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Middleton S, McElduff P, Drury P, D’Este C, Cadilhac DA, Dale S, Grimshaw JM, Ward J, Quinn C, Cheung NW, Levi C. Vital sign monitoring following stroke associated with 90-day independence: A secondary analysis of the QASC cluster randomized trial. Int J Nurs Stud 2019; 89:72-79. [DOI: 10.1016/j.ijnurstu.2018.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 09/21/2018] [Accepted: 09/21/2018] [Indexed: 01/04/2023]
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Whitley JC, Peralta CA, Haan M, Aiello AE, Lee A, Ward J, Zeki Al Hazzouri A, Neuhaus J, Moyce S, López L. The association of parental and offspring educational attainment with systolic blood pressure, fasting blood glucose and waist circumference in Latino adults. Obes Sci Pract 2018; 4:582-590. [PMID: 30574351 PMCID: PMC6298209 DOI: 10.1002/osp4.307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/14/2018] [Accepted: 09/22/2018] [Indexed: 12/29/2022] Open
Abstract
Objective The objective of the study is to evaluate the association of intergenerational educational attainment with cardiovascular disease (CVD) risk factors among US Latinos. Methods We used cross‐sectional data from the Niños Lifestyle and Diabetes Study, an offspring cohort of middle‐aged Mexican‐Americans whose parents participated in the Sacramento Latino Study on Aging. We collected educational attainment, demographic and health behaviours and measured systolic blood pressure (SBP), fasting glucose and waist circumference. We evaluated the association of parental, offspring and a combined parent–offspring education variable with each CVD risk factor using multivariable regression. Results Higher parental education was associated only with smaller offspring waist circumference. In contrast, higher offspring education was associated with lower SBP, fasting glucose and smaller waist circumference. Adjustment for parental health behaviours modestly attenuated these offspring associations, whereas adjustment for offspring health behaviours and income attenuated the associations of offspring education with offspring SBP and fasting glucose but not smaller waist circumference, even among offspring with low parental education. Conclusions Higher offspring education is associated with lower levels of CVD risk factors in adulthood, despite intergenerational exposure to low parental education.
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Armstrong K, Ward J, Hughes N, Mihai A, Blayney A, Mascott C, Kileen R, Armstrong J. Guidelines for Clinical Target Volume Definition for Perineural Spread of Major Salivary Gland Cancers. Clin Oncol (R Coll Radiol) 2018; 30:773-779. [DOI: 10.1016/j.clon.2018.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 07/23/2018] [Accepted: 07/23/2018] [Indexed: 12/25/2022]
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Arosi I, Salarbux T, Lindsay T, Ward J, Curethers S, Sultan A. PO061 Impact of COPD on Short-term Mortality of Patients Hospitalised For Treatment of Acute Heart Failure. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Arosi I, Salarbux T, Lindsay T, Ward J, Curethers S, Vijayenthiran H, Sammour R, Sultan A. PO062 HFpEF Vs. HFrEF: Six Month Retrospective Re-admission and Mortality Analysis. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Werth B, Nguyen B, Ward J, Reyes J, Helmer SD, Nold J, Brewer N, Haan J. Assessing Medical Student's Ability to Interpret Traumatic Injuries on Computed Tomography Before and After the Third Year Clerkships. Kans J Med 2018; 11:91-94. [PMID: 30937147 PMCID: PMC6276964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Exposure to radiologic images during clinical rotations may improve students' skill levels. This study aimed to quantify the improvement in radiographic interpretation of life-threatening traumatic injuries gained during third year clinical clerkships (MS-3). METHODS We used a paired-sample prospective study design to compare students' accuracy in reading computed tomography (CT) images at the beginning of their third year clerkships (Phase I) and again after completion of all of their third year clerkships (Phase II). Students were shown life-threatening injuries that included head, chest, abdomen, and pelvic injuries. Overall scores for Phase II were compared with Phase I, as well as sub-scores for each anatomical region: head, chest, abdomen, and pelvis. RESULTS Only scores from students participating in both Phase I and Phase II (N = 57) were used in the analysis. After completing their MS3 clerkship, students scored significantly better overall and in every anatomical region. Phase I and Phase II overall mean scores were 1.2 ± 1.1 vs. 4.6 ± 1.8 (p < 0.001). Students improved the most with respect to injuries of the head and chest and the area of least improvement was in interpreting CT scans of the abdomen. Although improvements in reading radiographic images were noted after the clerkship year, students accurately diagnosed only 46% of life-threatening images on CT scan in the trauma setting. CONCLUSIONS These results indicated that enhanced education is needed for medical students to interpret CT scans.
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Werth B, Nguyen B, Ward J, Reyes J, Helmer SD, Nold J, Brewer N, Haan J. Assessing Medical Student’s Ability to Interpret Traumatic Injuries on Computed Tomography Before and After the Third Year Clerkships. Kans J Med 2018. [DOI: 10.17161/kjm.v11i4.8704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction. Exposure to radiologic images during clinical rotationsmay improve students’ skill levels. This study aimed to quantifythe improvement in radiographic interpretation of life-threateningtraumatic injuries gained during third year clinical clerkships (MS-3).
Methods. We used a paired-sample prospective study design tocompare students’ accuracy in reading computed tomography (CT)images at the beginning of their third year clerkships (Phase I) andagain after completion of all of their third year clerkships (Phase II).Students were shown life-threatening injuries that included head,chest, abdomen, and pelvic injuries. Overall scores for Phase II werecompared with Phase I, as well as sub-scores for each anatomicalregion: head, chest, abdomen, and pelvis.
Results. Only scores from students participating in both Phase Iand Phase II (N = 57) were used in the analysis. After completingtheir MS3 clerkship, students scored significantly better overall andin every anatomical region. Phase I and Phase II overall mean scoreswere 1.2 ± 1.1 vs. 4.6 ± 1.8 (p < 0.001). Students improved the mostwith respect to injuries of the head and chest and the area of leastimprovement was in interpreting CT scans of the abdomen. Althoughimprovements in reading radiographic images were noted after theclerkship year, students accurately diagnosed only 46% of life-threateningimages on CT scan in the trauma setting.
Conclusions. These results indicated that enhanced education isneeded for medical students to interpret CT scans.Kans J Med 2018;11(4):91-94.
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Boakye D, Wyse CA, Morales-Celis CA, Biello SM, Bailey MES, Dare S, Ward J, Gill JMR, Pell JP, Mackay DF. Tobacco exposure and sleep disturbance in 498 208 UK Biobank participants. J Public Health (Oxf) 2018; 40:517-526. [PMID: 29040744 PMCID: PMC6166587 DOI: 10.1093/pubmed/fdx102] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/28/2017] [Indexed: 11/12/2022] Open
Abstract
Background The prevalence of sleep disturbance is high and increasing. The study investigated whether active, former and passive smoking were associated with sleep disturbance. Methods This cross-sectional study used data from the UK Biobank: a cohort study of 502 655 participants, of whom 498 208 provided self-reported data on smoking and sleep characteristics. Multivariable multinomial and logistic regression models were used to examine the associations between smoking and sleep disturbance. Results Long-sleep duration (>9 h) was more common among current smokers [odds ratio (OR): 1.47; 95% confidence interval (CI): 1.17-1.85; probability value (P) = 0.001] than never smokers, especially heavy (>20/day) smokers (OR: 2.85; 95% CI: 1.66-4.89; P < 0.001). Former heavy (>20/day) smokers were also more likely to report short (<6 h) sleep duration (OR: 1.41; 95% CI: 1.25-1.60; P < 0.001), long-sleep duration (OR: 1.99; 95% CI: 1.47-2.71; P < 0.001) and sleeplessness (OR: 1.47; 95% CI: 1.38-1.57; P < 0.001) than never smokers. Among never smokers, those who lived with more than one smoker had higher odds of long-sleep duration than those not cohabitating with a smoker (OR: 2.71; 95% CI: 1.26-5.82; P = 0.011). Conclusions Active and passive exposure to high levels of tobacco smoke are associated with sleep disturbance. Existing global tobacco control interventions need to be enforced.
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Edge L, Dosis A, Sherrington J, Hammoud I, Patel M, Berry S, Date R, Shetty V, Turner P, Ball C, Ward J, Pursnani K. Overview of cholecystectomies in lancashire teaching hospitals NHS trust. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ahonen-Siirtola M, Nevala T, Vironen J, Kössi J, Pinta T, Niemeläinen S, Keränen U, Ward J, Vento P, Karvonen J, Ohtonen P, Mäkelä J, Rautio T. Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a prospective randomized multicenter study of 1-month follow-up results. Hernia 2018; 22:1015-1022. [PMID: 29882170 DOI: 10.1007/s10029-018-1784-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 05/18/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE The seroma rate following laparoscopic incisional ventral hernia repair (LIVHR) is up to 78%. LIVHR is connected to a relatively rare but dangerous complication, enterotomy, especially in cases with complex adhesiolysis. Closure of the fascial defect and extirpation of the hernia sack may reduce the risk of seromas and other hernia-site events. Our aim was to evaluate whether hybrid operation has a lower rate of the early complications compared to the standard LIVHR. METHODS This is a multicenter randomized-controlled clinical trial. From November 2012 to May 2015, 193 patients undergoing LIVHR for primary incisional hernia with fascial defect size from 2 to 7 cm were recruited in 11 Finnish hospitals. Patients were randomized to either a laparoscopic (LG) or to a hybrid (HG) repair group. The outcome measures were the incidence of clinically and radiologically detected seromas and their extent 1 month after surgery, peri/postoperative complications, and pain. RESULTS Bulging was observed by clinical evaluation in 46 (49%) LG patients and in 27 (31%) HG patients (p = 0.022). Ultrasound examination detected more seromas (67 vs. 45%, p = 0.004) and larger seromas (471 vs. 112 cm3, p = 0.025) after LG than after HG. In LG, there were 5 (5.3%) enterotomies compared to 1 (1.1%) in HG (p = 0.108). Adhesiolysis was more complex in LG than in HG (26.6 vs. 13.3%, p = 0.028). Patients in HG had higher pain scores on the first postoperative day (VAS 5.2 vs. 4.3, p = 0.019). CONCLUSION Closure of the fascial defect and extirpation of the hernia sack reduce seroma formation. In hybrid operations, the risk of enterotomy seems to be lower than in laparoscopic repair, which should be considered in cases with complex adhesions. CLINICAL TRIAL NUMBER NCT02542085.
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Stiles R, Benge C, Stiles P, Dong F, Ward J, Ablah E, Haan JM. Evaluation of Protective Equipment Used Among Motorbike Riders. Kans J Med 2018; 11:1-13. [PMID: 29796154 PMCID: PMC5962319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION This study compared outcomes between patients injured at a motorbike track, which requires riders to follow safety equipment guidelines, and those involved in recreational riding where safety equipment usage is voluntary. METHODS A retrospective review was conducted of all patients presenting with motorbike-related injuries at an American College of Surgeons verified level-I trauma center between January 1, 2009 and December 31, 2013. Data collected included demographics, injury details, safety equipment use, hospitalization details, and discharge disposition. Comparisons were made regarding protective equipment usage. RESULTS Among the 115 patients admitted, more than half (54.8%, n = 63) were injured on a motorbike track, and 45.2% (n = 52) were injured in a recreational setting. The majority of patients were male (93.9%), Caucasian (97.4%), and between the ages of 18 to 54 (64.4%). Helmet usage was higher among track riders (95.2%, n = 60) than recreational riders (46.2%, n = 24, p < 0.0001). Comparisons of injury severity and outcomes between those who wore protective equipment and those who did not were not significant. CONCLUSION Even though track riders wore protective equipment more than recreational riders, there was no difference between the groups regarding injury severity or hospital outcomes. These results suggested that motocross riders should not rely on protective equipment as the only measure of injury prevention.
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Vaucher J, Keating BJ, Lasserre AM, Gan W, Lyall DM, Ward J, Smith DJ, Pell JP, Sattar N, Paré G, Holmes MV. Cannabis use and risk of schizophrenia: a Mendelian randomization study. Mol Psychiatry 2018; 23:1287-1292. [PMID: 28115737 PMCID: PMC5984096 DOI: 10.1038/mp.2016.252] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/15/2016] [Accepted: 11/28/2016] [Indexed: 01/17/2023]
Abstract
Cannabis use is observationally associated with an increased risk of schizophrenia, but whether the relationship is causal is not known. Using a genetic approach, we took 10 independent genetic variants previously identified to associate with cannabis use in 32 330 individuals to determine the nature of the association between cannabis use and risk of schizophrenia. Genetic variants were employed as instruments to recapitulate a randomized controlled trial involving two groups (cannabis users vs nonusers) to estimate the causal effect of cannabis use on risk of schizophrenia in 34 241 cases and 45 604 controls from predominantly European descent. Genetically-derived estimates were compared with a meta-analysis of observational studies reporting ever use of cannabis and risk of schizophrenia or related disorders. Based on the genetic approach, use of cannabis was associated with increased risk of schizophrenia (odds ratio (OR) of schizophrenia for users vs nonusers of cannabis: 1.37; 95% confidence interval (CI), 1.09-1.67; P-value=0.007). The corresponding estimate from observational analysis was 1.43 (95% CI, 1.19-1.67; P-value for heterogeneity =0.76). The genetic markers did not show evidence of pleiotropic effects and accounting for tobacco exposure did not alter the association (OR of schizophrenia for users vs nonusers of cannabis, adjusted for ever vs never smoker: 1.41; 95% CI, 1.09-1.83). This adds to the substantial evidence base that has previously identified cannabis use to associate with increased risk of schizophrenia, by suggesting that the relationship is causal. Such robust evidence may inform public health messages about cannabis use, especially regarding its potential mental health consequences.
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Reekie J, Kaldor JM, Mak DB, Ward J, Donovan B, Hocking JS, Preen D, Liu B. Long-term impact of childhood hepatitis B vaccination programs on prevalence among Aboriginal and non-Aboriginal women giving birth in Western Australia. Vaccine 2018; 36:3296-3300. [PMID: 29706293 DOI: 10.1016/j.vaccine.2018.04.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIMS To evaluate the long-term effect of infant and childhood hepatitis B (HBV) vaccination programs among birthing women in Western Australia. METHODS A cohort of Western Australian women born from 1974 to 1995 was created using Birth Registrations and Electoral Roll records. They were linked to a perinatal register and notifiable diseases register to identify women having respectively their first births between 2000 and 2012 and diagnoses of HBV infections. HBV prevalence was estimated in Aboriginal and non-Aboriginal women, and according to maternal birth year cohorts. RESULTS Of 66,073 women, 155 (0.23%) had a linked non-acute HBV notification. HBV prevalence was five times higher in Aboriginal women compared to their non-Aboriginal counterparts (0.92%, 95%CI 0.65-1.18 versus 0.18%, 0.15-0.21). Among Aboriginal women, after adjusting for year of giving birth and region of residence, those born in the targeted infant and school-based vaccination era (maternal year of birth 1988-1995) had an 89% lower risk (adjusted odds ratio [aOR] 0.11, 0.04-0.33) of HBV than those born in the pre-vaccination era (1974-1981). Prevalence also differed between Aboriginal women residing in rural/remote areas compared to those in major cities (aOR 3.06, 1.36-6.88). Among non-Aboriginal women, no significant difference in HBV prevalence was observed by maternal birth cohort (p = 0.20) nor by residence (p = 0.23), but there were significant differences by ethnicity with a 36-fold higher prevalence (aOR 36.08, 22.66-57.46) in non-Caucasian versus Caucasian women. CONCLUSIONS A significant decline in HBV prevalence in Aboriginal birthing mothers was observed following the introduction of HBV vaccination programs in Western Australia. There were also considerable disparities in prevalence between women by area of residence and ethnicity. Our findings reflect those observed in women in other Australian jurisdictions. Continued surveillance of HBV prevalence in birthing mothers will provide ongoing estimates of HBV vaccination program impact across Australia and the populations most at risk of chronic HBV.
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Botan V, Fan S, Critchley H, Ward J. Atypical susceptibility to the rubber hand illusion linked to sensory-localised vicarious pain perception. Conscious Cogn 2018. [PMID: 29529588 DOI: 10.1016/j.concog.2018.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The Rubber Hand Illusion (RHI) paradigm has been widely used to investigate the sense of body ownership. People who report experiencing the pain of others are hypothesised to have differences in computing body ownership and, hence, we predicted that they would perform atypically on the RHI. The Vicarious Pain Questionnaire (VPQ), was used to divide participants into three groups: (1) non-responders (people who report no pain when seeing someone else experiencing physical pain), (2) sensory-localised responders (report sensory qualities and a localised feeling of pain) and (3) affective-general responders (report a generalised and emotional feeling of pain). The sensory-localised group, showed susceptibility to the RHI (increased proprioceptive drift) irrespective of whether stimulation was synchronous or asynchronous, whereas the other groups only showed the RHI in the synchronous condition. This is not a general bias to always incorporate the dummy hand as we did not find increased susceptibility in other conditions (seeing touch without feeling touch, or feeling touch without seeing touch), but there was a trend for this group to incorporate the dummy hand when it was stroked with a laser light. Although individual differences in the RHI have been noted previously, this particular pattern is rare. It suggests a greater malleability (i.e. insensitivity to asynchrony) in the conditions in which other bodies influence own-body judgments.
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Cook A, Osler T, Glance L, Lecky F, Bouamra O, Weddle J, Gross B, Ward J, Moore FO, Rogers F, Hosmer D. Comparison of two prognostic models in trauma outcome. Br J Surg 2018; 105:513-519. [PMID: 29465764 DOI: 10.1002/bjs.10764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/01/2017] [Accepted: 10/22/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND The Trauma Audit and Research Network (TARN) in the UK publicly reports hospital performance in the management of trauma. The TARN risk adjustment model uses a fractional polynomial transformation of the Injury Severity Score (ISS) as the measure of anatomical injury severity. The Trauma Mortality Prediction Model (TMPM) is an alternative to ISS; this study compared the anatomical injury components of the TARN model with the TMPM. METHODS Data from the National Trauma Data Bank for 2011-2015 were analysed. Probability of death was estimated for the TARN fractional polynomial transformation of ISS and compared with the TMPM. The coefficients for each model were estimated using 80 per cent of the data set, selected randomly. The remaining 20 per cent of the data were used for model validation. TMPM and TARN were compared using calibration curves, measures of discrimination (area under receiver operating characteristic curves; AUROC), proximity to the true model (Akaike information criterion; AIC) and goodness of model fit (Hosmer-Lemeshow test). RESULTS Some 438 058 patient records were analysed. TMPM demonstrated preferable AUROC (0·882 for TMPM versus 0·845 for TARN), AIC (18 204 versus 21 163) and better fit to the data (32·4 versus 153·0) compared with TARN. CONCLUSION TMPM had greater discrimination, proximity to the true model and goodness-of-fit than the anatomical injury component of TARN. TMPM should be considered for the injury severity measure for the comparative assessment of trauma centres.
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Buche A, Borovickova I, Gama I, Barkham N, Ward J. 39. Acute Monoarthritis: look beyond just an acute attack. Rheumatol Adv Pract 2017. [PMCID: PMC6652437 DOI: 10.1093/rap/rkx011.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pumfrey PD, Ward J. Term of birth and special education placement: the impact of assessment procedures in an LEA. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/003452379104600106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Craig LE, Taylor N, Grimley R, Cadilhac DA, McInnes E, Phillips R, Dale S, O'Connor D, Levi C, Fitzgerald M, Considine J, Grimshaw JM, Gerraty R, Cheung NW, Ward J, Middleton S. Development of a theory-informed implementation intervention to improve the triage, treatment and transfer of stroke patients in emergency departments using the Theoretical Domains Framework (TDF): the T 3 Trial. Implement Sci 2017; 12:88. [PMID: 28716152 PMCID: PMC5513365 DOI: 10.1186/s13012-017-0616-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/28/2017] [Indexed: 11/12/2022] Open
Abstract
Background Theoretical frameworks and models based on behaviour change theories are increasingly used in the development of implementation interventions. Development of an implementation intervention is often based on the available evidence base and practical issues, i.e. feasibility and acceptability. The aim of this study was to describe the development of an implementation intervention for the T3 Trial (Triage, Treatment and Transfer of patients with stroke in emergency departments (EDs)) using theory to recommend behaviour change techniques (BCTs) and drawing on the research evidence base and practical issues of feasibility and acceptability. Methods A stepped method for developing complex interventions based on theory, evidence and practical issues was adapted using the following steps: (1) Who needs to do what, differently? (2) Using a theoretical framework, which barriers and enablers need to be addressed? (3) Which intervention components (behaviour change techniques and mode(s) of delivery) could overcome the modifiable barriers and enhance the enablers? A researcher panel was convened to review the list of BCTs recommended for use and to identify the most feasible and acceptable techniques to adopt. Results Seventy-six barriers were reported by hospital staff who attended the workshops (step 1: thirteen TDF domains likely to influence the implementation of the T3 Trial clinical intervention were identified by the researchers; step 2: the researcher panellists then selected one third of the BCTs recommended for use as appropriate for the clinical context of the ED and, using the enabler workshop data, devised enabling strategies for each of the selected BCTs; and step 3: the final implementation intervention consisted of 27 BCTs). Conclusions The TDF was successfully applied in all steps of developing an implementation intervention for the T3 Trial clinical intervention. The use of researcher panel opinion was an essential part of the BCT selection process to incorporate both research evidence and expert judgment. It is recommended that this stepped approach (theory, evidence and practical issues of feasibility and acceptability) is used to develop highly reportable implementation interventions. The classifying of BCTs using recognised implementation intervention components will facilitate generalisability and sharing across different conditions and clinical settings. Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0616-6) contains supplementary material, which is available to authorized users.
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Middleton S, Coughlan K, Mnatzaganian G, Low Choy N, Dale S, Jammali-Blasi A, Levi C, Grimshaw JM, Ward J, Cadilhac DA, McElduff P, Hiller JE, D’Este C. Mortality Reduction for Fever, Hyperglycemia, and Swallowing Nurse-Initiated Stroke Intervention. Stroke 2017; 48:1331-1336. [DOI: 10.1161/strokeaha.116.016038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 02/02/2017] [Accepted: 02/08/2017] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Implementation of nurse-initiated protocols to manage fever, hyperglycemia, and swallowing dysfunction decreased death and disability 90 days poststroke in the QASC trial (Quality in Acute Stroke Care) conducted in 19 Australian acute stroke units (2005–2010). We now examine long-term all-cause mortality.
Methods—
Mortality was ascertained using Australia’s National Death Index. Cox proportional hazards regression compared time to death adjusting for correlation within stroke units using the cluster sandwich (Huber–White estimator) method. Primary analyses included treatment group only unadjusted for covariates. Secondary analysis adjusted for age, sex, marital status, education, and stroke severity using multiple imputation for missing covariates.
Results—
One thousand and seventy-six participants (intervention n=600; control n=476) were followed for a median of 4.1 years (minimum 0.3 to maximum 70 months), of whom 264 (24.5%) had died. Baseline demographic and clinical characteristics were generally well balanced by group. The QASC intervention group had improved long-term survival (>20%), but this was only statistically significant in adjusted analyses (unadjusted hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.58–1.07;
P
=0.13; adjusted HR, 0.77; 95% CI, 0.59–0.99;
P
=0.045). Older age (75–84 years; HR, 4.9; 95% CI, 2.8–8.7;
P
<0.001) and increasing stroke severity (HR, 1.5; 95% CI, 1.3–1.9;
P
<0.001) were associated with increased mortality, while being married (HR, 0.70; 95% CI, 0.49–0.99;
P
=0.042) was associated with increased likelihood of survival. Cardiovascular disease (including stroke) was listed either as the primary or secondary cause of death in 80% (211/264) of all deaths.
Conclusions—
Our results demonstrate the potential long-term and sustained benefit of nurse-initiated multidisciplinary protocols for management of fever, hyperglycemia, and swallowing dysfunction. These protocols should be a routine part of acute stroke care.
Clinical Trial Registration—
URL:
http://www.anzctr.org.au
. Unique identifier: ACTRN12608000563369.
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Tolefree S, Truong A, Ward J, Dong F, Ablah E, Haan J. Outcomes Following Traumatic Grain Elevator Injuries. J Agromedicine 2017; 22:259-263. [PMID: 28406388 DOI: 10.1080/1059924x.2017.1318727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The absence of a comprehensive database of grain elevator-associated injuries hinders accurate evaluation of injury prevalence and may lead to discordant information about injury frequencies. The main purpose of this study was to identify the most common mechanisms of injury related to grain elevator events. Comparisons of hospital outcomes between patients who sustained traumatic injuries associated with grain elevators at Occupational Safety and Health Administration (OSHA)-regulated industrial sites versus those on OSHA-exempt farming operations were also made. METHODS A retrospective review was conducted of all patients' presenting with grain elevator-related injuries at a level-1 trauma center between January 1, 2003, and December 31, 2013. Data collected included demographics, mechanism of injury, injury severity, hospitalization details, and discharge disposition. Data were summarized, and comparisons were made between the groups. RESULTS All patients (N = 18) in the study were male, with a mean age of 37 years. Falls and being caught in equipment each accounted for 27.8% of injuries. Among the 18 patients, there were a total of 37 injuries. The majority of injuries were either lower extremity (29.7%) or chest injuries (21.6%). The average hospital length of stay was 4 ± 4.5 days, and one patient required mechanical ventilation. There were no reported deaths. CONCLUSION The literature reports entrapments as the leading cause of grain elevator-related injuries; however, this study found that falls and being caught in equipment were the most common mechanisms of injury. This suggests that a greater emphasis should be placed on fall prevention and equipment safety.
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Sharma P, Abramson VG, O'Dea A, Lewis S, Scott JN, Ward J, De Jong JA, Lehn C, Brown AR, Williamson SK, Perez RP, Komiya T, Godwin AK, Reed GA, Khan QJ. Abstract P6-11-08: Safety and efficacy results from phase I study of BYL 719 plus nab-paclitaxel in HER 2 negative metastatic breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-11-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Mutations/deregulations in the phosphatidylinositol-3-kinase (PI3K) pathway are common in breast cancer, Inhibition of the PI3K pathway is recognized as a promising target for the treatment of breast cancer. Although taxanes are effective early on in advanced stage breast cancer, resistance often develops. It has been demonstrated that activation of the PI3K/AKT pathway confers resistance to paclitaxel, and in preclinical models, concomitant inhibition of the PI3K pathway enhances the efficacy of taxanes. BYL719 is a potent oral, class I PI3K inhibitor which strongly inhibits the PI3K alpha isoforms and is significantly less active against the other class I isoforms. Targeting the alpha isoform of PI3K is expected to improve the therapeutic window over inhibitors with less isoform specificity. Nab-Paclitaxel is a solvent-free, nanoparticle, albumin-based paclitaxel which takes advantage of the antitumor activity of paclitaxel while decreasing the toxicities typically associated with the solvent (Cremophor) used to administer the most common formulation of paclitaxel.
Methods
A 3+3 dose-escalation design evaluated three dose levels of BYL719 (250mg, 300mg, and 350mg) administered PO once daily (D1-28) with nab-Paclitaxel (100 mg/m2 intravenously D 1, 8, 15) every 28 days in patients with metastatic HER 2 negative breast cancer. The aims of the study were to 1) determine the recommended phase II dose (RPTD) of BYL719 + nab-Paclitaxel, 2) assess pharmacokinetics of BYL and nab-paclitaxel, and 3) assess preliminary efficacy.
Results
10 patients were enrolled at 3 dose levels of BYL719 and 3 patients were enrolled in expansion cohort at the RPTD of BYL719 of 350 mg PO daily plus nab-paclitaxel 100mg/m2 (D 1, 8, 15). Median age was 61years; 54% (7/13) of patients were hormone receptor positive and 46% (6/13) triple negative. 85% (11/13) had visceral disease, 69% (9/13) had received prior chemotherapy for metastatic disease and 85% (11/13) had received prior taxane in adjuvant/metastatic setting. There were no DLTs in the three cohorts and the MTD of BYL was not reached. Hyperglycemia (G3:31%, G4:0%) and neutropenia (G3:15%, G4:8%), were the most common grade 3/4 adverse events. There were no Grade 3/4 diarrhea or rash. Best overall response for 12 patients was 58% (7/12) (complete response=1, partial response=6), and an additional 33% (4/12) demonstrated stable disease. Objective responses were noted in both hormone positive and triple negative disease. Median duration of response is 6.5 months (range 2-14 months). No pharmacokinetic interactions were detected when BYL and nab-paclitaxel were co-administered.
Discussion:
This phase I study demonstrates that combination of BYL719 and nab-paclitaxel was well tolerated and shows encouraging efficacy in metastatic HER2 negative breast cancer. Enrollment in the phase II portion of the trial at the RPTD (BYL719 350mg PO daily plus nab-paclitaxel 100mg/m2 D1,8,15 every 28 days) continues. Ongoing analysis of PI3K pathway alterations in tumor and cfDNA will be correlated with clinical response.
Citation Format: Sharma P, Abramson VG, O'Dea A, Lewis S, Scott JN, Ward J, De Jong JA, Lehn C, Brown AR, Williamson SK, Perez RP, Komiya T, Godwin AK, Reed GA, Khan QJ. Safety and efficacy results from phase I study of BYL 719 plus nab-paclitaxel in HER 2 negative metastatic breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-11-08.
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Ward J, Reyes AR, Kurumbail RG. Allosteric Modulation of AMPK Enzymatic Activity: In Vitro Characterization. Methods Enzymol 2016; 587:481-509. [PMID: 28253974 DOI: 10.1016/bs.mie.2016.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AMP-activated protein kinase (AMPK) is a heterotrimeric serine/threonine protein kinase found in nearly all eukaryotes that functions as a master energy sensor in cells. During times of cell stress and changes in the AMP/ATP ratio, AMPK becomes activated and phosphorylates a multitude of protein substrates involved in various cellular processes such as metabolism, cell growth and autophagy. The endogenous ligand AMP is known to bind to the γ-subunit and activates the enzyme via three distinct mechanisms (1) enhancing phosphorylation by upstream kinases of Thr172 in the activation loop (a site critical for AMPK activity), (2) protecting Thr172 from dephosphorylation by phosphatases, and (3) allosteric activation of the kinase activity. Given the important regulatory role for AMPK in various cellular processes and the multiple known modes of activation, there is great interest in identifying small-molecule activators of this kinase and a need for assays to identify and characterize compounds. Here we describe several assay formats that have been used for identifying and characterizing small-molecule AMPK activators.
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Brown RF, Davis R, Wilson Genderson M, Grant S, Cadet D, Lessard M, Alpert J, Ward J, Ginder G. African-American patients with cancer Talking About Clinical Trials (TACT) with oncologists during consultations: evaluating the efficacy of tailored health messages in a randomised controlled trial-the TACT study protocol. BMJ Open 2016; 6:e012864. [PMID: 27986738 PMCID: PMC5168644 DOI: 10.1136/bmjopen-2016-012864] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Low rates of accrual of African-American (AA) patients with cancer to therapeutic clinical trials (CTs) represent a serious and modifiable racial disparity in healthcare that impedes the development of promising cancer therapies. Suboptimal physician-patient consultation communication is a barrier to the accrual of patients with cancer of any race, but communication difficulties are compounded with AA patients. Providing tailored health messages (THM) to AA patients and their physician about CTs has the potential to improve communication, lower barriers to accrual and ameliorate health disparities. OBJECTIVE (1) Demonstrate the efficacy of THM to increase patient activation as measured by direct observation. (2) Demonstrate the efficacy of THM to improve patient outcomes associated with barriers to AA participation. (3) Explore associations among preconsultation levels of: (A) trust in medical researchers, (B) knowledge and attitudes towards CTs, (C) patient-family member congruence in decision-making, and (D) involvement/information preferences, and group assignment. METHODS AND ANALYSIS First, using established methods, we will develop THM materials. Second, the efficacy of the intervention is determined in a 2 by 2 factorial randomised controlled trial to test the effectiveness of (1) providing 357 AA patients with cancer with THM with 2 different 'depths' of tailoring and (2) either providing feedback to oncologists about the patients' trial THM or not. The primary analysis compares patient engaged communication in 4 groups preconsultation and postconsultation. ETHICS AND DISSEMINATION This study was approved by the Virginia Commonwealth University Institutional Review Board. To facilitate use of the THM intervention in diverse settings, we will convene 'user groups' at 3 major US cancer centres. To facilitate dissemination, we will post all materials and the implementation guide in publicly available locations. TRIAL REGISTRATION NUMBER NCT02356549.
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Early F, Wellwood I, Kuhn I, Dickerson T, Ward J, Brimicombe J, Deaton C, Fuld J. P212 Interventions to increase referral to and uptake of pulmonary rehabilitation programmes for people with chronic obstructive pulmonary disease (COPD): a systematic review. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Middleton S, Levi C, Dale S, Cheung NW, McInnes E, Considine J, D’Este C, Cadilhac DA, Grimshaw J, Gerraty R, Craig L, Schadewaldt V, McElduff P, Fitzgerald M, Quinn C, Cadigan G, Denisenko S, Longworth M, Ward J. Triage, treatment and transfer of patients with stroke in emergency department trial (the T 3 Trial): a cluster randomised trial protocol. Implement Sci 2016; 11:139. [PMID: 27756434 PMCID: PMC5069775 DOI: 10.1186/s13012-016-0503-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 10/07/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Internationally recognised evidence-based guidelines recommend appropriate triage of patients with stroke in emergency departments (EDs), administration of tissue plasminogen activator (tPA), and proactive management of fever, hyperglycaemia and swallowing before prompt transfer to a stroke unit to maximise outcomes. We aim to evaluate the effectiveness in EDs of a theory-informed, nurse-initiated, intervention to improve multidisciplinary triage, treatment and transfer (T3) of patients with acute stroke to improve 90-day death and dependency. Organisational and contextual factors associated with intervention uptake also will be evaluated. METHODS This prospective, multicentre, parallel group, cluster randomised trial with blinded outcome assessment will be conducted in EDs of hospitals with stroke units in three Australian states and one territory. EDs will be randomised 1:1 within strata defined by state and tPA volume to receive either the T3 intervention or no additional support (control EDs). Our T3 intervention comprises an evidence-based care bundle targeting: (1) triage: routine assignment of patients with suspected stroke to Australian Triage Scale category 1 or 2; (2) treatment: screening for tPA eligibility and administration of tPA where applicable; instigation of protocols for management of fever, hyperglycaemia and swallowing; and (3) transfer: prompt admission to the stroke unit. We will use implementation science behaviour change methods informed by the Theoretical Domains Framework [1, 2] consisting of (i) workshops to determine barriers and local solutions; (ii) mixed interactive and didactic education; (iii) local clinical opinion leaders; and (iv) reminders in the form of email, telephone and site visits. Our primary outcome measure is 90 days post-admission death or dependency (modified Rankin Scale >2). Secondary outcomes are health status (SF-36), functional dependency (Barthel Index), quality of life (EQ-5D); and quality of care outcomes, namely, monitoring and management practices for thrombolysis, fever, hyperglycaemia, swallowing and prompt transfer. Outcomes will be assessed at the patient level. A separate process evaluation will examine contextual factors to successful intervention uptake. At the time of publication, EDs have been randomised and the intervention is being implemented. DISCUSSION This theoretically informed intervention is aimed at addressing important gaps in care to maximise 90-day health outcomes for patients with stroke. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12614000939695 . Registered 2 September 2014.
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