT and Hybrid IMRT for Whole Breast Irradiation. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rupp ME, Cavalieri RJ, Lyden E, Kucera J, Martin M, Fitzgerald T, Tyner K, Anderson JR, VanSchooneveld TC. Effect of hospital-wide chlorhexidine patient bathing on healthcare-associated infections. Infect Control Hosp Epidemiol 2012; 33:1094-100. [PMID: 23041806 DOI: 10.1086/668024] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Chlorhexidine gluconate (CHG) bathing has been used primarily in critical care to prevent central line-associated bloodstream infections and infections due to multidrug-resistant organisms. The objective was to determine the effect of hospital-wide CHG patient bathing on healthcare-associated infections (HAIs). DESIGN Quasi-experimental, staged, dose-escalation study for 19 months followed by a 4-month washout period, in 3 cohorts. SETTING Academic medical center. PATIENTS All patients except neonates and infants. INTERVENTION AND MEASUREMENTS CHG bathing in the form of bed basin baths or showers administered 3 days per week or daily. CHG bathing compliance was monitored, and the rate of HAIs was measured. RESULTS Over 188,859 patient-days, 68,302 CHG baths were administered. Adherence to CHG bathing in the adult critical care units (90%) was better than that observed in other units (57.7%, [Formula: see text]). A significant decrease in infections due to Clostridium difficile was observed in all cohorts of patients during the intervention period, followed by a significant rise during the washout period. For all cohorts, the relative risk of C. difficile infection compared to baseline was 0.71 (95% confidence interval [CI], 0.57-0.89; [Formula: see text]) for 3-days-per-week CHG bathing and 0.41 (95% CI, 0.29-0.59; [Formula: see text]) for daily CHG bathing. During the washout period, the relative risk of infection was 1.85 (95% CI, 1.38-2.53; [Formula: see text]), compared to that with daily CHG bathing. A consistent effect of CHG bathing on other HAIs was not observed. No adverse events related to CHG bathing were reported. CONCLUSIONS CHG bathing was well tolerated and was associated with a significant decrease in C. difficile infections in hospitalized patients.
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Affiliation(s)
- Mark E Rupp
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA.
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Fitzgerald T, Sholtz LA, Marion N, Turner P, Carling PC, Rupp ME. Maintenance of Environmental Services Cleaning and Disinfection in the ICU After a Performance Improvement Project. Am J Infect Control 2012. [DOI: 10.1016/j.ajic.2012.04.281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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O'Donovan DO, Byrne S, Loughrey M, Browne G, Fitzgerald T, Perry I, Sahm L. P1-284 Variation in estimated ten-year cardiovascular risk across four risk scoring tools in both a general population sample and an occupational setting. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976e.76] [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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Abstract
Health disparities are a major concern in the United States. Research suggests that inequitable distribution of money, power, and resources shape the circumstances for daily life and create and exacerbate health disparities. In rural communities, inequitable distribution of these structural factors seems to limit employment opportunities. The Sustainable Livelihoods framework, an economic development model, provides a conceptual framework to understand how distribution of these social, economic, and political structural factors affect employment opportunities and community health in rural America. This study uses photo-elicitation interviews, a qualitative, participatory method, to understand community members' perceptions of how distribution of structural factors through creation and maintenance of institutional practices and policies influence employment opportunities and, ultimately, community health for African Americans living in rural Missouri.
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Browne G, Loughrey M, Harrington J, Lutomski J, Fitzgerald T, Perry I. P43 Dietary salt intake in Irish adults. Br J Soc Med 2010. [DOI: 10.1136/jech.2010.120477.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Barnidge E, Baker EA, Motton F, Rose F, Fitzgerald T. A participatory method to identify root determinants of health: the heart of the matter. Prog Community Health Partnersh 2010; 4:55-63. [PMID: 20364079 DOI: 10.1353/cpr.0.0105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Co-learning is one of the core principles of community-based participatory research (CBPR). Often, it is difficult to engage community members beyond those involved in the formal partnership in co-learning processes. However, to understand and address locally relevant root factors of health, it is essential to engage the broader community in participatory dialogues around these factors. OBJECTIVE This article provides a glimpse into how using a photo-elicitation process allowed a community-academic partnership to engage community members in a participatory dialogue about root factors influencing health. The article details the decision to use photo-elicitation and describes the photo-elicitation method. METHOD Similar to a focus group process, photo-elicitation uses photographs and questions to prompt reflection and dialogue. Used in conjunction with an economic development framework, this method allows participants to discuss underlying, or root, community processes and structures that influence health. CONCLUSION Photo-elicitation is one way to engage community members in a participatory dialogue that stimulates action around root factors of health. To use this method successfully within a CBPR approach, it is important to build on existing relationships of trust among community and academic partners and create opportunities for community partners to determine the issues for discussion.
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Byrne LH, Janku F, Bird BR, O' Keeffe J, O' Murchu E, O' Callaghan L, Fitzgerald T. The correlation between the number of lymph nodes identified and treatment outcomes in colorectal cancer patients: Single-institution experience. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Desmond AN, O'Regan K, Curran C, McWilliams S, Fitzgerald T, Maher MM, Shanahan F. Crohn's disease: factors associated with exposure to high levels of diagnostic radiation. Gut 2008; 57:1524-9. [PMID: 18443021 DOI: 10.1136/gut.2008.151415] [Citation(s) in RCA: 256] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS Exposure to diagnostic radiation may be associated with increased risk of malignancy. The aims of this study were to (1) examine patterns of use of imaging in Crohn's disease; (2) quantify the cumulative effective dose (CED) of diagnostic radiation received by patients; and (3) identify patients at greatest risk of exposure to high levels of diagnostic radiation. METHODS 409 patients with Crohn's disease were identified at a tertiary centre. CED was calculated retrospectively from imaging performed between July 1992 and June 2007. High exposure was defined as CED>75 mSv, an exposure level which has been reported to increase cancer mortality by 7.3%. Complete data were available for 399 patients. 45 were excluded (20 attended outside the study period, 25 were primarily managed at other centres). RESULTS Use of computed tomography increased significantly and accounted for 77.2% of diagnostic radiation. Mean CED was 36.1 mSv and exceeded 75 mSv in 15.5% of patients. Factors associated with high cumulative exposure were: age <17 years at diagnosis (hazard ratio 2.1, confidence interval (CI) 1.1 to 4.1), upper gastrointestinal tract disease (odds ratio (OR) 2.4, CI 1.2 to 4.9), penetrating disease (OR 2.0, CI 1.0 to 3.9) and requirement for intravenous steroids (OR 3.7, CI 2.0 to 6.6); infliximab (OR 2.3, CI 1.2 to 4.4); or multiple (>1) surgeries (OR 2.7, CI 1.4 to 5.4). CONCLUSIONS Identifiable subsets of patients with Crohn's disease are at risk of exposure to significant amounts of diagnostic radiation. Given the background risk of neoplasia and exposure to potentially synergistic agents such as purine analogues and other immune modulators, specialist centres should develop low-radiation imaging protocols.
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Affiliation(s)
- A N Desmond
- Department of Medicine, Alimentary Pharmabiotic Centre, National University of Ireland, Cork, Ireland
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Rupp ME, Fitzgerald T, Puumala S, Anderson JR, Craig R, Iwen PC, Jourdan D, Keuchel J, Marion N, Peterson D, Sholtz L, Smith V. Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units . Infect Control Hosp Epidemiol 2008; 29:8-15. [PMID: 18171181 DOI: 10.1086/524333] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND There are limited data from prospective studies to indicate whether improvement in hand hygiene associated with the use of alcohol-based hand hygiene products results in improved patient outcomes. DESIGN A 2-year, prospective, controlled, cross-over trial of alcohol-based hand gel. SETTING The study was conducted in 2 medical-surgical ICUs for adults, each with 12 beds, from August 2001 to September 2003 at a university-associated, tertiary care teaching hospital. METHODS An alcohol-based hand gel was provided in one critical care unit and not provided in the other. After 1 year, the assignment was reversed. The hand hygiene adherence rate and the incidence of nosocomial infection were monitored. Samples for culture were obtained from nurses' hands every 2 months. RESULTS During 17,994 minutes of observation, which included 3,678 opportunities for hand hygiene, adherence rates improved dramatically after the introduction of hand gel, increasing from 37% to 68% in one unit and from 38% to 69% in the other unit (P< .001). Improvement was observed among all groups of healthcare workers. Hand hygiene rates were better at higher workloads when hand gel was available in the unit (P= .02). No substantial change in the rates of device-associated infection, infection due to multidrug-resistant pathogens, or infection due to Clostridium difficile was observed. Culture of samples from the hands of nursing staff revealed that an increased number of microbes and an increased number of microbe species was associated with longer fingernails (ie, more than 2 mm long), the wearing of rings, and/or lack of access to hand gel. CONCLUSIONS The introduction of alcohol-based gel resulted in a significant and sustained improvement in the rate of hand hygiene adherence. Fingernail length greater than 2 mm, wearing rings, and lack of access to hand gel were associated with increased microbial carriage on the hands. This improvement in the hand hygiene adherence rate was not associated with detectable changes in the incidence of healthcare-associated infection.
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Affiliation(s)
- Mark E Rupp
- Department of Internal Medicine ,University of Nebraska Medical Center, Omaha, USA.
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Abstract
This study examined factors associated with reporting engaging in HIV/AIDS high-risk behaviours at two different time points spaced one year apart for a sample of 185 women who were active injection drug users (IDUs). The high-risk behaviours included injecting drugs in the past six months, having shared needles in the past six months and having engaged in unprotected sexual activity in the past thirty days. Through logistic regression modelling it was identified that living with a spouse at year one was significantly and positively associated with high-risk behaviours at both time points. Being prescribed medications for psychological or emotional problems as well as testing positive for the HIV/AIDS virus were significantly and negatively associated with reporting high-risk behaviours at both time points. These results suggest that spousal relationships may play an important role in HIV/AIDS high-risk behaviours of women drug users. An implication of this study is the need to focus on how spousal relationships and issues such as gender and empowerment should be incorporated into the design and implementation of HIV/AIDS prevention and treatment programs. The benefits of comprehensive mental health diagnosis and treatment services as well as HIV testing in reducing harm to female IDUs and their partners are also discussed.
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Affiliation(s)
- T Fitzgerald
- Boston University School of Social Work, Boston, MA, USA.
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Power C, Byrne PJ, Lim K, Ravi N, Moore J, Fitzgerald T, Keeling PWN, Reynolds JV. Superiority of anti-reflux stent compared with conventional stents in the palliative management of patients with cancer of the lower esophagus and esophago-gastric junction: results of a randomized clinical trial. Dis Esophagus 2007; 20:466-70. [PMID: 17958720 DOI: 10.1111/j.1442-2050.2007.00696.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [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: 02/05/2023]
Abstract
Palliation of inoperable esophageal cancer with covered stents aims to relieve progressive dysphagia and improve health-related quality of life (HRQoL). Introducing a stent across the esophagogastric junction in lower third tumors may predispose to unchecked gastro-esophageal reflux (GER). Esophageal stents incorporating an anti-reflux valve have been introduced to address this problem. We prospectively compared an anti-reflux stent with a standard stent in the palliation of inoperable lower third esophageal tumors. Forty-nine consecutive patients with malignant dysphagia were randomized to receive a standard (n = 25, group 1) or an anti-reflux stent (n = 24, group 2). HRQoL was assessed before stenting, at 1 week and at 2 months, utilizing European Organization for Research and Treatment of Cancer questionnaires QLQ-C30, QLQ-OES24 and reflux questionnaires. Esophageal pH testing was performed within 1 week of the stent insertion. Detailed statistical analysis was employed to assess general QoL, symptoms and pH scores in both groups. Both groups reported significantly improved QoL, health and dysphagia scores at 1 week and 2 months after stenting. Group 2 patients reported significantly (P < 0.05) better DeMeester symptom, general reflux scores, and normal pH profile at 1 week. At 2 months DeMeester symptom scores were significantly (P < 0.05) better in group 2 compared with group 1. Standard and anti-reflux stents afford comparable relief from dysphagia and improved quality of life in patients with inoperable lower third esophageal cancer. Anti-reflux stents, however, controlled symptomatic and physiologically relevant reflux and should therefore be considered as optimal palliation in this cohort.
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Affiliation(s)
- C Power
- Departments of Surgery and Gastrointestinal Physiology, Trinity Center for Health Sciences, St. James's Hospital, Trinity College Dublin, Dublin 8, Ireland
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Mayo C, Fitzgerald T, Lo Y, Ding L, Bogdanov M, Zammuto R, Urie M, Kuo E. 2041. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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41
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Roche-Nagle G, Fitzgerald T, McNeaney P, Harte P. Symptomatic Radiation-induced Upper Extremity Occlusive Arterial Disease. Eur J Vasc Endovasc Surg 2006. [DOI: 10.1016/j.ejvs.2005.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Blackstock A, Socinski M, Gu L, Wang X, Bogart J, Fitzgerald T, Green M, Vokes E. O-038 Initial pulmonary toxicity evaluation of chemoradiotherapy (CRT) utilizing 74 Gy 3-dimensional (3-D) thoracic radiation in stage III non-small cell lung cancer (NSCLC): A Cancer and Leukemia Group B (CALGB) randomized phase II trial. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80170-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Griffin E, Martin M, Fitzgerald T, O'Neill D. Gait abnormalities in older people--comparison of inter-professional assessment. Ir Med J 2005; 98:169-70. [PMID: 16097506] [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: 05/03/2023]
Abstract
Gait abnormalities are common in older people but relatively under-diagnosed. We investigated the prevalence of gait abnormalities among patients presenting to a geriatric medicine day hospital, classified them according to whether they were lower, middle or higher level gait disorders and compared inter-professional (physician and physiotherapist) assessments for this classification. Prospective independent assessment by a physician and a senior physiotherapist of 50 consecutive patients presenting to a day hospital. Presence of a gait abnormality was determined and then classified. Levels of agreement were determined between the two professions. There was 98% agreement that a gait abnormality existed in 43 people. In classifying the gait abnormality there was complete agreement in over two-thirds of cases (67.4%). There was further agreement of higher level gait disorders (but disagreement in the sub-classification) in 11.6% of cases. Given the high prevalence of gait abnormality presenting to the day hospital, screening for gait and balance disorders should be of paramount importance. While levels of agreement between the two professions were high, disagreement existed in approximately one-third of cases. Agreement among professionals essential for appropriate tailoring of treatment and intervention.
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Affiliation(s)
- E Griffin
- Department of Medical Gerontology, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin
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Fitzgerald T, Duva S, Ostrer H, Pass K, Oddoux C, Ruben R, Caggana M. The frequency of GJB2 and GJB6 mutations in the New York State newborn population: feasibility of genetic screening for hearing defects. Clin Genet 2004; 65:338-42. [PMID: 15025729 DOI: 10.1111/j.1399-0004.2004.00233.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the US, approximately one in every 1000 children has hearing loss sufficiently severe to interfere with the acquisition of normal speech [Ann NY Acad Sci 630 (1991) 16]. The causes of non-syndromic hearing loss (NSHL) are known to be heterogeneous, with genetic factors accounting for 50-75%[Am J Med Genet 46 (1993) 486]. Often individuals with NSHL thought to be caused by mutations in GJB2 have only one detectable mutant allele [Am J Hum Genet 62 (1998) 792, Hum Mol Genet 6 (12) (1997) 2173]. Another gene that has been identified as a possible cause of NSHL is GJB6 that codes for the gap junction protein, connexin 30. A consecutive series of anonymous newborn dried blood specimens (n = 2089) was tested for two GJB2 mutations: (i) 35delG, a pan-ethnic mutation; and (ii) 167delT, a mutation more frequently found in individuals of Ashkenazi Jewish and Mediterranean descents. Mutation detection was validated using allele-specific oligonucleotide hybridization in single wells. Once the positive samples had been identified, the samples were pooled and retested. All positives in the individual experiment were correctly identified in the pooled experiment. The same random set of anonymous newborn dried blood specimens plus some additional samples were tested (n = 2112) for the 342-kb deletion in the GJB6 gene.
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Affiliation(s)
- T Fitzgerald
- New York State Department of Health, Wadsworth Center, Albany, NY 12201, USA.
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Theilen U, Lyon AJ, Fitzgerald T, Hendry GMA, Keeling JW. Infection with Ureaplasma urealyticum: is there a specific clinical and radiological course in the preterm infant? Arch Dis Child Fetal Neonatal Ed 2004; 89:F163-7. [PMID: 14977904 PMCID: PMC1756044 DOI: 10.1136/adc.2003.026013] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Despite having mild early respiratory disease, many preterm babies develop chronic lung disease (CLD). Intrauterine infection with Ureaplasma urealyticum has been associated with preterm labour and CLD. OBJECTIVE To test the hypothesis that infection with U urealyticum results in a specific clinical and radiological picture in the first 10 days of life. METHODS Retrospective study of 60 ventilated babies < 30 weeks gestation, who had tracheal secretions tested for U urealyticum. Placental histology was reviewed by a paediatric pathologist for signs of chorioamnionitis. Chest radiographs were independently reviewed by two paediatric radiologists according to previously agreed criteria. All reviewers were blinded to the infection status of the babies. RESULTS Twenty five babies were U urealyticum positive. These were more likely to experience chorioamnionitis (p = 0.004), premature rupture of membranes (p = 0.01), and spontaneous vaginal delivery (p = 0.09). U urealyticum positive babies had fewer signs of respiratory distress syndrome on early chest radiographs (p = 0.038), and they could be weaned from their ventilation settings (fraction of inspired oxygen (FIO(2)) and mean airway pressure) more quickly in the first few days. Subsequently U urealyticum positive babies deteriorated clinically and radiologically. More often they required ventilation to be restarted (p = 0.051), a higher proportion being ventilated on day 10 (p = 0.027) with higher FIO(2) (p = 0.001) and mean airway pressure (p = 0.002). Their chest radiographs showed more emphysematous changes as early as day 5 (p = 0.045), with a pronounced difference by day 10 (p = 0.009). CONCLUSIONS Preterm ventilated babies with U urealyticum in their tracheal secretions have a different clinical and radiological course, with less acute lung disease but early onset of CLD, compared with those with negative cultures.
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Affiliation(s)
- U Theilen
- Simpson Centre for Reproductive Health, Royal Infirmary, Edinburgh, Scotland, UK
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Murphy SM, Donnelly M, Fitzgerald T, Tanner WA, Keane FBV, Tierney S. Patients' recall of clinical information following laparoscopy for acute abdominal pain. Br J Surg 2004; 91:485-8. [PMID: 15048753 DOI: 10.1002/bjs.4460] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Failures in doctor–patient communication and patients' understanding continue to confound improvements in the delivery of quality healthcare. In the context of acute abdominal pain managed by means of laparoscopy, it was hypothesized that patients are either not adequately informed, or do not reliably retain simple relevant information transmitted at the time of the procedure. This study was designed to evaluate the reliability of information transfer between doctor and patient in this setting, including the diagnosis and whether or not the appendix was removed.
Methods
A retrospective study of 350 consecutive patients who had undergone laparoscopy for acute abdominal pain over 3·5 years was designed. Each patient completed a telephone questionnaire that was used to evaluate the accuracy of patients' information.
Results
In total, 26·9 per cent of patients did not know or were incorrect regarding the surgical procedure performed. Similarly, 20·0 per cent of all patients did not know or were incorrect regarding the status of their appendix after surgery and 30·0 per cent of patients were incorrect regarding the diagnosis. Despite all of these statistics, 91·4 per cent of patients were happy with the information they had received regarding the procedure.
Conclusion
Some 26·9 per cent of patients who underwent laparoscopy for acute abdominal pain were incorrect or did not know about the procedure that had been performed. This could lead to a further unnecessary operation should they re-present with similar symptoms.
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Affiliation(s)
- S M Murphy
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland.
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Gallagher PM, Lowe G, Fitzgerald T, Bella A, Greene CM, McElvaney NG, O'Neill SJ. Association of IL-10 polymorphism with severity of illness in community acquired pneumonia. Thorax 2003; 58:154-6. [PMID: 12554901 PMCID: PMC1746580 DOI: 10.1136/thorax.58.2.154] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The influence of genetic polymorphisms of interleukin (IL)-10, tumour necrosis factor (TNF)-alpha, and IL-6 gene promoters on severity of systemic inflammatory response syndrome (SIRS) associated with community acquired pneumonia (CAP) was studied. METHODS Using PCR-RFLP analysis we analysed a -1082G/A single nucleotide polymorphism (SNP) of the anti-inflammatory IL-10 gene, a -308G/A SNP of the pro-inflammatory TNF-alpha gene and a -174G/C SNP of the IL-6 gene. Illness severity was stratified according to SIRS score, calculated by presence of up to four physiological indices: temperature, white blood cell count, heart rate and respiratory rate (non-SIRS, SIRS 2, SIRS 3, and SIRS 4). RESULTS A statistically significant stepwise increase in frequency of the IL-10 G allele, associated with higher expression of the gene, was observed in patients with increasing severity of illness from non-SIRS (n=19) to SIRS 2 (n=17), SIRS 3 (n=33) and SIRS 4 (n=24). This was primarily due to a higher frequency of the GG genotype with increasing severity from non-SIRS through to SIRS 4. IL-10 G allele frequency was also increased in patients who died as a result of CAP (n=11) compared with CAP survivors (n=82) (p=0.01). No association was seen between the TNF-alpha -308G/A and IL-6 -174G/C SNPs and disease. Additionally, no interaction between all three SNP genotypes and disease severity was observed. CONCLUSIONS A polymorphism affecting IL-10 expression may influence the severity of illness in patients with CAP.
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Affiliation(s)
- P M Gallagher
- Division of Respiratory Research, Department of Medicine, RCSI Education and Research Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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Abstract
BACKGROUND Smoking is known to be associated with an increased plasma homocysteine level. Both are associated with an increased risk of cardiovascular disease. B-vitamins modulate plasma homocysteine levels. AIMS To investigate the relationships between smoking, plasma homocysteine, nutrient levels and risk of cardiovascular disease. METHODS The European Concerted Action Project case control study of 750 cases and 800 age- and sex-matched controls aged less than 60 years from 19 centres in 10 European countries. RESULTS Smokers were at increased risk of vascular disease. This risk was greatly increased in the presence of a raised plasma homocysteine; cigarette smokers with a plasma homocysteine above 12 micromol.l(-1) had a 12-fold increased risk of cardiovascular disease (OR 12.4 95% CI 7.3 to 21.2) compared with non-smokers with a normal plasma homocysteine. In both cases and controls the current smokers had a higher plasma homocysteine level than the never smokers (11.7 micromol.l(-1) vs 10.07 micromol.l(-1), P<0.05 cases; 9.90 micromol.l(-1) vs 9.53 micromol.l(-1)P value non significant controls). Current smokers tended to have lower levels of folate, and vitamin B6 and vitamin B12 than never smokers. The risk of cardiovascular disease associated with smoking was not significantly altered by adjustment for levels of B-vitamins using a conditional regression model (OR for current smoker >20.day(-1) 8.19, after adjustment for B6, B12, folate OR 7.09). CONCLUSIONS This case control study suggests that smokers with high plasma homocysteine are at greatly increased risk of cardiovascular disease and should therefore be offered intensive advice to help them cease smoking. They also have reduced levels of those B-vitamins (folate, vitamin B6 and vitamin B12) that modulate homocysteine metabolism. While this finding may reflect a direct effect of smoking or reduced B-vitamin intake, supplementation of these nutrients may be appropriate in smokers with high homocysteine levels.
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Affiliation(s)
- P O'Callaghan
- The Adelaide and Meath Hospital Dublin, Dublin, Ireland
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Abstract
In the standard routine for testing cranial nerve function following a cerebrovascular accident (CVA) compromising the corticonuclear supply to the cranial nerves, sternomastoid muscle (SCM) function is checked by means of head rotation against resistance. SCM appears to be an exception to the generally contralateral motor weakness resulting from a CVA. The thrust of this article is that appearances can be deceptive: SCM is more likely to be a postural stabilizer than a prime mover in head rotation.
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Affiliation(s)
- T Fitzgerald
- Department of Anatomy, National University of Ireland at Galway, Galway, Ireland.
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Schifitto G, McDermott MP, Evans T, Fitzgerald T, Schwimmer J, Demeter L, Kieburtz K. Autonomic performance and dehydroepiandrosterone sulfate levels in HIV-1-infected individuals: relationship to TH1 and TH2 cytokine profile. Arch Neurol 2000; 57:1027-32. [PMID: 10891985 DOI: 10.1001/archneur.57.7.1027] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Products of immune activation, including cytokines and lipid membrane derivatives, have been implicated in the pathogenesis of the neurologic sequelae, including autonomic dysfunction, associated with human immunodeficiency virus 1 (HIV-1) infection. In animal models, autonomic and endocrine dysfunction are associated with an altered cytokine profile. OBJECTIVES To investigate the relationship between markers of immune activation (beta(2)-microglobulin), HIV-1 disease progression (CD4(+) cell count and viral load), and autonomic nervous system performance and to assess the relationship between autonomic performance, plasma levels of dehydroepiandrosterone sulfate (DHEAS), and T(H)1 and T(H)2 cytokine profile. METHODS Thirty-one HIV-1-infected individuals and 22 HIV-1-negative controls were evaluated with a comprehensive neurologic, neuropsychological, and autonomic examination. Interleukin 4 and interferon gamma were measured by enzyme-linked immunosorbent assay in the supernatant of stimulated peripheral blood mononuclear cells. RESULTS A composite measure of autonomic performance (AZ score) was significantly lower (worse autonomic function) in patients compared with controls (P=.04). A lower AZ score was associated with higher beta(2)-microglobulin serum levels and a lower CD4(+) cell count. Interleukin 4 levels were significantly inversely associated with AZ score (P=.01), whereas interferon gamma levels were significantly positively associated with DHEAS levels (P=.04). CONCLUSIONS Our data show significant associations between markers of immune activation and disease progression and a composite measure of autonomic function in HIV-1-infected individuals. In addition, they suggest that poor autonomic function and low DHEAS plasma levels tend to be associated with an unbalanced cytokine profile.
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Affiliation(s)
- G Schifitto
- Department of Neurology, University of Rochester, 601 Elmwood Ave, Box 673, Rochester, NY 14642.
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