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Hoi K, Kelly AM, Chan A, Kerr D. Is Cardiac Monitoring Necessary for Intermediate Risk Acute Coronary Syndrome Patients who Have a Normal Electrocardiogram and Cardiac Markers in the Emergency Department? HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790701400102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to investigate the safety of managing selected patients with suspected acute coronary syndrome without cardiac monitoring by determining the rate of complications occurring in chest pain patients classified as intermediate risk according to the National Heart Foundation of Australia guidelines and with normal cardiac marker levels and a normal/unchanged ECG in the emergency department. One patient suffered a critical adverse event within 24 hours (0.3%, 95% CI 0.1–1.7%) and 24 patients suffered other adverse events (6.3%, 95% CI 4.2–9.4%). This study provides further evidence that this group of patients are at low risk of experiencing a critical adverse event within 24 hours of hospital presentation and may be safely managed without continuous cardiac monitoring.
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Anderson B, Kelly AM, Kerr D, Jolley D. Capillary Refill Time in Adults Has Poor Inter-Observer Agreement. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790801500202] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives Capillary refill time (CRT) has been taught as a rapid indicator of circulatory status but to be a useful clinical test, CRT needs to be reproducible when performed by another health care worker. No inter-rater agreement studies have been reported for adult patients. The aim of this study was to determine the inter-observer reliability of CRT in a sample of adult emergency department (ED) patients. Methods This prospective observational study included clinically stable ED patients with a variety of conditions from two community EDs. A doctor and a nurse each measured CRT by estimation to the nearest half-second using a standard method on each patient. They were blinded to each other's measurements. The primary outcome of interest was inter-rater agreement. Secondary outcome was agreement in classification as normal or abnormal according to accepted definitions. Data was analysed using bias plot analysis, correlation, absolute percent agreement and kappa analysis. Results Totally, 209 patients were enrolled; 51% were female and 86% were Caucasian. Median CRT was 2 seconds (95% CI 2–2.35 seconds). The mean difference between measurements by the different observers was 0 second, however the 95% limits of agreement were very wide (–1.7 to +1.9 seconds). Agreement was 70% for classification of ‘normal’ or ‘abnormal’ using the 2-second definition of normal, with a kappa of 0.38. Conclusion Interobserver agreement in measurement of CRT was poor in adult subjects with wide limits of agreement. This is a serious threat to the appropriateness of this test for use in clinical practice.
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Merl W, Koutsogiannis Z, Kerr D, Kelly AM. How Safe is Intravenous N-Acetylcysteine for the Treatment of Paracetamol Poisoning? HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790701400402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Paracetamol poisoning remains one of the most common and potentially lethal ingestions. N-acetylcysteine (NAC) has been proven to be a highly effective antidote. The aim of this study was to determine the rate of adverse drug reactions (ADR) to intravenous (IV) NAC. Our hypothesis was that IV NAC for the treatment of paracetamol toxicity has a low rate of adverse events. Methods This was an observational cohort study undertaken by explicit retrospective medical record review. It included patients who presented to the emergency department with paracetamol overdose over the ten-year period from July 1995 to June 2004. The primary outcome measure was the occurrence of an ADR during NAC administration. Adverse drug reactions were classified as minor (including flushing, urticaria, pruritus, bronchospasm, tachycardia, and non-ischaemic chest pain) and major (including hypotension, angio-oedema and death). Data analysis was by descriptive statistics and chi-square analysis using univariate analysis, Fisher's exact test and Mann-Whitney U-test. Inter-rater agreement was checked for 9% of the sample. Results There were 470 cases of paracetamol poisoning. Of these, 320 received IV NAC. Thirty-six (11%, 95% CI 8–15%) of these patients developed ADRs. There were two major ADRs, one hypotension and one angio-oedema (0.6%, 95% CI 0.02–2%). Two patients died during hospitalisation, but neither had an ADR to NAC. The most common ADRs were urticaria (20), flushing (15), bronchospasm (12), and pruritus (3). None of the variables analysed was a clinically significant predictor of increased ADR risk. Conclusion Adverse drug reactions after IV NAC infusion occur commonly, but most are minor. Treatment of paracetamol poisoning with IV NAC appears to be safe, however a large prospective study would be required to confirm this.
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Topley D, Kerr D, Wilson I. Repeated re-referrals – accounting for a pattern in musculoskeletal outpatient physiotherapy. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mesker W, van Pelt G, Huijbers A, van der Laak J, Dequeker E, Fléjou JF, Al Dieri R, Kerr D, Van Krieken J, Tollenaar R. Improving treatment decisions in colon cancer: The tumor-stroma ratio (TSR) additional to the TNM classification. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Macpherson H, Miller E, Dunstan D, Nowson C, Kerr D, Menzies D, Daly R. CAN PROTEIN AND VITAMIN D ENHANCE THE COGNITIVE BENEFITS OF RESISTANCE TRAINING IN TYPE 2 DIABETICS? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Eyre T, Folkes L, Collins G, Hildyard C, Stratford M, Myers K, La Thangue N, Kerr D, Middleton M. PHARMACOKINETIC ANALYSIS AND CLINICAL RESULTS OF THE PHASE 1 DOSE ESCALATION AND EXPANSION CXD101 TRIAL IN RELAPSED, REFRACTORY LYMPHOMA. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Bowes A, Begley J, Kerr D. Lifestyle change reduces cardiometabolic risk factors and glucagon-like peptide-1 levels in obese first-degree relatives of people with diabetes. J Hum Nutr Diet 2017; 30:490-498. [DOI: 10.1111/jhn.12440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kerr D, Holland R, Eckhardt E, Demers M, Ellis N, Agan K, Martin D, Paradis N. 119 Development of a Clinical Prediction Rule for Urinary Tract Infection. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2016.08.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Glaire M, Domingo E, Vermeulen L, van Wezel T, Liefers GJ, Lothe R, Nesbakkend A, Danielsen S, Zlobec I, Koelzer V, Berger M, Castellví-Bel S, de Bruyn M, Novelli M, Tejpar S, Delorenzi M, Kerr R, Kerr D, Tomlinson I, Church D. POLE proofreading domain mutation defines a subset of immunogenic colorectal cancers with excellent prognosis. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Eyre T, Collins G, Gupta A, Sheikh S, Woodcock V, Whittaker J, Wang L, Soilleux E, Tysoe F, Cousins R, Thangue N, Kerr D, Middleton M. A phase I trial to assess the safety, PK and PD of CXD101 in advanced cancer expressing the biomarker HR23B. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw392.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kagawa M, Kerr D, Binns C. Ethnic Differences in the BMI-%BF Relationships between Young Japanese and Australian-Caucasian Males Living in Australia Using Dual-Energy X-ray Absorptiometry. Asia Pac J Public Health 2016; 15 Suppl:S27-32. [DOI: 10.1177/101053950301500s08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Body Mass Index (BMI) has been used worldwide as an indicator of fatness. However, the universal cut-off points by the World Health Organisation (WHO) classification may not be appropriate for every ethnic group when consider the relationship with their actual total body fatness (%BF). The application of population-specific classifications to assess BMI may be more relevant to public health. Ethnic differences in the BMI-%BF relationship between 45 Japanese and 42 Australian-Caucasian males were assessed using whole body dual-energy X-ray absorptiometry (DXA) scan and anthropometry using a standard protocol. Japanese males had significantly ( p<0.05) greater %BF at given BMI values than Australian males. When this is taken into account the newly proposed Asia-Pacific BMI classification of BMI >23 as overweight and >25 as obese may better assess the level of obesity that is associated increased health risks for this population. To clarify the current findings, further studies that compare the relationships across other Japanese populations are recommended.
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Fotheringham S, Danielsen H, Hveem T, Domingo E, Pradhan M, Syvertsen R, Kostolomov I, Nesheim J, Johnstone E, Novelli M, Tomlinson I, Kerr R, Kerr D. O-016 A prognostic marker for colorectal cancer: combining analyses of ploidy and stroma. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw198.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Frampton MJE, Law P, Litchfield K, Morris EJ, Kerr D, Turnbull C, Tomlinson IP, Houlston RS. Implications of polygenic risk for personalised colorectal cancer screening. Ann Oncol 2016; 27:429-34. [PMID: 26578737 DOI: 10.1093/annonc/mdv540] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/19/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND We modelled the utility of applying a personalised screening approach for colorectal cancer (CRC) when compared with standard age-based screening. In this personalised screening approach, eligibility is determined by absolute risk which is calculated from age and polygenic risk score (PRS), where the PRS is relative risk attributable to common genetic variation. In contrast, eligibility in age-based screening is determined only by age. DESIGN We calculated absolute risks of CRC from UK population age structure, incidence and mortality rate data, and a PRS distribution which we derived for the 37 known CRC susceptibility variants. We compared the number of CRC cases potentially detectable by personalised and age-based screening. Using Genome-Wide Complex Trait Analysis to calculate the heritability attributable to common variation, we repeated the analysis assuming all common CRC risk variants were known. RESULTS Based on the known CRC variants, individuals with a PRS in the top 1% have a 2.9-fold increased CRC risk over the population median. Compared with age-based screening (aged 60: 10-year absolute risk 1.96% in men, 1.19% in women, as per the UK NHS National Bowel Screening Programme), personalised screening of individuals aged 55-69 at the same risk would lead to 16% fewer men and 17% fewer women being eligible for screening with 10% and 8%, respectively, fewer screen-detected cases. If all susceptibility variants were known, individuals with a PRS in the top 1% would have an estimated 7.7-fold increased risk. Personalised screening would then result in 26% fewer men and women being eligible for screening with 7% and 5% fewer screen-detected cases. CONCLUSION Personalised screening using PRS has the potential to optimise population screening for CRC and to define those likely to maximally benefit from chemoprevention. There are however significant technical and operational details to be addressed before any such programme is introduced.
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Kerr D, Taylor D, Evans B. Corrigendum to ‘‘Patient-controlled intranasal fentanyl analgesia: a pilot study to assess practicality and tolerability during childbirth’’ Int J Obstet Anesth 2015; 24: 117–23. Int J Obstet Anesth 2016; 24:398. [PMID: 26764430 DOI: 10.1016/j.ijoa.2015.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kerr D. Response to Dallosso et al. Self-monitoring of blood glucose versus self-monitoring of urine glucose in adults with newly diagnosed Type 2 diabetes receiving structured education: a cluster randomized controlled trial. Diabet Med 2015; 32:1116. [PMID: 25600996 DOI: 10.1111/dme.12695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 11/28/2022]
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Boardman G, Kerr D, McCann T. Peers experience of delivering a problem-solving programme to enhance antipsychotic medication adherence for individuals with schizophrenia. J Psychiatr Ment Health Nurs 2015; 22:423-30. [PMID: 25944402 DOI: 10.1111/jpm.12195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2014] [Indexed: 11/28/2022]
Abstract
ACCESSIBLE SUMMARY No research has been conducted into the experience of peer support in improving adherence with oral antipsychotic medication for consumers with schizophrenia. Altruism influences peers to participate in peer support. Engagement in peer support can be challenging and rewarding for peers, and helps improve their own confidence and well-being. ABSTRACT Many consumers with schizophrenia are reluctant to take their prescribed antipsychotic medications; however, non-adherence can lead to relapse. The aim of this study was to evaluate peers' perspectives of their participation in a problem-solving peer support programme to enhance adherence in consumers who are reluctant to take antipsychotic medication. Peers contacted consumers by a weekly telephone call for 8 weeks, and used a problem-solving approach to inform their discussion about medication adherence. Semi-structured qualitative interviews were used to evaluate peers' perspectives of their involvement in the programme. Three main themes were abstracted from the data: motivation to participate in the study, experience of peer support programme, and rewards and challenges of the peer experience. Helping others was an important motivator for peers in agreeing to participate in the study. Telephone delivery was a convenient way to deliver the peer support programme. However, at times, it was difficult to contact consumers by telephone and this caused some frustration. Despite these difficulties, peers recognized that being involved in the programme increased their confidence and made them feel worthwhile. The findings have implications for the use of peer support as an adjunct intervention to promote medication adherence in consumers with schizophrenia.
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Barnard KD, Oliver N, Adolfsson P, Aldred C, Kerr D. Is iatrogenic sleep disturbance worth the effort in Type 1 diabetes? Diabet Med 2015; 32:984-6. [PMID: 25644585 DOI: 10.1111/dme.12699] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 11/27/2022]
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Kelly AM, Bradshaw L, Kerr D. Can nurses apply the Canadian C-Spine Rule? A pilot study. CAN J EMERG MED 2015; 6:161-4. [PMID: 17433168 DOI: 10.1017/s1481803500006850] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACT
Objective:
The aim of this study was to determine the inter-rater agreement between physicians and nurses regarding eligibility for application of the Canadian C-Spine Rule (CCR) and assessment of the criteria of the CCR.
Methods:
In this observational study, nurses and physicians independently assessed the CCR criteria in a convenience sample of patients with potential C-spine injury. Data were entered onto separate data sheets. The outcomes of interest were the inter-rater agreement between nurse and physician regarding eligibility for application of the rule, for assessment of each component of the rule and for interpretation of the rule overall, assessed by kappa analysis.
Results:
In total, 88 cases were eligible for analysis. Physicians and nurses agreed on which patients were eligible for CCR application in 96.6% of cases. Inter-rater agreement for most CCR criteria was good (κ > 0.61), with the exception of midline tenderness (κ = 0.58) and range of motion, which most nurses did not test.
Conclusion:
This study shows that nurses have the potential to reliably apply the Canadian C-Spine Rule but require further training in the assessment of midline tenderness and range of motion.
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Kerr D, Taylor D, Evans B. Patient-controlled intranasal fentanyl analgesia: a pilot study to assess practicality and tolerability during childbirth. Int J Obstet Anesth 2015; 24:117-23. [DOI: 10.1016/j.ijoa.2014.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 11/10/2014] [Accepted: 11/23/2014] [Indexed: 11/30/2022]
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Renfro LA, Grothey A, Kerr D, Haller DG, André T, Van Cutsem E, Saltz L, Labianca R, Loprinzi CL, Alberts SR, Schmoll H, Twelves C, Yothers G, Sargent DJ. Survival following early-stage colon cancer: an ACCENT-based comparison of patients versus a matched international general population†. Ann Oncol 2015; 26:950-958. [PMID: 25697217 DOI: 10.1093/annonc/mdv073] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/05/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Post-treatment survival experience of early colon cancer (CC) patients is well described in the literature, which states that cure is probable for some patients. However, comparisons of treated patients' survival versus that expected from a matched general population (MGP) are limited. PATIENTS AND METHODS A total of 32 745 patients from 25 randomized adjuvant trials conducted from 1977 to 2012 in 41 countries were pooled. Observed long-term survival of these patients was compared with expected survival matched on sex, age, country, and year, both overall and by stage (II and III), sex, treatment [surgery, 5-fluorouracil (5-FU), 5-FU + oxaliplatin], age (<70 and 70+), enrollment year (pre/post 2000), and recurrence (yes/no). Comparisons were made at randomization and repeated conditional on survival to 1, 2, 3, and 5 years. CC and MGP equivalence was tested, and observed Kaplan-Meier survival rates compared with expected MGP rates 3 years out from each landmark. Analyses were also repeated in patients without recurrence. RESULTS Within most cohorts, long-term survival of CC patients remained statistically worse than the MGP, though conditional survival generally improved over time. Among those surviving 5 years, stage II, oxaliplatin-treated, elderly, and recurrence-free patients achieved subsequent 3-year survival rates within 5% of the MGP, with recurrence-free patients achieving equivalence. CONCLUSIONS Conditional on survival to 5 years, long-term survival of most CC patients on clinical trials remains modestly poorer than an MGP, but achieves MGP levels in some subgroups. These findings emphasize the need for access to quality care and improved treatment and follow-up strategies.
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Kerr D, Klim S, Kelly AM, McCann T. Impact of a modified nursing handover model for improving nursing care and documentation in the emergency department: A pre- and post-implementation study. Int J Nurs Pract 2014; 22:89-97. [DOI: 10.1111/ijn.12365] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Martin R, Triebel K, Falola M, Cutter G, Kerr D, Marson D. A-75 * Financial Decline in Patients with Mild Cognitive Impairment: A Six-year Longitudinal Study. Arch Clin Neuropsychol 2014. [DOI: 10.1093/arclin/acu038.75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kerr D, Bartel T, McLaren D, Marson D. A-76 * Associations between Brain Atrophy and Financial Capacity in Prodromal and Clinical AD. Arch Clin Neuropsychol 2014. [DOI: 10.1093/arclin/acu038.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Boardman G, McCann T, Kerr D. A peer support programme for enhancing adherence to oral antipsychotic medication in consumers with schizophrenia. J Adv Nurs 2014; 70:2293-302. [DOI: 10.1111/jan.12382] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2013] [Indexed: 01/03/2023]
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