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Maher C, Lewis L, Katzmarzyk PT, Dumuid D, Cassidy L, Olds T. The associations between physical activity, sedentary behaviour and academic performance. J Sci Med Sport 2016; 19:1004-1009. [PMID: 26971300 DOI: 10.1016/j.jsams.2016.02.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 07/08/2015] [Revised: 02/10/2016] [Accepted: 02/23/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To examine the relationships between children's moderate-to-vigorous physical activity (MVPA), sedentary behaviours, and academic performance. DESIGN This study investigated cross-sectional relationships between children's accelerometer-measured physical activity and sedentary behaviour patterns, and academic performance using a standardised, nationally-administered academic assessment. METHODS A total of 285 Australian children aged 9-11 years from randomly selected schools undertook 7-day 24h accelerometry to objectively determine their MVPA and sedentary behaviour. In the same year, they completed nationally-administered standardised academic testing (National Assessment Program-Literacy and Numeracy; NAPLAN). BMI was measured, and socio-demographic variables were collected in a parent-reported survey. Relationships between MVPA, sedentary behaviour and academic performance across five domains were examined using Generalised Linear Mixed Models, adjusted for a wide variety of socio-demographic variables. RESULTS Higher academic performance was strongly and consistently related to higher sedentary time, with significant relationships seen across all five academic domains (range F=4.13, p=0.04 through to F=18.65, p=<0.01). In contrast, higher academic performance was only related to higher MVPA in two academic domains (writing F=5.28, p=0.02, and numeracy F=6.28, p=0.01) and was not related to language, reading and spelling performance. CONCLUSIONS Findings highlight that sedentary behaviour can have positive relationships with non-physical outcomes. Positive relationships between MVPA and literacy and numeracy, as well as the well documented benefits for MVPA on physical and social health, suggest that it holds an important place in children's lives, both in and outside of school.
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Affiliation(s)
- Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Australia.
| | - Lucy Lewis
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Australia
| | | | - Dot Dumuid
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Australia
| | - Leah Cassidy
- Department for Education and Child Development, Australia
| | - Tim Olds
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Australia
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Kuliukas L, Duggan R, Lewis L, Hauck Y. Women's experience of intrapartum transfer from a Western Australian birth centre co-located to a tertiary maternity hospital. BMC Pregnancy Childbirth 2016; 16:33. [PMID: 26857353 PMCID: PMC4745174 DOI: 10.1186/s12884-016-0817-z] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 01/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this Western Australian study was to describe the overall labour and birth experience of women who were transferred during the first and second stages of labour from a low risk woman-centred, midwifery-led birth centre to a co-located tertiary maternity referral hospital. METHODS Using a descriptive phenomenological design, fifteen women were interviewed up to 8 weeks post birth (July to October, 2013) to explore their experience of the intrapartum transfer. Giorgi's method of analysis was used. RESULTS The following themes and subthemes emerged: 1) The midwife's voice with subthemes, a) The calming effect and b) Speaking up on my behalf; 2) In the zone with subthemes, a) Hanging in there and b) Post birth rationalizing; 3) Best of both worlds with subthemes a) The feeling of relief on transfer to tertiary birth suite and b) Returning back to the comfort and familiarity of the birth centre; 4) Lost sense of self; and 5) Lost birth dream with subthemes a) Narrowing of options and b) Feeling of panic. Women found the midwife's voice guided them through the transfer experience and were appreciative of continuity of care. There was a sense of disruption to expectations and disappointment in not achieving the labour and birth they had anticipated. There was however appreciation that the referral facility was nearby and experts were close at hand. The focus of care altered from woman to fetus, making women feel diminished. Women were glad to return to the familiar birth centre after the birth with the opportunity to talk through and fully understand their labour journey which helped them contextualise the transfer as one part of the whole experience. CONCLUSIONS Findings can inform midwives of the value of a continuity of care model within a birth centre, allowing women both familiarity and peace of mind. Maternity care providers should ensure that the woman remains the focus of care after transfer and understand the significance of effective communication to ensure women are included in all care discussions.
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Affiliation(s)
- Lesley Kuliukas
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia. .,Family Birth Centre, King Edward Memorial Hospital, PO Box 134, Subiaco, 6904, Western Australia.
| | - Ravani Duggan
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia
| | - Lucy Lewis
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia.,Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, PO Box 134, Subiaco, 6904, Western Australia
| | - Yvonne Hauck
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia.,Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, PO Box 134, Subiaco, 6904, Western Australia
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Lewis L, Hauck YL, Ronchi F, Crichton C, Waller L. Gaining insight into how women conceptualize satisfaction: Western Australian women's perception of their maternity care experiences. BMC Pregnancy Childbirth 2016; 16:29. [PMID: 26846257 PMCID: PMC4743199 DOI: 10.1186/s12884-015-0759-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 11/23/2015] [Indexed: 11/16/2022] Open
Abstract
Background The concept of maternal satisfaction is challenging, as women’s and clinicians’ expectations and experiences can differ. Our aim was to investigate women’s experiences of maternity care in an urban tertiary obstetric setting, to gain insight into conceptualization of satisfaction across the childbirth continuum. Methods This mixed method study was conducted at a public maternity hospital in Western Australia. A questionnaire was sent to 733 women two weeks post birth, which included an invitation for an audio-recorded, telephone interview. Frequency distributions and univariate comparisons were employed for quantitative data. Thematic analysis of interview transcripts was undertaken to extract common themes. Results A total of 54 % (399 of 733) returned the questionnaire. Quantitative results indicated that women were less likely to feel: involved if they did not have a spontaneous vaginal birth (P = 0.020); supported by a midwife if they had a caesarean (P = <0.001); or supported by an obstetrician if they had a spontaneous vaginal birth (P = <0.001). Qualitative findings emerged from 63 interviews which highlighted the influence that organization of care, resources and facilities had on women’s satisfaction. These paradigms unfolded as three broad themes constructed by four sub-themes, each illustrating a dichotomy of experiences. The first theme ‘how care was provided’ encompassed: familiar faces versus a different one every time and the best place to be as opposed to so disappointed. The second theme ‘attributes of staff’ included: above and beyond versus caring without caring and in good hands as opposed to handled incorrectly. The third theme ‘engaged in care’ incorporated: explained everything versus did not know why and had a choice as opposed to did not listen to my needs. Conclusions Quantitative analysis confirmed that the majority of women surveyed were satisfied. Mode of birth influenced women’s perception of being involved with their birth. Being able to explore the diversity of women’s experiences in relation to satisfaction with their maternity care in an urban, tertiary obstetric setting has offered greater insight into what women value: a sensitive, respectful, shared relationship with competent clinicians who recognise and strive to provide woman focused care across the childbirth continuum.
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Affiliation(s)
- Lucy Lewis
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Perth, 6102, Western Australia, Australia. .,Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Perth, 6008, Western Australia, Australia.
| | - Yvonne L Hauck
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Perth, 6102, Western Australia, Australia. .,Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Perth, 6008, Western Australia, Australia.
| | - Fiona Ronchi
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Perth, 6008, Western Australia, Australia.
| | - Caroline Crichton
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Perth, 6008, Western Australia, Australia.
| | - Liana Waller
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Perth, 6008, Western Australia, Australia.
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Kuliukas LJ, Lewis L, Hauck YL, Duggan R. Midwives’ experiences of transfer in labour from a Western Australian birth centre to a tertiary maternity hospital. Women Birth 2016; 29:18-23. [DOI: 10.1016/j.wombi.2015.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 07/07/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
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Lewis L, Maher C, Katzmarzyk P, Olds T. Individual and School-Level Socioeconomic Gradients in Physical Activity in Australian Schoolchildren. J Sch Health 2016; 86:105-112. [PMID: 26762821 DOI: 10.1111/josh.12357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 05/13/2015] [Accepted: 06/18/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND We attempted to determine whether there was a socioeconomic gradient in 9- to 11-year-old Australian children's moderate-to-vigorous physical activity (MVPA), and whether school facilities or policies supporting physical activity were associated with school-level socioeconomic status (SES) and MVPA. METHODS Children (N = 528) from 26 randomly selected schools participated in the International Study of Childhood Obesity, Lifestyle and the Environment. School-level SES was determined by the Index of Community Socio-Educational Advantage. MVPA was determined from 7-day, 24-hour accelerometry. School facilities (21 items) were evaluated with an objective school ground audit. School policies related to physical activity were collected (18 items) in a school administrator survey. Relationships among SES, MVPA, school facilities, and policies were examined using bivariate regression, correlation analyses, and analysis of variance. RESULTS There was a clear SES gradient in daily and in-school MVPA. School facilities or physical activity policies were not associated with SES or in-school MVPA, with the exception of presence of a sports field which was associated with lower SES schools (p = .02) and lower in-school MVPA (p = .001). CONCLUSIONS School-built, policy, and resource environments are similar across different SES-level schools. Therefore, some other mechanism must be underlying the SES gradients seen in MVPA participation in Australian children.
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Affiliation(s)
- Lucy Lewis
- Discipline of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia.
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, Australia.
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia.
| | | | - Timothy Olds
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia.
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Barnett L, Hauck YL, Lewis L. Midwives’ Journey Through the First Year of a Hospital-Based Midwifery Group Practice. Int J Childbirth 2016. [DOI: 10.1891/2156-5287.6.4.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM:To explore the experiences of midwives involved in the first midwifery group practice situated at a Western Australian tertiary maternity hospital.METHODS:A descriptive phenomenology study was undertaken to extract common themes from interview transcripts using the 6-step process by Braun and Clarke. Seven midwives participated in 2 interviews over 12 months.FINDINGS:Six months into the midwifery group practice (MGP) journey, 5 themes were captured: “adapting to a new way of working,” “working out the glitches,” “work–life balance,” “opportunity to grow,” and “perceived benefits for women.” After 12 months, 2 themes emerged: “making progress into new ways of working” and “future sustainability.”CONCLUSIONS:Midwives felt women must be realistically informed of what an MGP offers. Priorities were regular meetings for open communication, taking scheduled days off and leave, and providing mentoring. Insight around benefits and challenges encountered by MGP midwives can inform health services, considering offering a similar service and ensure its sustainability.
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Wiggans RE, Lewis L, Sumner J, Robinson E, Bradshaw L, Codling A, Fishwick D, Barber CM. P54 Respiratory symptoms, lung function and quality of life in British foundry workers: Abstract P54 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.191] [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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Fishwick D, Sumner J, Barber CM, Robinson E, Codling A, Lewis L, Young C, Warren N. P61 Respiratory ill health in the silica exposed brick manufacturing sector. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.198] [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: 11/04/2022]
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Fishwick D, Sumner J, Barber CM, Robinson E, Codling A, Lewis L, Young C, Warren N. P65 Respiratory ill health in the silica exposed stone working sector. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.202] [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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Kuliukas L, Hauck Y, Duggan R, Lewis L. The phenomenon of intrapartum transfer from a western Australian birth centre to a tertiary maternity hospital: The overall experiences of partners. Midwifery 2015; 31:e87-93. [DOI: 10.1016/j.midw.2015.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 11/28/2014] [Accepted: 01/21/2015] [Indexed: 11/24/2022]
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O'Connor A, Lewis L, McLaurin R, Barnett L. Maternal and neonatal outcomes of Hepatitis C positive women attending a midwifery led drug and alcohol service: A West Australian perspective. Midwifery 2015; 31:793-7. [PMID: 25957760 DOI: 10.1016/j.midw.2015.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 04/09/2015] [Accepted: 04/11/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND the Women and Newborn Drug and Alcohol Service (WANDAS) is a specialist, midwifery-led service providing pregnancy care to women dealing with alcohol and other drug (AOD) use, at the sole tertiary maternity hospital in Western Australia. AIM to assess the antenatal, intrapartum and neonatal outcomes of women with Hepatitis C (HCV) who attended the WANDAS service between 2009 and 2012. DESIGN this retrospective cohort study used data obtained from computerised midwifery records. Univariate comparisons between those who were HCV positive and those who were not, were performed. Multivariable logistic regression was utilised to investigate the simultaneous factors associated with being HCV positive and an opiate user. FINDINGS the incidence of HCV in this cohort was 37% (213 of 570). Compared to those who were HCV negative those who were positive were more likely to: be older (P<0.001); use opioids in pregnancy (P<0.001); be an intravenous drug user (P<0.001); engage in polysubstance use (P<0.001); and receive an induction of labour (P=0.036). There were no intrapartum characteristics found to be significant at a multivariate level associated with being HCV positive and an opiate user, but there were a couple of neonatal complications. These were having a baby admitted to Special Care Nursery (OR 1.95, 95% CI 1.33-2.88, P<0.001) and a baby at increased risk of being diagnosed with neonatal abstinence syndrome (OR 3.40, 95% CI 2.24-5.15, P<0.001). CONCLUSION our findings highlight the complexity of caring for pregnant women who are HCV positive, they also highlight that all pregnant women who are AOD users are an at risk population. IMPLICATIONS FOR PRACTICE these results improve our understanding of the obstetric and midwifery issues associated with caring for pregnant women who are HCV positive and the value of provision of specialist care from a multidisciplinary team, led by a consultant midwife.
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Affiliation(s)
- Angela O'Connor
- King Edward Memorial Hospital, Subiaco, Western Australia, Australia. angela.o'
| | - Lucy Lewis
- School of Nursing and Midwifery, Curtin University, Western Australia, Australia; Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.
| | - Renate McLaurin
- King Edward Memorial Hospital, Subiaco, Western Australia, Australia.
| | - Lisa Barnett
- King Edward Memorial Hospital, Subiaco, Western Australia, Australia.
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Hauck Y, Lewis L, Ronchi F, Crichton C, Waller L. How women conceptualise satisfaction of their maternity care experiences. Women Birth 2015. [DOI: 10.1016/j.wombi.2015.07.064] [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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Freiberger D, Lewis L, Helfand L. Human papillomavirus-related high-grade squamous intraepithelial lesions of the esophagus, skin, and cervix in an adolescent lung transplant recipient: a case report and literature review. Transpl Infect Dis 2014; 17:98-102. [PMID: 25537681 DOI: 10.1111/tid.12322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 08/22/2014] [Accepted: 09/25/2014] [Indexed: 01/20/2023]
Abstract
High-risk (carcinogenic) genotype human papillomavirus (HPV) infections can be associated with significant morbidity in the immunocompromised solid organ transplant (SOT) recipient. Immunosuppression-associated persistent infection can predispose to the development of rapidly progressive high-grade squamous intraepithelial lesions (HSIL) in this population. We present a case report of an adolescent bilateral lung transplant recipient who developed HSIL of the esophagus, cervix, and skin secondary to HPV. This review highlights the unique developmental needs of the sexually active adolescent SOT recipient and reviews guidelines for HPV-related screening and education of this population.
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Affiliation(s)
- D Freiberger
- Division of Pulmonary/Pediatric Transplant Center, Boston Children's Hospital, Boston, Massachusetts, USA
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Fishwick D, Lewis L, Darby A, Waterhouse J, Wiggans R, Bradshaw L. P127 Copd And The Workplace; Attitudes Of Those With And Without The Condition In A Population Based Study. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.268] [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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Polanyi Z, Dale P, Taylor M, Lewis L, Glanville J, Vieira J, Chandiwana D. A Cost Effectiveness Analysis of Everolimus Plus Exemestane Compared to Chemotherapy Agents for the Treatment of ER+ HER2- Metastastic Breast Cancer in the United Kingdom. Value Health 2014; 17:A634. [PMID: 27202260 DOI: 10.1016/j.jval.2014.08.2275] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Z Polanyi
- Novartis Pharmaceuticals UK Limited, Camberley, UK
| | - P Dale
- HEOR Solutions, London, UK
| | - M Taylor
- York Health Economics Consortium, York, UK
| | - L Lewis
- York Health Economics Consortium, York, UK
| | | | - J Vieira
- Novartis Pharmaceuticals UK Limited, Camberley, UK
| | - D Chandiwana
- Novartis Pharmaceuticals UK Limited, Camberley, UK
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Lewis L, Taylor M, Suriya Y, Kuanysh N, Kaldygul S, Ramil A. Budget Impact Analysis of Everolimus for the Treatment of Hormone Receptor Positive, Human Epidermal Growth Factor Receptor-2 Negative (HER2-) Advanced Breast Cancer in Kazakhstan. Value Health 2014; 17:A621. [PMID: 27202187 DOI: 10.1016/j.jval.2014.08.2202] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- L Lewis
- York Health Economics Consortium, York, UK
| | - M Taylor
- York Health Economics Consortium, York, UK
| | - Y Suriya
- Kazakh Research Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - N Kuanysh
- Kazakh Research Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - S Kaldygul
- Kazakh Research Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - A Ramil
- Kazakh Research Institute of Oncology and Radiology, Almaty, Kazakhstan
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Perry R, Taylor M, Lewis L, Yellowlees A, Fleetwood K, Barata T. Estimating Survival Data from Published Kaplan-Meier Curves: a Comparison of Methods. Value Health 2014; 17:A326. [PMID: 27200548 DOI: 10.1016/j.jval.2014.08.588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- R Perry
- Quantics Consulting Ltd, Edinburgh, UK
| | - M Taylor
- York Health Economics Consortium, York, UK
| | - L Lewis
- York Health Economics Consortium, York, UK
| | | | | | - T Barata
- Quantics Consulting Ltd, Edinburgh, UK
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Polanyi Z, Dale P, Taylor M, Lewis L, Glanville J, Vieira J, Chandiwana D. Everolimus Plus Exemestane Compared to Exemestane and Fulvestrant for the Treatment of ER+ HER2- Metastastic Breast Cancer in the United Kingdom - A Societal Perspective. Value Health 2014; 17:A632. [PMID: 27202245 DOI: 10.1016/j.jval.2014.08.2262] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Z Polanyi
- Novartis Pharmaceuticals UK Limited, Camberley, UK
| | - P Dale
- HEOR Solutions, London, UK
| | - M Taylor
- York Health Economics Consortium, York, UK
| | - L Lewis
- York Health Economics Consortium, York, UK
| | | | - J Vieira
- Novartis Pharmaceuticals UK Limited, Camberley, UK
| | - D Chandiwana
- Novartis Pharmaceuticals UK Limited, Camberley, UK
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Egol KA, Marcano AI, Lewis L, Tejwani NC, McLaurin TM, Davidovitch RI. Can the use of an evidence-based algorithm for the treatment of intertrochanteric fractures of the hip maintain quality at a reduced cost? Bone Joint J 2014; 96-B:1192-7. [PMID: 25183589 DOI: 10.1302/0301-620x.96b9.34153] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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] [Indexed: 11/05/2022]
Abstract
In March 2012, an algorithm for the treatment of intertrochanteric fractures of the hip was introduced in our academic department of Orthopaedic Surgery. It included the use of specified implants for particular patterns of fracture. In this cohort study, 102 consecutive patients presenting with an intertrochanteric fracture were followed prospectively (post-algorithm group). Another 117 consecutive patients who had been treated immediately prior to the implementation of the algorithm were identified retrospectively as a control group (pre-algorithm group). The total cost of the implants prior to implementation of the algorithm was $357 457 (mean: $3055 (1947 to 4133)); compared with $255 120 (mean: $2501 (1052 to 4133)) after its implementation. There was a trend toward fewer complications in patients who were treated using the algorithm (33% pre- versus 22.5% post-algorithm; p = 0.088). Application of the algorithm to the pre-algorithm group revealed a potential overall cost saving of $70 295. The implementation of an evidence-based algorithm for the treatment of intertrochanteric fractures reduced costs while maintaining quality of care with a lower rate of complications and re-admissions.
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Affiliation(s)
- K A Egol
- NYU Hospital for Joint Diseases, Department of Orthopaedic Surgery, 301 East 17th Street, New York, New York 10003, USA
| | - A I Marcano
- NYU Hospital for Joint Diseases, 301 East 17th Street, New York, New York 10003, USA
| | - L Lewis
- Upstate Medical School, Syracuse, New York, New York 13210, USA
| | - N C Tejwani
- NYU Hospital for Joint Diseases, Department of Orthopaedic Surgery, 301 East 17th Street, New York, New York 10003, USA
| | - T M McLaurin
- NYU Hospital for Joint Diseases, Department of Orthopaedic Surgery, 301 East 17th Street, New York, New York 10003, USA
| | - R I Davidovitch
- NYU Hospital for Joint Diseases, 301 East 17th Street, New York, New York 10003, USA
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Lewis L, Boraas C, Dunn S, Krans E. Postpartum contraceptive intention and initiation among opioid-dependent women. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ganapathi L, Lewis L, Gilarde J, Jones S, Kim H, Sharma T. Using Standardized Clinical Assessment and Management Plans (SCAMPs) for Cytomegalovirus (CMV) Disease Prevention: A Novel Quality Improvement Approach in Solid Organ Transplant (SOT) Recipients. Transplantation 2014. [DOI: 10.1097/00007890-201407151-00704] [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: 11/25/2022]
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Lewis L, Taylor M, Broom J, Johnston KL. The cost-effectiveness of the LighterLife weight management programme as an intervention for obesity in England. Clin Obes 2014; 4:180-8. [PMID: 25826774 DOI: 10.1111/cob.12060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 04/02/2014] [Accepted: 04/12/2014] [Indexed: 11/29/2022]
Abstract
LighterLife Total is a very low calorie diet total dietary replacement weight reduction programme that provides Foodpacks, behavioural change therapy and group support appropriate for people with a body mass index of 30 kg m(-2) or above. A model was built to assess the cost-effectiveness of LighterLife Total, compared with (i) no treatment, Counterweight, Weight Watchers and Slimming World, as a treatment for obesity in those with a body mass index of 30 kg m(-2) or above, and (ii) no treatment, gastric banding and gastric bypass in those with a body mass index of 40 kg m(-2) or above. Change in body mass index over time was modelled, and prevalence of comorbidities (diabetes, coronary heart disease and colorectal cancer) was calculated. Costs (of intervention and treatment for comorbidities) and quality-adjusted life years were calculated. LighterLife Total was cost-effective against no treatment, Counterweight, Weight Watchers and Slimming World in the 30+ kg m(-2) group (incremental cost-effectiveness ratios: £11 895, £12 453, £12 585 and £12 233, respectively). In the 40+ kg m(-2) group, LighterLife Total was cost-effective against no treatment (incremental cost-effectiveness ratio: £4356), but less effective than gastric banding and bypass.
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Affiliation(s)
- L Lewis
- York Health Economics Consortium, Level 2 Market Square, University of York, York, UK
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Lewis L, Hauck YL, Ritchie S, Barnett L, Nunan H, Rivers C. Australian women's perception of their preparation for and actual experience of a recent scheduled caesarean birth. Midwifery 2014; 30:e131-6. [DOI: 10.1016/j.midw.2013.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 11/15/2013] [Accepted: 12/16/2013] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Occupational lung diseases remain common, and health surveillance is one approach used to assist identification of early cases. AIMS To identify areas of good practice within respiratory health surveillance and to formulate recommendations for practice. METHODS Published literature was searched since 1990 using a semi-systematic methodology. RESULTS A total of 561 documents were identified on Medline and Embase combined. Other search engines did not identify relevant documents that had not already been identified by these two main searches. Seventy-nine of these were assessed further and 36 documents were included for the full analysis. CONCLUSIONS Respiratory health surveillance remains a disparate process, even within disease type. A standard validated questionnaire and associated guidance should be developed. Lung function testing was common and generally supported by the evidence. Cross-sectional interpretation of lung function in younger workers needs careful assessment in order to best identify early cases of disease. More informed interpretation of the forced expiratory volume in 1 s/forced vital capacity ratio, for example by using a lower limit of normal for each worker, and of longitudinal lung function information is advised. Immunological tests appear useful in small groups of workers exposed to common occupational allergens. Education, training and improved occupational health policies are likely to improve uptake of health surveillance, to ensure that those who fail health surveillance at any point are handled appropriately.
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Affiliation(s)
- L Lewis
- Centre for Workplace Health, Health and Safety Laboratory, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK
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Frayne J, Lewis L, Allen S, Hauck Y, Nguyen T. Severe mental illness and induction of labour: outcomes for women at a specialist antenatal clinic in Western Australia. Aust N Z J Obstet Gynaecol 2013; 54:132-7. [DOI: 10.1111/ajo.12143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 09/04/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Jacqueline Frayne
- Childbirth and Mental Illness Antenatal Clinic; King Edward Memorial Hospital; Perth Western Australia Australia
| | - Lucy Lewis
- School of Nursing and Midwifery; Curtin University and King Edward Memorial Hospital; Subiaco Western Australia Australia
- Department of Nursing and Midwifery Education Research; King Edward Memorial Hospital; Western Australia Australia
| | - Suzanna Allen
- Childbirth and Mental Illness Antenatal Clinic; King Edward Memorial Hospital; Perth Western Australia Australia
| | - Yvonne Hauck
- School of Nursing and Midwifery; Curtin University and King Edward Memorial Hospital; Subiaco Western Australia Australia
- Department of Nursing and Midwifery Education Research; King Edward Memorial Hospital; Western Australia Australia
- Clinical Applications Unit; North Metropolitan Health Service Mental Health; Perth Western Australia Australia
| | - Thinh Nguyen
- School of Psychiatry and Clinical Neurosciences; The University of Western Australia; Western Australia Australia
- Peel and Rockingham Mental Health Service; Rockingham Western Australia Australia
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Abstract
BACKGROUND It is more common for women in both high- and low-income countries giving birth in health facilities, to labour in bed. There is no evidence that this is associated with any advantage for women or babies, although it may be more convenient for staff. Observational studies have suggested that if women lie on their backs during labour this may have adverse effects on uterine contractions and impede progress in labour, and in some women reduce placental blood flow. OBJECTIVES To assess the effects of encouraging women to assume different upright positions (including walking, sitting, standing and kneeling) versus recumbent positions (supine, semi-recumbent and lateral) for women in the first stage of labour on duration of labour, type of birth and other important outcomes for mothers and babies. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2013). SELECTION CRITERIA Randomised and quasi-randomised trials comparing women randomised to upright versus recumbent positions in the first stage of labour. DATA COLLECTION AND ANALYSIS We used methods described in the Cochrane Handbook for Systematic Reviews of Interventions for carrying out data collection, assessing study quality and analysing results. Two review authors independently evaluated methodological quality and extracted data for each study. We sought additional information from trial authors as required. We used random-effects analysis for comparisons in which high heterogeneity was present. We reported results using the average risk ratio (RR) for categorical data and mean difference (MD) for continuous data. MAIN RESULTS Results should be interpreted with caution as the methodological quality of the 25 included trials (5218 women) was variable.For Comparison 1: Upright and ambulant positions versus recumbent positions and bed care, the first stage of labour was approximately one hour and 22 minutes shorter for women randomised to upright as opposed to recumbent positions (average MD -1.36, 95% confidence interval (CI) -2.22 to -0.51; 15 studies, 2503 women; random-effects, T(2) = 2.39, Chi(2) = 203.55, df = 14, (P < 0.00001), I(2) = 93%). Women who were upright were also less likely to have caesarean section (RR 0.71, 95% CI 0.54 to 0.94; 14 studies, 2682 women) and less likely to have an epidural (RR 0.81, 95% CI 0.66 to 0.99, nine studies, 2107 women; random-effects, T(2) = 0.02, I(2) = 61%). Babies of mothers who were upright were less likely to be admitted to the neonatal intensive care unit, however this was based on one trial (RR 0.20, 95% CI 0.04 to 0.89, one study, 200 women). There were no significant differences between groups for other outcomes including duration of the second stage of labour, or other outcomes related to the well being of mothers and babies.For Comparison 2: Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), there were no significant differences between groups for outcomes including duration of the second stage of labour, or other outcomes related to the well being of mothers and babies. AUTHORS' CONCLUSIONS There is clear and important evidence that walking and upright positions in the first stage of labour reduces the duration of labour, the risk of caesarean birth, the need for epidural, and does not seem to be associated with increased intervention or negative effects on mothers' and babies' well being. Given the great heterogeneity and high performance bias of study situations, better quality trials are still required to confirm with any confidence the true risks and benefits of upright and mobile positions compared with recumbent positions for all women. Based on the current findings, we recommend that women in low-risk labour should be informed of the benefits of upright positions, and encouraged and assisted to assume whatever positions they choose.
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Affiliation(s)
- Annemarie Lawrence
- Health & Well Being Service Group and Tropical Health Research Unit for Nursing and Midwifery Practice, The Townsville Hospital and Health Service, Douglas, Queensland, Australia, 4810
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Lewis L, Graffeo C, Crosley P, Klausner H, Clark C, Frank A, Miner J, Iarrobino R, Chyung Y. Ecallantide for the Acute Treatment of Angiotensin Converting Enzyme Inhibitor-Induced Angioedema: A Multicenter Randomized Controlled Trial. Ann Emerg Med 2013. [DOI: 10.1016/j.annemergmed.2013.07.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hauck Y, Ronchi F, Lourey B, Lewis L. Challenges and enablers to smoking cessation for young pregnant Australian women: a qualitative study. Birth 2013; 40:202-8. [PMID: 24635505 DOI: 10.1111/birt.12057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 07/16/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Western Australian (WA) perinatal statistics indicate an 8 percent decrease in smoking by pregnant women from 1999 to 2009. Despite the success of cessation interventions, the incidence of tobacco smokers among young pregnant women remains a cause for concern. To inform development of an appropriate suite of interventions, a qualitative study was undertaken to gain insight into the perceived challenges and enablers young pregnant women encounter when attempting to modify their smoking. METHOD A hypothetical scenario and interview questions were used: if a young pregnant woman decided to decrease or stop her smoking 1) what could assist her, and 2) what are the challenges that she would need to overcome? Thematic analysis was conducted. Our sample included English-speaking pregnant women recorded as a smoker, 16 to 24 years of age, and attending antenatal services at a public maternity hospital. RESULTS Thirty-six women participated in an interview. "Habit" was noted as the key theme under perceived challenges and incorporated three subthemes: learn to deal with stress; the urge for a smoke; and not being left out. Concern over the health of their baby emerged as the main theme and enabler to change behavior. Four subthemes were extracted around keeping their baby healthy: getting the facts; you need someone; something you can take to help; and keeping your mind off it. CONCLUSIONS Our findings highlight the complex issues around smoking for young pregnant WA women. Insight into these challenges and enablers may inform development of more suitable interventions to address the unique needs of this group of pregnant women.
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Affiliation(s)
- Yvonne Hauck
- Curtin University and King Edward Memorial Hospital, Curtin Health Innovation Research Institute, Perth, WA, Australia
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79
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Abstract
BACKGROUND It is more common for women in both high- and low-income countries giving birth in health facilities, to labour in bed. There is no evidence that this is associated with any advantage for women or babies, although it may be more convenient for staff. Observational studies have suggested that if women lie on their backs during labour this may have adverse effects on uterine contractions and impede progress in labour, and in some women reduce placental blood flow. OBJECTIVES To assess the effects of encouraging women to assume different upright positions (including walking, sitting, standing and kneeling) versus recumbent positions (supine, semi-recumbent and lateral) for women in the first stage of labour on duration of labour, type of birth and other important outcomes for mothers and babies. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2013). SELECTION CRITERIA Randomised and quasi-randomised trials comparing women randomised to upright versus recumbent positions in the first stage of labour. DATA COLLECTION AND ANALYSIS We used methods described in the Cochrane Handbook for Systematic Reviews of Interventions for carrying out data collection, assessing study quality and analysing results. Two review authors independently evaluated methodological quality and extracted data for each study. We sought additional information from trial authors as required. We used random-effects analysis for comparisons in which high heterogeneity was present. We reported results using the average risk ratio (RR) for categorical data and mean difference (MD) for continuous data. MAIN RESULTS Results should be interpreted with caution as the methodological quality of the 25 included trials (5218 women) was variable.For Comparison 1: Upright and recumbent positions versus recumbent positions and bed care, the first stage of labour was approximately one hour and 22 minutes shorter for women randomised to upright as opposed to recumbent positions (average MD -1.36, 95% confidence interval (CI) -2.22 to -0.51; 15 studies, 2503 women; random-effects, T(2) = 2.39, Chi(2) = 203.55, df = 14, (P < 0.00001), I(2) = 93%). Women who were upright were also less likely to have caesarean section (RR 0.71, 95% CI 0.54 to 0.94; 14 studies, 2682 women) and less likely to have an epidural (RR 0.81, 95% CI 0.66 to 0.99, nine studies, 2107 women; random-effects, T(2) = 0.02, I(2) = 61%). Babies of mothers who were upright were less likely to be admitted to the neonatal intensive care unit, however this was based on one trial (RR 0.20, 95% CI 0.04 to 0.89, one study, 200 women). There were no significant differences between groups for other outcomes including duration of the second stage of labour, or other outcomes related to the well being of mothers and babies.For Comparison 2: Upright and recumbent positions versus recumbent positions and bed care (with epidural: all women), there were no significant differences between groups for outcomes including duration of the second stage of labour, or other outcomes related to the well being of mothers and babies. AUTHORS' CONCLUSIONS There is clear and important evidence that walking and upright positions in the first stage of labour reduces the duration of labour, the risk of caesarean birth, the need for epidural, and does not seem to be associated with increased intervention or negative effects on mothers' and babies' well being. Given the great heterogeneity and high performance bias of study situations, better quality trials are still required to confirm with any confidence the true risks and benefits of upright and mobile positions compared with recumbent positions for all women. Based on the current findings, we recommend that women in low-risk labour should be informed of the benefits of upright positions, and encouraged and assisted to assume whatever positions they choose.
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Affiliation(s)
- Annemarie Lawrence
- Health & Well Being Service Group and Tropical Health Research Unit for Nursing and Midwifery Practice, The Townsville Hospital and Health Service, Douglas, Queensland, Australia, 4810
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Lewis L, Wahesh E. Facebook and the Cognitive Model: A Tool for Promoting Adolescent Self-Awareness. Journal of Creativity in Mental Health 2012. [DOI: 10.1080/15401383.2012.740335] [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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83
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Kehoe S, Zhang XF, Lewis L, O'Shea H, Boyd D. Characterization of PLGA based composite nerve guidance conduits: effect of F127 content on modulus over time in simulated physiological conditions. J Mech Behav Biomed Mater 2012; 14:180-5. [PMID: 23026696 DOI: 10.1016/j.jmbbm.2012.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 05/31/2012] [Accepted: 06/07/2012] [Indexed: 11/15/2022]
Abstract
PLGA/pluronic F127 based nerve guidance conduits (NGCs) for peripheral nerve regeneration offer excellent potential for clinical use. To date, little emphasis has been directed towards the effect of pluronic F127 on their subsequent mechanical properties as a function of degradation time or the physiological environment. This report was designed to redress the balance. This study synthesised 5 groups of 20wt% PLGA NGCs with varied additions of pluronic F127 (range 0-5wt%) to obtain Young's Moduli (E) in the range of 7-107MPa, depending on degradation conditions and pluronic F127 content.
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Affiliation(s)
- S Kehoe
- Department of Applied Oral Science, Dalhousie University, P.O. Box 15000, Halifax, NS, Canada B3H 4R2.
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Abstract
The new National Institute for Health and Clinical Excellence (NICE) guidance cites genitourinary (GU) medicine clinics as one setting where screening for alcohol-use disorders should be part of routine clinical practice. Northumberland GU medicine service has routinely used the Fast Alcohol Screening Tool (FAST) since June 2009. An audit of all first attendees to the service in April 2010 (n = 256) was carried out. This audit found that the FAST questionnaire was acceptable to both patients and staff (uptake of 95.7%). Statistically significant associations between excessive alcohol and higher rates of unprotected sex (P < 0.01), an increased number of sexual partners (P < 0.01) and higher rates of sexually transmitted infection (STI) diagnosis (P < 0.05) were also demonstrated.
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Affiliation(s)
- L Mitchell
- New Croft Centre, Newcastle-upon-Tyne, UK.
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85
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Drummond F, Lewis L, Bourne C, Ramanathan V, Hocking J, Wand H, Donovan B, Kaldor J, Guy R. P1-S6.32 Optimising clinical systems to increase HIV/STI testing in gay men: the eTEST project. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.256] [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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86
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Lewis L, Saenz M, Fine I. Patterns of cross-modal plasticity in the visual cortex of early blind human subjects across a variety of tasks and input modalities. J Vis 2010. [DOI: 10.1167/7.9.875] [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: 11/24/2022] Open
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87
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Lewis L, Dziuba D. 213: Major Barriers to Follow-Up of Emergency Department Patients at Federally Funded Clinics: Metropolitan-Wide Survey Pilot Data. Ann Emerg Med 2009. [DOI: 10.1016/j.annemergmed.2009.06.242] [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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88
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Lewis L, Theodoro D, Purim-Shem-Tov Y, Mosnaim G, Sepulveda P, Staats P, Hoffman T. 164: Percutaneous Vagal Electrical Stimulation for Severe Asthma. Ann Emerg Med 2009. [DOI: 10.1016/j.annemergmed.2009.06.192] [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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89
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Dziuba D, Theodoro D, Lewis L. 429: Demographic and Clinical Variables Associated With Follow-Up of Emergency Department Patients at Federally Funded Clinics: Metropolitan-Wide Survey Pilot Data. Ann Emerg Med 2009. [DOI: 10.1016/j.annemergmed.2009.06.469] [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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90
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Horwitz D, Schwarz E, Scott M, Lewis L. 382: Glycemic Control Is Improved in Emergency Department Patients With an Identifiable Primary Care Provider. Ann Emerg Med 2009. [DOI: 10.1016/j.annemergmed.2009.06.421] [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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91
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Lewis L, Frank R, Dandamudi UB, Gallagher J, Zhao L, Woo M, Hirawat S, Shapiro GI. Influence of food on the pharmacokinetics (PK) of panobinostat (LBH589), an orally active histone deacetylase inhibitor, in patients with advanced cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.2550] [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: 11/20/2022] Open
Abstract
2550 Background: The effect of food on the bioavailability and PK of panobinostat (PAN) are of considerable importance in allowing appropriate dosing of chronic oral cancer therapy. Methods: Patients (pts) with advanced cancer received 20 mg PAN twice a week of a 21-day cycle and were randomized to receive 1 of 6 treatment sequences where PAN PK was evaluated weekly under fasting, high fat and normal breakfast. Serial blood samples were collected for PAN PK evaluations on Days 1, 8, and 15. Plasma PAN concentrations were measured by LC-MS-MS. PK parameters were estimated by using non-compartmental analysis. Results: A total of 34 patients were evaluated. PAN was generally well tolerated with no significant lab, ECG, or other safety concerns. No residual PAN concentrations were detected in pre-dose samples on Days 8 and 15. Meal conditions and PAN PK parameters expressed as either mean (CV%) or median [range] or ratio are described in the Table . The overall exposure and inter-patient variability (CV 59%) remained unchanged with or without food, whereas Cmax was transiently reduced (<45%) by food. Although tumor response was not the main objective, a pt with recurrent RCC, following sunitinib and sorafenib treatment, has achieved a PR after ∼6 cycles of PAN and is continued on study. Conclusions: Since the overall extent of absorption and variability was not changed due to food, PAN administration with or without food is unlikely to significantly impact systemic PAN exposure in cancer patients. PAN can be administered without regards to food in future studies. [Table: see text] [Table: see text]
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Affiliation(s)
- L. Lewis
- Dartmouth, Lebanon, NH; Whittingham Cancer Center at Norwalk Hospital, Norwalk, CT; Novartis Oncology, Florham Park, NJ; Novartis Oncology, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - R. Frank
- Dartmouth, Lebanon, NH; Whittingham Cancer Center at Norwalk Hospital, Norwalk, CT; Novartis Oncology, Florham Park, NJ; Novartis Oncology, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - U. B. Dandamudi
- Dartmouth, Lebanon, NH; Whittingham Cancer Center at Norwalk Hospital, Norwalk, CT; Novartis Oncology, Florham Park, NJ; Novartis Oncology, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - J. Gallagher
- Dartmouth, Lebanon, NH; Whittingham Cancer Center at Norwalk Hospital, Norwalk, CT; Novartis Oncology, Florham Park, NJ; Novartis Oncology, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - L. Zhao
- Dartmouth, Lebanon, NH; Whittingham Cancer Center at Norwalk Hospital, Norwalk, CT; Novartis Oncology, Florham Park, NJ; Novartis Oncology, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - M. Woo
- Dartmouth, Lebanon, NH; Whittingham Cancer Center at Norwalk Hospital, Norwalk, CT; Novartis Oncology, Florham Park, NJ; Novartis Oncology, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - S. Hirawat
- Dartmouth, Lebanon, NH; Whittingham Cancer Center at Norwalk Hospital, Norwalk, CT; Novartis Oncology, Florham Park, NJ; Novartis Oncology, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - G. I. Shapiro
- Dartmouth, Lebanon, NH; Whittingham Cancer Center at Norwalk Hospital, Norwalk, CT; Novartis Oncology, Florham Park, NJ; Novartis Oncology, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
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Abstract
BACKGROUND It is more common for women in the developed world, and those in low-income countries giving birth in health facilities, to labour in bed. There is no evidence that this is associated with any advantage for women or babies, although it may be more convenient for staff. Observational studies have suggested that if women lie on their backs during labour this may have adverse effects on uterine contractions and impede progress in labour. OBJECTIVES The purpose of the review is to assess the effects of encouraging women to assume different upright positions (including walking, sitting, standing and kneeling) versus recumbent positions (supine, semi-recumbent and lateral) for women in the first stage of labour on length of labour, type of delivery and other important outcomes for mothers and babies. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2008). SELECTION CRITERIA Randomised and quasi-randomised trials comparing women randomised to upright versus recumbent positions in the first stage of labour. DATA COLLECTION AND ANALYSIS We used methods described in the Cochrane Handbook for Systematic Reviews of Interventions for carrying out data collection, assessing study quality and analysing results. A minimum of two review authors independently assessed each study. MAIN RESULTS The review includes 21 studies with a total of 3706 women. Overall, the first stage of labour was approximately one hour shorter for women randomised to upright as opposed to recumbent positions (MD -0.99, 95% CI -1.60 to -0.39). Women randomised to upright positions were less likely to have epidural analgesia (RR 0.83 95% CI 0.72 to 0.96).There were no differences between groups for other outcomes including length of the second stage of labour, mode of delivery, or other outcomes related to the wellbeing of mothers and babies. For women who had epidural analgesia there were no differences between those randomised to upright versus recumbent positions for any of the outcomes examined in the review. Little information on maternal satisfaction was collected, and none of the studies compared different upright or recumbent positions. AUTHORS' CONCLUSIONS There is evidence that walking and upright positions in the first stage of labour reduce the length of labour and do not seem to be associated with increased intervention or negative effects on mothers' and babies' wellbeing. Women should be encouraged to take up whatever position they find most comfortable in the first stage of labour.
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Affiliation(s)
- Annemarie Lawrence
- Institute of Women's and Children's Health (15), Townsville Hospital, 100 Angus Smith Drive, Douglas, Queensland, Australia, 4810.
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Mwihia JT, Straetmans M, Ibrahim A, Njau J, Muhenje O, Guracha A, Gikundi S, Mutonga D, Tetteh C, Likimani S, Breiman RF, Njenga K, Lewis L. Aflatoxin levels in locally grown maize from Makueni District, Kenya. ACTA ACUST UNITED AC 2009; 85:311-7. [PMID: 19133419 DOI: 10.4314/eamj.v85i7.9648] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Investigations were carried out to determine aflatoxin levels in household maize in Makueni District and to correlate aflatoxin levels to maize drying and storage practices. Also, aflatoxin exposure in villages that reported aflatoxicosis cases in 2005 was compared with that in villages that did not report cases to assess whether aflatoxin exposure levels could be used to identify high-risk villages for targeted prevention interventions. DESIGN A cross-sectional study. SETTING Three divisions of Makueni district, Kibwezi, Makindu and Mtito Andei in Eastern Province, Kenya. SUBJECTS Ninety six households were surveyed, and 104 maize samples were analysed for total aflatoxin levels from June to July 2005. The households were selected from high and low aflatoxicosis risk areas. RESULTS Out of the 104 maize samples collected from 96 households, 37 (35.5%) had aflatoxin levels above the World Health Organisation (WHO) recommended maximum limit of 20 ppb. All of these samples were homegrown or purchased. Twenty one samples (20.1%) had levels above 100 ppb. Eleven (10.6%) had extremely high levels above 1000 ppb. No relief supply maize had aflatoxin levels above the WHO maximum limit. CONCLUSION High levels of aflatoxin in homegrown and purchased maize suggested that aflatoxin exposure was widespread.
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Affiliation(s)
- J T Mwihia
- National Public Health Laboratory Services, Kenya, P.O. Box 20750-00202, Nairobi, Kenya
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Ashamalla H, Zaki B, Mokhtar B, Lewis L, Lavaf A, Nasr H, Colella F, Dosik D, Krishnamurthy M, Saad N, Guriguis A. Fractionated stereotactic radiotherapy boost and weekly paclitaxel in malignant gliomas clinical and pharmacokinetics results. Technol Cancer Res Treat 2007; 6:169-76. [PMID: 17535024 DOI: 10.1177/153303460700600303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 10/24/2022] Open
Abstract
Management of Malignant Gliomas continues to be a challenge. We prospectively studied the role of adding weekly Paclitaxel to Fractionated Stereotactic Radiation Therapy (FSRT) in the treatment of Malignant Gliomas. Twenty-three Glioblastoma Multiforme and two Anaplastic Astrocytoma were studied. Patients received 46 Gy at 2 Gy/fraction followed by a boost utilizing FSRT at a fraction of 2.5 Gy for 8 fractions. Paclitaxel is delivered concomitantly at 150 mg/m(2) weekly for six cycles. Eighteen patients had pharmacokinetic assays of Paclitaxel levels. All patients were followed until death or for a maximum of 36 months. The overall survival of the whole group was 14 months. The median survival for RPA prognostic classes III, IV, V, and VI were 20, 14, 12, and 11 months. Higher survival (14 months) was noted in the subtherapeutic phenytoin level group compared to 10 months in the therapeutic group (P=0.271). No grade 4 CTCAE (version 3.0) toxicities were observed. Enhanced survival was demonstrated with gross tumor resection (20.8 months), KPS > or =80 (18.7 months) and age < or =60 years (27 months) as compared to subtotal resection or biopsy (12.1 months, P< 0.005), KPS < or =70 (10.8 months, P=0. 005) and older age > 60 (10.46 months, P=0.006), respectively. Our study suggests that: i) the use of weekly Paclitaxel and FSRT in Gliomas is well tolerated with a survival of 14 months; ii) the regimen resulted in improvement of survival of RPA classes IV, V, VI; and iii) the use of FSRT boost may be studied with other chemotherapeutic agents to see if superior results can be attained.
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Affiliation(s)
- H Ashamalla
- Radiation Oncology, New York Methodist Hospital, Weill Medical College of Cornell University, 506 6th Street, Brooklyn, NY 11215, USA.
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95
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James A, Asaro P, Lewis L. 250: Comparing Differences in the Triage Distribution of Emergency Department Patients Using Two Different 5-tier Triage Acuity Scales. Ann Emerg Med 2007. [DOI: 10.1016/j.annemergmed.2007.06.236] [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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96
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Mounday A, Aubin C, Lewis L. 246: Absence of Fever and Elevated White Blood Count Does Not Exclude the Diagnosis of Diverticulitis as Determined by CT in the Emergency Department. Ann Emerg Med 2007. [DOI: 10.1016/j.annemergmed.2007.06.229] [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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97
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Lewis L, Jones R, Scherer T, Buhlinger Y. Effect of Follow-up to a Federally Funded Health Clinic System on Repeat Emergency Department Visits. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1286] [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: 11/10/2022]
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98
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Scherer T, Bullinger Y, Lewis L. Effect of an Expedited Referral System on Follow-up Rate of Emergency Department Patients to a Federally Funded Health Clinic System. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1283] [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: 11/10/2022]
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99
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Schackman BR, Finkelstein R, Neukermans CP, Lewis L, Eldred L. The cost of HIV medication adherence support interventions: Results of a cross-site evaluation. AIDS Care 2007; 17:927-37. [PMID: 16265786 DOI: 10.1080/09540120500100635] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of this study was to determine the direct cost of HIV adherence support programmes participating in a cross-site evaluation in the US. Data on the frequency, type, and setting of adherence encounters; providers' professions; and adherence tools provided were collected for 1,122 patients enrolled in 13 interventions at 9 sites. The site staff estimated the average duration of each type of encounter and national wage rates were used for labour costs. The median (range) adherence encounters/year among interventions was 16.5 (4.3-104.6) per patient; encounters lasted 24.6 (8.9-40.9) minutes. Intervention direct cost was correlated with the average frequency of encounters (r = 0.57), but not with encounter duration or providers' professions. The median direct cost/month was 35 dollars(5 dollars-58 dollars) per patient, and included direct provider costs (66%); incentives (17%); reminders and other tools (8%); and direct administrative time, provider transportation, training, and home delivery (9%). The median direct cost/month from a societal perspective, which includes patient time and travel costs, was 47 dollars(24 dollars-114 dollars) per patient. Adherence interventions with moderate efficacy costing < or =100 dollars/month have been estimated to meet a cost-effectiveness threshold that is generally accepted in the US. Payers should consider enhanced reimbursement for adherence support services.
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Affiliation(s)
- B R Schackman
- Weill Medical College of Cornell University, New York, USA.
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100
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Affiliation(s)
- H Dam
- The Biochemical Institute of the University, Copenhagen
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