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Lipworth W, Kerridge I, Stewart C, Silva D, Upshur R. The Fragility of Scientific Rigour and Integrity in "Sped up Science": Research Misconduct, Bias, and Hype and in the COVID-19 Pandemic. J Bioeth Inq 2023; 20:607-616. [PMID: 38064166 DOI: 10.1007/s11673-023-10289-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 07/20/2023] [Indexed: 03/16/2024]
Abstract
During the early years of the COVID-19 pandemic, preclinical and clinical research were sped up and scaled up in both the public and private sectors and in partnerships between them. This resulted in some extraordinary advances, but it also raised a range of issues regarding the ethics, rigour, and integrity of scientific research, academic publication, and public communication. Many of the failures of scientific rigour and integrity that occurred during the pandemic were exacerbated by the rush to generate, disseminate, and implement research findings, which not only created opportunities for unscrupulous actors but also compromised the methodological, peer review, and advisory processes that would usually identify sub-standard research and prevent compromised clinical or policy-level decisions. While it would be tempting to attribute these failures of science and its translation solely to the "unprecedented" circumstances of the COVID-19 pandemic, the reality is that they preceded the pandemic and will continue to arise once it is over. Existing strategies for promoting scientific rigour and integrity need to be made more rigorous, better integrated into research training and institutional cultures, and made more sophisticated. They might also need to be modified or supplemented with other strategies that are fit for purpose not only in public health emergencies but in any research that is sped-up and scaled up to address urgent unmet medical needs.
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Affiliation(s)
- W Lipworth
- Department of Philosophy, Macquarie University, Sydney, NSW, Australia.
| | - I Kerridge
- Department of Philosophy, Macquarie University, Sydney, NSW, Australia
- Royal North Shore Hospital and Sydney Health Ethics, University of Sydney, Sydney, NSW, Australia
| | - C Stewart
- Sydney Law School, University of Sydney, Sydney, NSW, Australia
| | - D Silva
- Sydney Health Ethics, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - R Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Li W, Daoud SZ, Trivedi R, Lukka PB, Jimenez E, Molins E, Stewart C, Bharali P, Garcia-Gil E. The Pharmacokinetics, Safety and Tolerability of Aclidinium Bromide 400 μg Administered by Inhalation as Single and Multiple (Twice Daily) Doses in Healthy Chinese Participants. Int J Chron Obstruct Pulmon Dis 2023; 18:2725-2735. [PMID: 38046981 PMCID: PMC10691958 DOI: 10.2147/copd.s434588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose To date, aclidinium pharmacokinetic (PK) studies have focused on Caucasian populations, and no data are available for Chinese populations. We aimed to characterize the PK and safety profile of aclidinium and its metabolites (LAS34823 and LAS34850) following single and multiple (twice-daily; BID) dosing in healthy Chinese participants, and to compare PK data between Chinese and Caucasian populations. Materials and methods In this Phase I, open-label study (NCT03276052), healthy participants from a single site in China received aclidinium bromide 400 µg via a dry powder inhaler. The Day 1 single dose was followed by a washout period of 96 hours. On Days 5 through 8, participants received BID doses. Results Twenty healthy Chinese participants, aged 18-45 years, were enrolled. Aclidinium absorption was rapid (median time to maximum concentration [tmax] 0.08 hours post-dose following single/multiple doses). LAS34823 had a similar median tmax of 0.08 hours, whereas LAS34850 tmax occurred later (median 2.50-3.00 hours). Aclidinium, LAS34823, and LAS34850 concentrations declined in a bi-phasic manner; geometric mean half-life was 13.5 hours (single dosing) and 21.4 hours (multiple dosing), while steady state was generally achieved after 5 days' continuous dosing. Area under the concentration-time curve during a dosage interval (AUCτ) metabolite to parent ratios for LAS34823 were 2.6 (Day 1) and 2.9 (Day 9), while LAS34850 had ratios of 136.0 and 94.8, respectively. Aclidinium accumulation occurred after 5 days of BID dosing (LS mean accumulation ratio for AUCτ Day 9/Day 1: 214.1% [90% CI, 176.5, 259.6]); LAS34823 accumulation was similar, while LAS34850 accumulation was lower. Between-participant exposure variability was moderate to high for aclidinium and LAS34823, and low for LAS34850. Conclusion Single and multiple doses of aclidinium were well tolerated in healthy Chinese participants. The safety profile of and exposure to aclidinium was consistent with previous studies conducted in Caucasian populations.
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Affiliation(s)
- Weimin Li
- Clinical Trial Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Sami Z Daoud
- Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Roopa Trivedi
- Late Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Durham, NC, USA
| | - Pradeep B Lukka
- Clinical & Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Eulalia Jimenez
- Clinical & Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Barcelona, Spain
| | - Eduard Molins
- Clinical & Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Barcelona, Spain
| | | | - Pranob Bharali
- Late Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Durham, NC, USA
- BioPharmaceuticals R&D Late-Stage Development, AstraZeneca India Pvt Ltd., Bangalore, Karnataka, India
| | - Esther Garcia-Gil
- Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Barcelona, Spain
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Rubin G, Stewart C, McGowan L, Woodside JV, Barrett G, Godfrey KM, Hall J. Maternal folic acid supplementation and the risk of ankyloglossia (tongue-tie) in infants; a systematic review. PLoS One 2023; 18:e0294042. [PMID: 37922258 PMCID: PMC10624271 DOI: 10.1371/journal.pone.0294042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/25/2023] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND Maternal folic acid supplementation is protective against the development of neural tube defects (NTDs) in babies. However, recent public-facing communications have raised concerns about a causal relationship between folic acid supplementation, particularly after the first trimester, and ankyloglossia (tongue-tie) in infants. Non-evidence-based communications are potentially harmful because they could adversely affect adherence to folic acid supplementation, increasing NTD occurrence. This study aimed to review evidence on the relationships between maternal folic acid supplementation during preconception and/or pregnancy and the risk of ankyloglossia in infants. METHODS We searched the databases MEDLINE, EMBASE, Cochrane CENTRAL, and Scopus. We searched for observational, and interventional studies, and systematic reviews investigating the effect of maternal folic acid supplementation during preconception or pregnancy on the occurrence of ankyloglossia in offspring. The search was registered on PROSPERO on 01/12/2022, ID: CRD42022375862. RESULTS The database searches yielded 93 articles. After removing duplicates and screening titles and abstracts, 26 remained. One article was judged relevant for inclusion in analyses; a case-control study that directly mentions the relationship between folic acid supplementation and ankyloglossia. This study reported that regular intake of folic acid supplements was higher in women with infants with ankyloglossia. However, this study has limitations regarding design, selection bias, and confounding, calling the findings into question. CONCLUSIONS Insufficient evidence exists for a relationship between folic acid supplementation and ankyloglossia. Currently, the benefits of folic acid supplementation far outweigh the risks. This must be clearly communicated to patients by their clinicians during preconception and antenatal care.
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Affiliation(s)
- Gal Rubin
- UCL EGA Institute for Women’s Health, Reproductive Health Research Dept, UCL, London, United Kingdom
- Minerva University: College of Natural Sciences, San Francisco, CA, United States America
| | - Catherine Stewart
- UCL EGA Institute for Women’s Health, Reproductive Health Research Dept, UCL, London, United Kingdom
| | - Laura McGowan
- Centre for Public Health, Institute for Global Food Security, Queen’s University Belfast, Belfast, Ireland
| | - Jayne V. Woodside
- Centre for Public Health, Institute for Global Food Security, Queen’s University Belfast, Belfast, Ireland
| | - Geraldine Barrett
- UCL EGA Institute for Women’s Health, Reproductive Health Research Dept, UCL, London, United Kingdom
| | - Keith M. Godfrey
- MRC Lifecourse Epidemiology Centre and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Jennifer Hall
- UCL EGA Institute for Women’s Health, Reproductive Health Research Dept, UCL, London, United Kingdom
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Hayaki J, Cinq-Mars H, Christopher PP, Anderson BJ, Stewart C, Stein MD. Gender Differences in Civil Commitment Hearing Experience for Persons Who Use Opioids. J Addict Med 2023; 17:e355-e360. [PMID: 37934523 PMCID: PMC10759199 DOI: 10.1097/adm.0000000000001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
OBJECTIVES Civil commitment has increasingly served as a court-based legal intervention for severe opioid use, but little research has examined the civil commitment (CC) hearing process from the perspective of the person who is committed. Despite documented gender differences in opioid use and experiences within the legal system, past research has also not investigated gender differences in perceptions of the CC process for persons who use opioids. METHODS Participants were 121 persons (43% female) with opioid use who were interviewed upon arrival at the CC facility about their experience of the CC hearing process in Massachusetts. RESULTS Two thirds of participants were taken to the commitment hearing by police, and 59.5% shared a cell with others while waiting. Overall, the commitment intake process at the courthouse took over 5 hours. Participants spent, on average, less than 15 minutes with their lawyer before the hearing, and a majority of CC hearings lasted less than 15 minutes. Once transferred to a CC facility, opioid withdrawal management began within 4 hours. Compared with women, men reported longer wait times between the hearing and transfer, as well as longer wait times for withdrawal management at the facility ( P < 0.05). Women perceived worse interactions with the judge and greater dissatisfaction with the commitment process compared with men ( P < 0.05). CONCLUSIONS There were few gender differences in the experience of CC. However, overall, participants reported a lengthy court process and low levels of perceived procedural justice.
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Affiliation(s)
- Jumi Hayaki
- Department of Psychology, College of the Holy Cross, Worcester, MA, USA
| | - Haley Cinq-Mars
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, MA, USA
- Present address: Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Paul P. Christopher
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Bradley J. Anderson
- Behavioral Medicine and Addiction Research Unit, Butler Hospital, Providence, RI, USA
| | - Catherine Stewart
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, MA, USA
| | - Michael D. Stein
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, MA, USA
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Sun Y, Molins E, Daoud SZ, Trivedi R, Stewart C, Lamarca R, Bharali P, Garcia-Gil E. Efficacy and safety of aclidinium/formoterol versus monotherapies and aclidinium versus placebo in Chinese and other Asian patients with moderate-to-severe COPD: The AVANT Phase 3 study. Respir Med 2023; 218:107393. [PMID: 37640273 DOI: 10.1016/j.rmed.2023.107393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/01/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023]
Abstract
AVANT was a Phase 3, 24-week, randomized, parallel-group, double-blind, double-dummy, placebo-controlled study to assess the efficacy and safety of aclidinium/formoterol 400 μg/12 μg combination vs monotherapies and aclidinium vs placebo (1:1:1:1) in Asian patients (∼70% of whom were Chinese) with moderate-to-severe stable chronic obstructive pulmonary disease. Endpoints were analyzed hierarchically to incorporate type I error control. At Week 24, aclidinium/formoterol demonstrated improvements from baseline in 1-h morning post-dose forced expiratory volume in 1 s (FEV1) vs aclidinium (least squares [LS] mean 92 mL; 95% confidence interval [CI] 60, 124 mL; p < 0.001), and in trough FEV1 vs formoterol (LS mean 85 mL; 95% CI 53, 117 mL; p < 0.001). Furthermore, aclidinium provided improvements in trough FEV1 vs placebo (LS mean 134 mL; 95% CI 103, 166 mL; p < 0.001). There was an improvement in transition dyspnea index focal score at Week 24 for aclidinium/formoterol vs placebo (LS mean 0.8; 95% CI 0.2, 1.3; p = 0.005) but not for aclidinium vs placebo (LS mean 0.4; 95% CI -0.1, 1.0; p = 0.132). Improvements in St George's Respiratory Questionnaire total scores occurred for aclidinium/formoterol vs placebo (LS mean -4.0; 95% CI -6.7, -1.4; p = 0.003) and aclidinium vs placebo (LS mean -2.9; 95% CI -5.5, -0.3; p = 0.031). Aclidinium/formoterol and aclidinium were well tolerated and safety findings were consistent with known profiles; rates of treatment-emergent adverse events (AEs) (aclidinium/formoterol: 54.8%; aclidinium: 47.4%; placebo: 53.9%), serious AEs (7.2, 7.9, and 7.8%, respectively), and AEs leading to discontinuation of study medication (2.3, 1.5, and 2.2%, respectively) were similar between groups.
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Affiliation(s)
- Yongchang Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Eduard Molins
- Late Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Barcelona, Spain
| | - Sami Z Daoud
- Late Respiratory & Immunology, BioPharmaceuticals R&D, Gaithersburg, MD, USA.
| | - Roopa Trivedi
- Late Respiratory & Immunology, BioPharmaceuticals R&D, Durham, NC, USA
| | | | - Rosa Lamarca
- Late Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Barcelona, Spain
| | - Pranob Bharali
- Late Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca Pvt. Ltd, Bangalore, India
| | - Esther Garcia-Gil
- Late Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Barcelona, Spain
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Smith L, Hunt K, Parker S, Camp J, Stewart C, Morris A. Parent and Carer Skills Groups in Dialectical Behaviour Therapy for High-Risk Adolescents with Severe Emotion Dysregulation: A Mixed-Methods Evaluation of Participants' Outcomes and Experiences. Int J Environ Res Public Health 2023; 20:6334. [PMID: 37510567 PMCID: PMC10379026 DOI: 10.3390/ijerph20146334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND There is an established evidence-base for dialectical behaviour therapy for adolescents (DBT-A) in the treatment of young people with severe emotion dysregulation and related problems, including repeated self-harm and suicidal behaviours. However, few studies have reported on parental involvement in such treatments. This study aims to explore the outcomes and experiences of participants of a dedicated skills group for parents and carers embedded within an adapted DBT-A programme in the United Kingdom. METHOD This study was conducted within a specialist outpatient Child and Adolescent Mental Health Services (CAMHS) DBT programme in the National Health Service (NHS) in London. Participants were parents and carers of adolescents engaged in the DBT-A programme. Participants attended a 6-month parent and carer skills group intervention and completed self-report measures relating to carer distress, communication and family functioning, at pre-intervention and post-intervention. Following the intervention, semi-structured interviews were also completed with a subgroup of participants to explore their experiences of the skills group and how they perceived its effectiveness. Quantitative and qualitative methods were used to analyse the data collected from participants. RESULTS Forty-one parents and carers completed the intervention. Participants reported a number of statistically significant changes from pre- to post-intervention: general levels of distress and problems in family communication decreased, while perceived openness of family communication and strengths and adaptability in family functioning increased. A thematic analysis of post-intervention interviews examining participant experiences identified six themes: (1) experiences prior to DBT; (2) safety in DBT; (3) experiences with other parents and carers; (4) new understandings; (5) changes in behaviours; and (6) future suggestions. DISCUSSION Parents and carers who attended a dedicated DBT skills groups, adapted for local needs, reported improvements in their wellbeing, as well as interactions with their adolescents and more general family functioning, by the end of the intervention. Further studies are needed which report on caregiver involvement in DBT.
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Affiliation(s)
- Lindsay Smith
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Katrina Hunt
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Sam Parker
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Jake Camp
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Catherine Stewart
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Andre Morris
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
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Bento SP, Stewart C, Conroy C, Smith A, Reece L, Jervis K, Cole-Lewis Y, Logan D, Randall ET. The Telehealth Tradeoff: A Multimethod Study of the Benefits and Challenges Associated With Maintaining Treatment Outcomes Using a Hybrid Model of Pediatric Intensive Interdisciplinary Pain Treatment. Clin J Pain 2023; 39:307-318. [PMID: 37341690 DOI: 10.1097/ajp.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/10/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES The COVID-19 pandemic required intensive interdisciplinary pain treatment (IIPT) programs to shift to virtual models of care. This study used a multimethod approach to examine outcomes of a pediatric hybrid IIPT program (50% in-person treatment and 50% synchronous video-based telehealth) and assessed staff experiences while treating within this model. MATERIALS AND METHODS Patients (M=14.73, SD=2.04; 79% female) reported pain intensity, functional disability, and psychological factors (anxiety, depressive symptoms, fear of pain, pain catastrophizing, social functioning) at admission, discharge, and short-term follow-up. Differences in treatment outcomes at discharge and short-term follow-up between patients who participated in the hybrid IIPT model (n=42) during the pandemic and those who participated in the traditional in-person model before the pandemic (n=42) were examined. Quantitative assessments of staff burnout and perceived effort and qualitative assessments exploring staff perspectives about the challenges and advantages of the hybrid IIPT model were gathered. RESULTS Youth in both groups made significant improvements across the majority of treatment outcomes; however, the hybrid group reported higher levels of pain at discharge and anxiety at follow-up. The majority of IIPT staff reported moderate to high levels of overall burnout, and almost half reported high levels of emotional exhaustion. Staff highlighted various challenges and benefits associated with treating within the hybrid model. DISCUSSION When considering telehealth as a treatment tool for youth with complex chronic pain, it is crucial to leverage its benefits while addressing its challenges for patients and providers.
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Affiliation(s)
- Samantha P Bento
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute
- Cancer and Blood Disorders Center, Dana Farber Cancer Institute/Boston Children's Hospital
- Harvard Medical School
| | - Catherine Stewart
- Harvard Medical School
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital
- Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital
| | - Caitlin Conroy
- Harvard Medical School
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital
- Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital
| | - Allison Smith
- Harvard Medical School
- Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Leah Reece
- Harvard Medical School
- Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Kelsey Jervis
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital
| | - Yasmin Cole-Lewis
- Harvard Medical School
- Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital
| | - Deirdre Logan
- Harvard Medical School
- Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Edin T Randall
- Harvard Medical School
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital
- Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital
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McLaughlin NCR, Magnotti JF, Banks GP, Nanda P, Hoexter MQ, Lopes AC, Batistuzzo MC, Asaad WF, Stewart C, Paulo D, Noren G, Greenberg BD, Malloy P, Salloway S, Correia S, Pathak Y, Sheehan J, Marsland R, Gorgulho A, De Salles A, Miguel EC, Rasmussen SA, Sheth SA. Gamma knife capsulotomy for intractable OCD: Neuroimage analysis of lesion size, location, and clinical response. Transl Psychiatry 2023; 13:134. [PMID: 37185805 PMCID: PMC10130137 DOI: 10.1038/s41398-023-02425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 02/27/2023] [Accepted: 03/31/2023] [Indexed: 05/17/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) affects 2-3% of the population. One-third of patients are poorly responsive to conventional therapies, and for a subgroup, gamma knife capsulotomy (GKC) is an option. We examined lesion characteristics in patients previously treated with GKC through well-established programs in Providence, RI (Butler Hospital/Rhode Island Hospital/Alpert Medical School of Brown University) and São Paulo, Brazil (University of São Paolo). Lesions were traced on T1 images from 26 patients who had received GKC targeting the ventral half of the anterior limb of the internal capsule (ALIC), and the masks were transformed into MNI space. Voxel-wise lesion-symptom mapping was performed to assess the influence of lesion location on Y-BOCS ratings. General linear models were built to compare the relationship between lesion size/location along different axes of the ALIC and above or below-average change in Y-BOCS ratings. Sixty-nine percent of this sample were full responders (≥35% improvement in OCD). Lesion occurrence anywhere within the targeted region was associated with clinical improvement, but modeling results demonstrated that lesions occurring posteriorly (closer to the anterior commissure) and dorsally (closer to the mid-ALIC) were associated with the greatest Y-BOCS reduction. No association was found between Y-BOCS reduction and overall lesion volume. GKC remains an effective treatment for refractory OCD. Our data suggest that continuing to target the bottom half of the ALIC in the coronal plane is likely to provide the dorsal-ventral height required to achieve optimal outcomes, as it will cover the white matter pathways relevant to change. Further analysis of individual variability will be essential for improving targeting and clinical outcomes, and potentially further reducing the lesion size necessary for beneficial outcomes.
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Affiliation(s)
- N C R McLaughlin
- Butler Hospital, Providence, RI, USA.
- Alpert Medical School of Brown University, Providence, RI, USA.
| | - J F Magnotti
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - G P Banks
- Columbia University Medical Center, New York, NY, USA
| | - P Nanda
- Columbia University Medical Center, New York, NY, USA
| | - M Q Hoexter
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - A C Lopes
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - M C Batistuzzo
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Department of Methods and Techniques in Psychology, Pontifical Catholic University, São Paulo, SP, Brazil
| | - W F Asaad
- Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | - C Stewart
- Boston University School of Public Health, Boston, MA, USA
| | - D Paulo
- Columbia University Medical Center, New York, NY, USA
| | - G Noren
- Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | - B D Greenberg
- Butler Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
- Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - P Malloy
- Butler Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
| | - S Salloway
- Butler Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
| | - S Correia
- Alpert Medical School of Brown University, Providence, RI, USA
| | - Y Pathak
- Columbia University Medical Center, New York, NY, USA
| | - J Sheehan
- University of Virginia, Charlottesville, VA, USA
| | | | - A Gorgulho
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - A De Salles
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - E C Miguel
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - S A Rasmussen
- Butler Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | - S A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
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Lawrence JD, Washam PM, Stevens C, Hulbe C, Horgan HJ, Dunbar G, Calkin T, Stewart C, Robinson N, Mullen AD, Meister MR, Hurwitz BC, Quartini E, Dichek DJG, Spears A, Schmidt BE. Crevasse refreezing and signatures of retreat observed at Kamb Ice Stream grounding zone. Nat Geosci 2023; 16:238-243. [PMID: 36920161 PMCID: PMC10005960 DOI: 10.1038/s41561-023-01129-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
Ice streams flowing into Ross Ice Shelf are presently responsible for around 10% of the mass flux from West Antarctica, with the noteworthy exception of Kamb Ice Stream, which stagnated in the late 1800s. The subsequent reduction in ice supply led to grounding-line retreat at the coastal margin where Kamb transitions into the floating Ross Ice Shelf. Grounding-line migration is linked to broader changes in ice-sheet mass balance and sea level, but our understanding of related ice, ocean and seafloor interactions is limited by the difficulty in accessing these remote regions. Here we report in situ observations from an underwater vehicle deployed at Kamb that show how fine-scale variability in ice and ocean structure combine to influence a diversity of ice-ocean interactions. We found a stratified water column within a tenth of a degree of freezing at the ice base and mapped basal crevasses with supercooled water and active marine ice formation. At the seafloor, we interpret parallel ridges as crevasse impressions left as the ice lifted off during grounding-line retreat. These observations from a recently ungrounded sub-shelf environment illuminate both the geomorphological signatures of past grounding-line retreat and the fine-scale sensitivity of ongoing ice-ocean interactions to ice topography.
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Affiliation(s)
- J. D. Lawrence
- School of Earth and Atmospheric Sciences, Georgia Institute of Technology, Atlanta, GA USA
- Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY USA
- Honeybee Robotics, Exploration Systems, Altadena, CA USA
- Department of Astronomy, Cornell University, Ithaca, NY USA
| | - P. M. Washam
- Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY USA
- Department of Astronomy, Cornell University, Ithaca, NY USA
| | - C. Stevens
- Ocean Dynamics Group, National Institute of Water and Atmospheric Research (NIWA), Wellington, New Zealand
- Department of Physics, University of Auckland, Auckland, New Zealand
| | - C. Hulbe
- School of Surveying, University of Otago, Dunedin, New Zealand
| | - H. J. Horgan
- Antarctic Research Centre, Victoria University of Wellington, Wellington, New Zealand
| | - G. Dunbar
- Antarctic Research Centre, Victoria University of Wellington, Wellington, New Zealand
| | - T. Calkin
- Antarctic Research Centre, Victoria University of Wellington, Wellington, New Zealand
| | - C. Stewart
- Ocean Dynamics Group, National Institute of Water and Atmospheric Research (NIWA), Wellington, New Zealand
| | - N. Robinson
- Ocean Dynamics Group, National Institute of Water and Atmospheric Research (NIWA), Wellington, New Zealand
| | - A. D. Mullen
- Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY USA
- Department of Astronomy, Cornell University, Ithaca, NY USA
| | - M. R. Meister
- Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY USA
- Department of Astronomy, Cornell University, Ithaca, NY USA
| | - B. C. Hurwitz
- School of Earth and Atmospheric Sciences, Georgia Institute of Technology, Atlanta, GA USA
| | - E. Quartini
- Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY USA
- Department of Astronomy, Cornell University, Ithaca, NY USA
| | - D. J. G. Dichek
- Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY USA
- Department of Astronomy, Cornell University, Ithaca, NY USA
| | - A. Spears
- School of Earth and Atmospheric Sciences, Georgia Institute of Technology, Atlanta, GA USA
| | - B. E. Schmidt
- Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY USA
- Department of Astronomy, Cornell University, Ithaca, NY USA
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10
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Hernández-Verdin I, Kirasic E, Wienand K, Mokhtari K, Eimer S, Loiseau H, Rousseau A, Paillassa J, Ahle G, Lerintiu F, Uro-Coste E, Oberic L, Figarella-Branger D, Chinot O, Gauchotte G, Taillandier L, Marolleau JP, Polivka M, Adam C, Ursu R, Schmitt A, Barillot N, Nichelli L, Lozano-Sánchez F, Ibañez-Juliá MJ, Peyre M, Mathon B, Abada Y, Charlotte F, Davi F, Stewart C, de Reyniès A, Choquet S, Soussain C, Houillier C, Chapuy B, Hoang-Xuan K, Alentorn A. Molecular and clinical diversity in primary central nervous system lymphoma. Ann Oncol 2023; 34:186-199. [PMID: 36402300 DOI: 10.1016/j.annonc.2022.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare and distinct entity within diffuse large B-cell lymphoma presenting with variable response rates probably to underlying molecular heterogeneity. PATIENTS AND METHODS To identify and characterize PCNSL heterogeneity and facilitate clinical translation, we carried out a comprehensive multi-omic analysis [whole-exome sequencing, RNA sequencing (RNA-seq), methylation sequencing, and clinical features] in a discovery cohort of 147 fresh-frozen (FF) immunocompetent PCNSLs and a validation cohort of formalin-fixed, paraffin-embedded (FFPE) 93 PCNSLs with RNA-seq and clinico-radiological data. RESULTS Consensus clustering of multi-omic data uncovered concordant classification of four robust, non-overlapping, prognostically significant clusters (CS). The CS1 and CS2 groups presented an immune-cold hypermethylated profile but a distinct clinical behavior. The 'immune-hot' CS4 group, enriched with mutations increasing the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) and nuclear factor-κB activity, had the most favorable clinical outcome, while the heterogeneous-immune CS3 group had the worse prognosis probably due to its association with meningeal infiltration and enriched HIST1H1E mutations. CS1 was characterized by high Polycomb repressive complex 2 activity and CDKN2A/B loss leading to higher proliferation activity. Integrated analysis on proposed targets suggests potential use of immune checkpoint inhibitors/JAK1 inhibitors for CS4, cyclin D-Cdk4,6 plus phosphoinositide 3-kinase (PI3K) inhibitors for CS1, lenalidomide/demethylating drugs for CS2, and enhancer of zeste 2 polycomb repressive complex 2 subunit (EZH2) inhibitors for CS3. We developed an algorithm to identify the PCNSL subtypes using RNA-seq data from either FFPE or FF tissue. CONCLUSIONS The integration of genome-wide data from multi-omic data revealed four molecular patterns in PCNSL with a distinctive prognostic impact that provides a basis for future clinical stratification and subtype-based targeted interventions.
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Affiliation(s)
- I Hernández-Verdin
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France
| | - E Kirasic
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France
| | - K Wienand
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany; Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany; Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - K Mokhtari
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neuropathology, Groupe Hospitalier Pitié Salpêtrière, APHP, Paris, France
| | - S Eimer
- Department of Pathology, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - H Loiseau
- Department of Neurosurgery, Bordeaux University Hospital Center, Pellegrin Hospital, Bordeaux, France; EA 7435-IMOTION, University of Bordeaux, Bordeaux, France
| | - A Rousseau
- Department of Pathology, PBH, CHU Angers, Angers, France; CRCINA, Université de Nantes-université d'Angers, Angers, France
| | - J Paillassa
- Department of Hematology, CHU Angers, Angers, France
| | - G Ahle
- Department of Neurology, Hôpitaux Civils de Colmar, Colmar, France
| | - F Lerintiu
- Department of Neuropathology, Hôpitaux Civils de Colmar, Strasbourg, France
| | - E Uro-Coste
- Department of Pathology, CHU de Toulouse, IUC-Oncopole, Toulouse, France; INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France; Université Toulouse III Paul Sabatier, Toulouse, France
| | - L Oberic
- Department of Hematology, IUC Toulouse Oncopole, Toulouse, France
| | - D Figarella-Branger
- Neuropathology Department, University Hospital Timone, Aix Marseille University, Marseille, France; Inst Neurophysiopathol, CNRS, INP, Aix-Marseille University, Marseille, France
| | - O Chinot
- Department of Neuro-oncology, CHU Timone, APHM, Marseille, France; Institute of NeuroPhysiopathology, CNRS, INP, Aix-Marseille University, Marseille, France
| | - G Gauchotte
- Department of Biopathology, CHRU Nancy, CHRU/ICL, Bâtiment BBB, Vandoeuvre-lès-Nancy, France; Department of Legal Medicine, CHRU Nancy, Vandoeuvre-lès-Nancy, France; INSERM U1256, University of Lorraine, Vandoeuvre-lès-Nancy, France; Centre de Ressources Biologiques, BB-0033-00035, CHRU, Nancy, France
| | - L Taillandier
- Department of Neuro-oncology, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - J-P Marolleau
- Department of Hematology, CHU Amiens-Picardie, Amiens, France
| | - M Polivka
- Department of Anatomopathology, Lariboisière Hospital, Assistance Publique-Hopitaux de Paris, University of Paris, Paris, France
| | - C Adam
- Pathology Department, Bicêtre University Hospital, Public Hospital Network of Paris, Le Kremlin Bicêtre, France
| | - R Ursu
- Department of Neurology, Université de Paris, AP-HP, Hôpital Saint Louis, Paris, France
| | - A Schmitt
- Department of Hematology, Institut Bergonié Hospital, Bordeaux, France
| | - N Barillot
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France
| | - L Nichelli
- Department of Neuroradiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - F Lozano-Sánchez
- Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | | | - M Peyre
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurosurgery, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - B Mathon
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurosurgery, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Y Abada
- Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - F Charlotte
- Department Pathology, Hôpital Pitié-Salpêtrière and Sorbonne University, Paris, France
| | - F Davi
- Department Hematology, APHP, Hôpital Pitié-Salpêtrière and Sorbonne University, Paris, France
| | - C Stewart
- Department Broad Institute of MIT and Harvard, Cambridge, USA
| | - A de Reyniès
- Department INSERM UMR_S1138-Centre de Recherche des Cordeliers-Université Pierre et Marie Curie et Université Paris Descartes, Paris, France
| | - S Choquet
- Department Pathology, Hôpital Pitié-Salpêtrière and Sorbonne University, Paris, France
| | - C Soussain
- Department Hematology Unit, Institut Curie, Saint-Cloud, France
| | - C Houillier
- Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - B Chapuy
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany; Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - K Hoang-Xuan
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - A Alentorn
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France.
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11
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Taylor I, Bull JW, Ashton B, Biggs E, Clark M, Gray N, Grub HMJ, Stewart C, Milner-Gulland EJ. Nature-positive goals for an organization's food consumption. Nat Food 2023; 4:96-108. [PMID: 37118582 DOI: 10.1038/s43016-022-00660-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 11/04/2022] [Indexed: 04/30/2023]
Abstract
Organizations are increasingly committing to biodiversity protection targets with focus on 'nature-positive' outcomes, yet examples of how to feasibly achieve these targets are needed. Here we propose an approach to achieve nature-positive targets with respect to the embodied biodiversity impacts of an organization's food consumption. We quantify these impacts using a comprehensive database of life-cycle environmental impacts from food, and map exploratory strategies to meet defined targets structured according to a mitigation and conservation hierarchy. By considering the varying needs and values across the organization's internal community, we identify a range of targeted approaches towards mitigating impacts, which balance top-down and bottom-up actions to different degrees. Delivering ambitious nature-positive targets within current constraints will be challenging, particularly given the need to mitigate cumulative impacts. Our results evidence that however committed an organization is to being nature positive in its food provision, this is unachievable in the absence of systems change.
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Affiliation(s)
- I Taylor
- Wild Business Ltd., Kershen Fairfax, London, UK.
| | - J W Bull
- Wild Business Ltd., Kershen Fairfax, London, UK
- Durrell Institute for Conservation and Ecology, University of Kent, Canterbury, UK
| | - B Ashton
- Lady Margaret Hall, University of Oxford, Oxford, UK
| | - E Biggs
- Department of Biology, University of Oxford, Oxford, UK
| | - M Clark
- Department of Biology, University of Oxford, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Oxford Martin School, University of Oxford, Oxford, UK
| | - N Gray
- Department of Biology, University of Oxford, Oxford, UK
| | - H M J Grub
- Department of Biology, University of Oxford, Oxford, UK
| | - C Stewart
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, UK
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12
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Woodhall-Melnik J, Dunn JR, Dweik I, Monette C, Nombro E, Pappas J, Lamont A, Dutton D, Doucet S, Luke A, Matheson FI, Nisenbaum R, Stergiopoulos V, Stewart C. NB housing study protocol: investigating the relationship between subsidized housing, mental health, physical health and healthcare use in New Brunswick, Canada. BMC Public Health 2022; 22:2448. [PMID: 36577991 PMCID: PMC9795752 DOI: 10.1186/s12889-022-14923-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Income and housing are pervasive social determinants of health. Subsidized housing is a prominent affordability mechanism in Canada; however, waitlists are lengthy. Subsidized rents should provide greater access to residual income, which may theoretically improve health outcomes. However, little is known about the health of tenants who wait for and receive subsidized housing. This is especially problematic for New Brunswick, a Canadian province with low population density, whose inhabitants experience income inequality, social exclusion, and challenges with healthcare access. METHODS: This study will use a longitudinal, prospective matched cohort design. All 4,750 households on New Brunswick's subsidized housing wait list will be approached to participate. The survey measures various demographic, social and health indicators at six-month intervals for up to 18 months as they wait for subsidized housing. Those who receive housing will join an intervention group and receive surveys for an additional 18 months post-move date. With consent, participants will have their data linked to a provincial administrative database of medical records. DISCUSSION: Knowledge of housing and health is sparse in Canada. This study will provide stakeholders with a wealth of health information on a population that is historically under-researched and underserved.
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Affiliation(s)
- J. Woodhall-Melnik
- grid.266820.80000 0004 0402 6152Department of Social Sciences, University of New Brunswick, 100 Tucker Park, Saint John, New Brunswick, NB E2L 4L5 Canada
| | - J. R. Dunn
- grid.25073.330000 0004 1936 8227Department of Health, Aging and Society, McMaster University, Hamilton, ON Canada
| | - I. Dweik
- grid.266820.80000 0004 0402 6152Department of Social Sciences, University of New Brunswick, 100 Tucker Park, Saint John, New Brunswick, NB E2L 4L5 Canada
| | - C. Monette
- grid.266820.80000 0004 0402 6152Department of Social Sciences, University of New Brunswick, 100 Tucker Park, Saint John, New Brunswick, NB E2L 4L5 Canada
| | - E. Nombro
- grid.266820.80000 0004 0402 6152Department of Social Sciences, University of New Brunswick, 100 Tucker Park, Saint John, New Brunswick, NB E2L 4L5 Canada
| | - J. Pappas
- grid.266820.80000 0004 0402 6152Department of Social Sciences, University of New Brunswick, 100 Tucker Park, Saint John, New Brunswick, NB E2L 4L5 Canada
| | - A. Lamont
- grid.266820.80000 0004 0402 6152Department of Social Sciences, University of New Brunswick, 100 Tucker Park, Saint John, New Brunswick, NB E2L 4L5 Canada ,grid.266820.80000 0004 0402 6152Department of Psychology, University of New Brunswick, Fredericton, Canada
| | - D. Dutton
- grid.55602.340000 0004 1936 8200Department of Community Health and Epidemiology, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - S. Doucet
- grid.266820.80000 0004 0402 6152Department of Nursing, University of New Brunswick, Saint John, New Brunswick, Canada
| | - A. Luke
- grid.415502.7MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON Canada
| | - F. I. Matheson
- grid.415502.7MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - R. Nisenbaum
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - V. Stergiopoulos
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.468082.00000 0000 9533 0272Canadian Mental Health Association, Toronto, ON Canada
| | - C. Stewart
- grid.266820.80000 0004 0402 6152Department of Mathematics and Statistics, University of New Brunswick, Saint John, New Brunswick, Canada
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13
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Stewart C, Siu A, Tsui C, Finer Y, Hatton B. Rapid synthesis of drug-encapsulated films by evaporation-induced self-assembly for highly-controlled drug release from biomaterial surfaces. J Mater Chem B 2022; 10:6453-6463. [PMID: 35993489 DOI: 10.1039/d1tb02121d] [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: 11/21/2022]
Abstract
Infection at the surgical site for dental implants results in failed procedures, patient pain, burdensome economic impact, and the over-prescription of prophylactic antibiotics. Mesoporous silica films as coatings for implants may provide an ideal antimicrobial drug storage and local release vector to the site of infection, however traditional drug loading techniques result in insufficient drug load and short-term release kinetics. In this work, we have applied a method to use a surfactant-antimicrobial drug octenidine dihydrochloride (OCT) as a template for mesostructured silica, to demonstrate silica-OCT composite films. The films are synthesized by evaporation induced self-assembly (EISA) and we explore the effects of synthesis parameters on porous film structure, OCT incorporation, and OCT drug release rates. Drug micelle incorporation into the silica mesostructure was highly dependent on silica precursor pre-reaction to form silica oligomers before film spin-casting. The OCT drug concentration of the synthesis solution dictated the time required for effective incorporation (without phase separation), with total loading in the film of up to 90% by mass. The OCT content in the films was found to directly determine the timescale of drug release, from 2 to 8 h for a single layer film. The total release timescale was increased by the addition of multiple layers of OCT-silica films to nearly 2 weeks. Drug release from films completely inhibited Streptococcus mutans (UA159) growth, while drug-free porous silica films showed no increase in bacterial growth over non-porous control. These OCT-silica films have a significant potential to store and release antimicrobial drugs from dental implant surfaces.
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Affiliation(s)
- C Stewart
- Faculty of Dentistry, University of Toronto, 124 Edward St, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, 164 College St, Toronto, Ontario, Canada.
| | - A Siu
- Faculty of Dentistry, University of Toronto, 124 Edward St, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, 164 College St, Toronto, Ontario, Canada.
| | - C Tsui
- Department of Materials Science and Engineering, University of Toronto, 184 College St, Toronto, Ontario, Canada
| | - Y Finer
- Faculty of Dentistry, University of Toronto, 124 Edward St, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, 164 College St, Toronto, Ontario, Canada.
| | - B Hatton
- Institute of Biomedical Engineering, University of Toronto, 164 College St, Toronto, Ontario, Canada. .,Department of Materials Science and Engineering, University of Toronto, 184 College St, Toronto, Ontario, Canada
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14
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Sreekantam S, Smith L, Stewart C, Kearney S, Lawson S, Raiman J, Vijay S, Santra S. Efficacy of early haematopoietic stem cell transplantation versus enzyme replacement therapy on neurological progression in severe Hunter syndrome: Case report of siblings and literature review. Mol Genet Metab Rep 2022; 32:100881. [PMID: 35663302 PMCID: PMC9160838 DOI: 10.1016/j.ymgmr.2022.100881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022] Open
Abstract
Hunter syndrome is a neurodegenerative lysosomal storage disorder with limited treatment options to halt the progressive neurocognitive decline. Whilst Intravenous enzyme replacement therapy (ERT) does not cross the blood brain barrier; Intrathecal ERT, in clinical studies, did not demonstrate significant effect on cognition, despite having better CNS delivery. Hematopoietic stem cell transplantation (HSCT) has the potential to treat CNS disease. We reviewed the literature and outline our experience of treating two siblings with severe Hunter syndrome: ‘Sibling A' with intravenous and intrathecal ERT and ‘Sibling B' with Early HSCT. A literature review identified 8 articles reporting on the comparative efficacy of both treatments. Our clinical outcomes indicate that Sibling B performed better than Sibling A in relation to early developmental milestones as well as neurocognition, activities of daily living, quality of life and neurophysiological outcomes in mid childhood. Sibling A's developmental trajectory fell within the extremely low range and Sibling B's development trajectory fell within the low-average to average range. This suggests HSCT had a disease modifying effect and highlights the efficacy of early HSCT in moderating the CNS progression in Hunter syndrome. Long term follow up is needed to elucidate the efficacy of HSCT on neurological progression.
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Affiliation(s)
- Srividya Sreekantam
- Department of Inherited Metabolic Disorders, Birmingham Women's And Children's Hospital NHS Trust, UK
| | - Laura Smith
- Department of Clinical Psychology, Birmingham Women's And Children's Hospital NHS Trust, UK
| | - Catherine Stewart
- Department of Inherited Metabolic Disorders, Birmingham Women's And Children's Hospital NHS Trust, UK
| | - Shauna Kearney
- Department of Clinical Psychology, Birmingham Women's And Children's Hospital NHS Trust, UK
| | - Sarah Lawson
- Department of Haematology, Birmingham Women's And Children's Hospital NHS Trust, UK
| | - Julian Raiman
- Department of Inherited Metabolic Disorders, Birmingham Women's And Children's Hospital NHS Trust, UK
| | - Suresh Vijay
- Department of Inherited Metabolic Disorders, Birmingham Women's And Children's Hospital NHS Trust, UK
| | - Saikat Santra
- Department of Inherited Metabolic Disorders, Birmingham Women's And Children's Hospital NHS Trust, UK
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15
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Matcham F, Leightley D, Siddi S, Lamers F, White K, Annas P, De Girolamo G, Difrancesco S, Haro J, Horsfall M, Ivan A, Lavelle G, Li Q, Lombardini F, Mohr D, Narayan V, Oetzmann C, Penninx B, Simblett S, Bruce S, Nica R, Wykes T, Brasen J, Myin-Germeys I, Rintala A, Conde P, Dobson R, Folarin A, Stewart C, Ranjan Y, Rashid Z, Cummins N, Manyakov N, Vairavan S, Hotopf M. Remote Assessment of Disease and Relapse in Major Depressive Disorder (RADAR-MDD): Recruitment, retention, and data availability in a longitudinal remote measurement study. Eur Psychiatry 2022. [PMCID: PMC9564033 DOI: 10.1192/j.eurpsy.2022.315] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Major Depressive Disorder (MDD) is prevalent, often chronic, and requires ongoing monitoring of symptoms to track response to treatment and identify early indicators of relapse. Remote Measurement Technologies (RMT) provide an exciting opportunity to transform the measurement and management of MDD, via data collected from inbuilt smartphone sensors and wearable devices alongside app-based questionnaires and tasks.
Objectives
To describe the amount of data collected during a multimodal longitudinal RMT study, in an MDD population.
Methods
RADAR-MDD is a multi-centre, prospective observational cohort study. People with a history of MDD were provided with a wrist-worn wearable, and several apps designed to: a) collect data from smartphone sensors; and b) deliver questionnaires, speech tasks and cognitive assessments and followed-up for a maximum of 2 years.
Results
A total of 623 individuals with a history of MDD were enrolled in the study with 80% completion rates for primary outcome assessments across all timepoints. 79.8% of people participated for the maximum amount of time available and 20.2% withdrew prematurely. Data availability across all RMT data types varied depending on the source of data and the participant-burden for each data type. We found no evidence of an association between the severity of depression symptoms at baseline and the availability of data. 110 participants had > 50% data available across all data types, and thus able to contribute to multiparametric analyses.
Conclusions
RADAR-MDD is the largest multimodal RMT study in the field of mental health. Here, we have shown that collecting RMT data from a clinical population is feasible.
Disclosure
No significant relationships.
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Kumaravel B, Stewart C, Ilic D. Face-to-face versus online clinically integrated EBM teaching in an undergraduate medical school: a pilot study. BMJ Evid Based Med 2022; 27:162-168. [PMID: 34635481 DOI: 10.1136/bmjebm-2021-111776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The aim of this study was to test the feasibility and effectiveness of two models (face-to-face vs online teaching) of clinically integrating evidence-based medicine (EBM) teaching in an undergraduate medical school. DESIGN AND SETTING A pilot study of face-to-face versus online EBM teaching. PARTICIPANTS This study focused on undergraduate medical students who entered the University of Buckingham Medical School MBChB course in 2016 (n=65). Of the 65 students, 45 received face-to-face teaching, while 20 received online teaching. MAIN OUTCOME MEASURES Feasibility was assessed by the ability to deliver the content, students' engagement during teaching and their completion rates in formative assessments-Assessing Competency in EBM (ACE) tool, and educational prescriptions (EPs). Effectiveness of teaching for the two models was compared by evaluating students' performance in the formative assessments and in the summative final professional examination and final year EBM objective structured clinical examination (OSCE). RESULTS We had similar students' engagement and completion rates in formative assessments in both models. Students receiving face-to-face teaching performed better in EPs (mean difference=-2.28, 95% CI: -4.31 to -0.26). There was no significant difference in performances in the ACE tool (mean difference=-1.02, 95% CI: -2.20 to 0.16); the written final professional exams (mean difference=-0.11, 95% CI: -0.65 to 0.44) and the EBM OSCE station (mean difference=-0.81, 95% CI: -2.38 to 0.74). CONCLUSIONS It was feasible to deliver both models of clinically integrated EBM teaching. While students in the face-to-face model scored higher in EPs; there was no significant difference between the two models of teaching as measured by performances in the ACE tool or the summative assessments.
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Affiliation(s)
| | - C Stewart
- University of Nottingham, Nottingham, UK
| | - Dragan Ilic
- Medical Education Research & Quality (MERQ) unit, Monash Medical School, Clayton, Victoria, Australia
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17
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Jawa R, Stein MD, Anderson B, Liebschutz JM, Stewart C, Phillips KT, Barocas JA. Behavioral Risk Factors for HIV Infection in Hospitalized Persons Who Co-use Stimulants and Opioids. AIDS Behav 2022; 26:1047-1055. [PMID: 34510289 PMCID: PMC8435119 DOI: 10.1007/s10461-021-03460-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 01/03/2023]
Abstract
We investigated the association of 90-day opioid and stimulant co-use and HIV risk behaviors in a cross-sectional analysis of hospitalized HIV-negative people who inject drugs (PWID). We compared those injecting opioids alone to two sub-groups who co-used opioids with (1) cocaine, (2) amphetamine-type stimulants (ATS), on sex and injection drug risk behaviors assessed via the Risk Assessment Battery (RAB), where a higher score indicates a higher risk. Of 197 participants who injected opioids, 53% co-used cocaine only, 5% co-used ATS only, 18% co-used both cocaine and ATS, 24% co-used neither stimulant. PWID who injected opioids alone had a mean RAB drug risk score of 5.98 points and sex risk score of 2.16 points. Compared to PWID who injected opioids alone, PWID who co-used stimulants had higher mean drug risk RAB scores: cocaine, b = 2.84 points [95% confidence interval (CI) 1.01; 4.67]; ATS, b = 3.43 points (95% CI 1.29; 5.57). Compared to PWID who injected opioids alone, cocaine co-use was associated with higher sex RAB scores b = 1.06 points (95% CI 0.32; 1.79). Overall, we found a significant association between stimulant co-use and higher HIV sex and drug risk scores.
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Affiliation(s)
- Raagini Jawa
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA.
- Boston University School of Medicine, Boston, MA, USA.
| | - Michael D Stein
- Boston University School of Public Health, Boston, MA, USA
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
| | - Bradley Anderson
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
| | - Jane M Liebschutz
- Division of General Internal Medicine, Center for Research On Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Kristina T Phillips
- Center for Integrated Health Care Research, Kaiser Permanente Honolulu, Honolulu, HI, USA
| | - Joshua A Barocas
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
- Boston University School of Medicine, Boston, MA, USA
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18
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Stewart C, Goddard E, Cakir Z, Hall R, Allen G. Can more people be "Happy Being Me"? Testing the delivery of a universal body satisfaction program by clinicians and school staff. Eat Disord 2022; 30:182-209. [PMID: 33131458 DOI: 10.1080/10640266.2020.1771165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The research presented here evaluates the delivery of Happy Being Me (HBM; Dunstan, Paxton & McLean, 2017) with boys and girls in their first year of secondary school in the UK (Year 7 and after comparisons aged 11-12). HBM is a manualised universal prevention programme which aims to improve body dissatisfaction and associated risk factors. Risk factors studied here were internalization of the thin ideal, physical appearance comparisons, appearance conversations. Secondary outcomes measured were self-esteem and eating disorder symptomsStudy 1 tested the effectiveness of HBM (n = 172) compared to a control group (n = 197) who received curriculum as usual. HBM resulted in significantly improved body satisfaction post-intervention which was maintained at follow up. There were no significant changes in risk factors.Study 2 compared clinician (n = 172) and teacher (n = 174) delivery. Students who received clinician-led, but not teacher-led, HBM had improved body satisfaction and this was maintained at follow up. Internalization of the thin ideal and self-esteem, improved in both clinician and teacher-led groups with small to medium sized effects. HBM can be delivered by clinicians independent of programme developers in a heterogeneous sample with positive effects on body satisfaction. Issues arising for wider delivery are discussed.
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Affiliation(s)
- Catherine Stewart
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Elizabeth Goddard
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ziba Cakir
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Richard Hall
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - Gill Allen
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK.,Bromley Y, Community Well-being Service for Children and Families, Bromley, UK
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19
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Freibott CE, Phillips KT, Anderson BJ, Stewart C, Liebschutz JM, Stein MD. Under the Skin: The Relationship Between Subcutaneous Injection and Skin Infections Among People Who Inject Drugs. J Addict Med 2022; 16:164-168. [PMID: 33813580 PMCID: PMC8486890 DOI: 10.1097/adm.0000000000000844] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES People who inject drugs (PWID) are at increased risk for numerous negative health outcomes. Subcutaneous injections (aka skin popping) can result in greater risk of skin and soft tissue infections (SSTIs), but less is known about PWID who choose this route of administration. This study compares subcutaneous injectors to intravenous injectors, characterizes those who inject subcutaneously, and examines whether subcutaneous injection is associated with SSTIs in the past year. METHODS A cohort of hospitalized PWID (n = 252) were interviewed regarding injection-related behaviors, history of SSTI, and knowledge of subcutaneous injection risk. We examined differences between those who do and do not inject subcutaneously and used a negative binomial regression model to estimate adjusted odds associating subcutaneous injection and SSTI. RESULTS Participants averaged 38 years, with 58.3% male, 59.5% White, 20.6% Black, and 15.9% Latinx. PWID who performed subcutaneous injection were not demographically different from other PWID; however, the mean rate of past year SSTIs was higher for persons injecting subcutaneously than for those who did not (1.98 vs 0.96, P < 0.001). Persons injecting subcutaneously did not differ from those who injected intravenously in terms of their knowledge of subcutaneous injection risk (P = 0.112) and knowledge score was not associated with SSTIs (P = 0.457). CONCLUSIONS PWID who perform subcutaneous injections are demographically similar to other PWID but had higher rates of past year SSTIs. Knowledge of subcutaneous injection risk was not associated with SSTI risk.
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Affiliation(s)
| | - Kristina T. Phillips
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI, 96817
| | - Bradley J. Anderson
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, 02906
| | | | - Jane M. Liebschutz
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA 15213
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20
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Bradley A, Faulkner J, Jatan A, Stewart C. 61 Use of Ketamine Sedation for the Treatment of Minor Plastic Surgery Procedures in the Paediatric Emergency Department. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.032] [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: 11/14/2022]
Abstract
Abstract
Aim
To determine if ketamine sedation is a safe and cost-effective way of treating paediatric patients presenting with minor injuries, requiring plastic surgery procedures, in the emergency department.
Method
A retrospective cohort study was carried out over a 9-month period in children between ages 18 months and 16 years old, presenting to the paediatric emergency department at Chelsea and Westminster Hospital with minor injuries requiring plastic surgery input. The data collected included previously validated co-primary outcome measures of surgical site infection at 7 days and cosmetic appearance summary score at a minimum of 4 months. Parental satisfaction surveys were completed at 4 months to assess perceived quality of treatment. A cost analysis comparison against procedures completed under general anaesthetic was also undertaken.
Results
During the 9-month period of study, 24 minor procedures were performed under ketamine in the paediatric emergency department. There were no serious adverse events recorded. Three cases exceeded the recommended 20-minute maximum procedure duration, but there was no associated adverse outcome. No cases required further procedures under general anaesthesia and there were no cases of surgical site infections at 7 days. Parents reported extremely favourable outcomes using this technique, with an average overall satisfaction score of 9.2 (assessed over a number of parameters, where 10 is complete satisfaction).
Conclusions
Ketamine procedural sedation in the paediatric population is a safe and cost-effective method for the treatment of minor plastic surgery procedures, with low risk for surgical site infection post-operatively, and high parent satisfaction rates
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Affiliation(s)
- A. Bradley
- University College London Hospital, London, United Kingdom
| | - J. Faulkner
- Chelsea and Westminster Hospital, London, United Kingdom
| | - A. Jatan
- Chelsea and Westminster Hospital, London, United Kingdom
| | - C. Stewart
- Chelsea and Westminster Hospital, London, United Kingdom
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21
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Patten H, Stewart C, Horler C, Hemmings S, Daluiso G. Using health coaching and the Patient Activation Measure® to support self-management within musculoskeletal outpatients: A service improvement project. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.128] [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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22
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McIntire R, Howard C, Stewart C, McIntosh H, Vassar M. The use of superlatives in news articles pertaining to asthma treatment. Pulmonology 2022; 28:228-230. [DOI: 10.1016/j.pulmoe.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022] Open
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23
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Christopher PP, Stewart C, Manning W, Anderson BJ, Woodruff A, Monteiro J, Stein MD. Risk behaviors among persons civilly committed for opioid use. J Subst Abuse Treat 2022; 132:108493. [PMID: 34098213 PMCID: PMC8627518 DOI: 10.1016/j.jsat.2021.108493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/26/2021] [Accepted: 05/24/2021] [Indexed: 01/03/2023]
Abstract
Despite the growth in civil commitment for persons who use opioids, we know little about the kinds of risk behaviors among those committed. This study examined the behaviors that a judge might use to determine if there is sufficient evidence that an individual's opioid use poses a risk for serious harm. The study recruited participants (n = 121) from three Massachusetts Department of Public Health civil commitment facilities in 2018. We used a list of risk behaviors that courts consider supportive of opioid-related civil commitment. Participants averaged 28 years of age, 56% were male, and 91% met criteria for severe opioid use disorder. Participants endorsed an average of 9 of the 27 risk behaviors. On average, participants endorsed three of the six drug use behaviors representing a danger to themselves, four of eleven behaviors representing an inability to care for or protect themselves (home safety, weight loss), and two of ten behaviors representing a danger to others (driving high or drunk). Participants who reported they were "not at all pleased" to have been civilly committed endorsed significantly (p = .009) fewer behaviors representing a danger to themselves than those who said they were at least "a little pleased." We conclude that the majority of individuals civilly committed for opioid use are engaging in multiple high-risk behaviors that pose a serious risk of harm to themselves.
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Affiliation(s)
- Paul P Christopher
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, United States of America
| | - Catherine Stewart
- Department of Health Law, Policy & Management, School of Public Health, Boston University, United States of America
| | - William Manning
- Department of Health Law, Policy & Management, School of Public Health, Boston University, United States of America
| | - Bradley J Anderson
- Behavioral Medicine and Addiction Research Unit, Butler Hospital, Providence, RI, United States of America
| | - Alexander Woodruff
- Department of Health Law, Policy & Management, School of Public Health, Boston University, United States of America
| | - Jordanna Monteiro
- Department of Health Law, Policy & Management, School of Public Health, Boston University, United States of America
| | - Michael D Stein
- Department of Health Law, Policy & Management, School of Public Health, Boston University, United States of America.
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24
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Barnes GL, Stewart C, Browning S, Bracegirdle K, Laurens KR, Gin K, Hirsch C, Abbott C, Onwumere J, Banerjea P, Kuipers E, Jolley S. Distressing psychotic-like experiences, cognitive functioning and early developmental markers in clinically referred young people aged 8-18 years. Soc Psychiatry Psychiatr Epidemiol 2022; 57:461-472. [PMID: 34480219 PMCID: PMC8934329 DOI: 10.1007/s00127-021-02168-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/26/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE Neurocognitive difficulties and early childhood speech/motor delays are well documented amongst older adolescents and young adults considered at risk for psychosis-spectrum diagnoses. We aimed to test associations between unusual or psychotic-like experiences (PLEs), co-occurring distress/emotional symptoms, current cognitive functioning and developmental delays/difficulties in young people (aged 8-18 years) referred to Child and Adolescent Mental Health Services in South London, UK. METHODS Study 1 examined receptive language, verbal learning and caregiver-reported speech and motor delays/difficulties in a sample of 101 clinically-referred children aged 8-14 years, comparing those reporting no PLEs (n = 19), PLEs without distress (n = 16), and PLEs with distress (n = 66). Study 2 tested associations of severity of distressing PLEs with vocabulary, perceptual reasoning, word reading and developmental delays/difficulties in a second sample of 122 adolescents aged 12-18 years with distressing PLEs. RESULTS In Study 1, children with distressing PLEs had lower receptive language and delayed recall and higher rates of developmental delays/difficulties than the no-PLE and non-distressing PLE groups (F values: 2.3-2.8; p values: < 0.005). Receptive language (β = 0.24, p = 0.03) and delayed recall (β = - 0.17, p = 0.02) predicted PLE distress severity. In Study 2, the cognitive-developmental variables did not significantly predict PLE distress severity (β values = 0.01-0.22, p values: > 0.05). CONCLUSION Findings may be consistent with a cognitive-developmental model relating distressing PLEs in youth with difficulties in cognitive functioning. This highlights the potential utility of adjunctive cognitive strategies which target mechanisms associated with PLE distress. These could be included in cognitive-behavioural interventions offered prior to the development of an at-risk mental state in mental health, educational or public health settings.
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Affiliation(s)
- G L Barnes
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK.
| | - C Stewart
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK
| | - S Browning
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK
| | - K Bracegirdle
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK
| | - K R Laurens
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
- Queensland University of Technology (QUT), School of Psychology and Counselling, Brisbane, QLD, 4059, Australia
- University of New South Wales, School of Psychiatry, Sydney, NSW, 2052, Australia
| | - K Gin
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK
| | - C Hirsch
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK
- NIHR Biomedical Research Centre (BRC) at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AZ, UK
| | - C Abbott
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK
| | - J Onwumere
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK
- NIHR Biomedical Research Centre (BRC) at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AZ, UK
| | - P Banerjea
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK
| | - E Kuipers
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK
- NIHR Biomedical Research Centre (BRC) at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AZ, UK
| | - S Jolley
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
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25
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Kemp J, Mechlenburg I, O’Brien M, Reimer L, Semciw A, Stewart C. Pain and quality of life are impaired in adults with hip dysplasia undergoing periacetabular osteotomy (PAO): A systematic review and meta-analysis. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.147] [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: 11/29/2022]
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26
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Gin K, Stewart C, Abbott C, Banerjea P, Bracegirdle K, Browning S, Byrne M, Emsley R, Ginestet C, Hirsch C, Kuipers E, Laurens KR, Onwumere J, Plant D, Valmaggia L, Jolley S. Psychosocial predictors of distressing unusual experiences in adolescence: Testing the fit of an adult cognitive model of psychosis. Schizophr Res 2021; 237:1-8. [PMID: 34461373 DOI: 10.1016/j.schres.2021.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 08/09/2021] [Accepted: 08/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND For adults with psychosis, international guidelines recommend individual and family based cognitive behavioural therapy interventions. Recommendations are extended to children and adolescents, based on adult research. It is also recommended that psychological interventions are offered for childhood presentations of psychotic-like or Unusual Experiences (UE), in the absence of a formal diagnosis, when these are Distressing (UEDs). Cognitive models underpinning these interventions require testing in adolescent populations, to further refine therapies. We address this need, by testing for the first time, the application of the adult cognitive model of psychosis to adolescent UEDs. METHODS We used baseline data from the Coping with Unusual ExperienceS (CUES+) randomised controlled trial for 122 clinically referred adolescents (12-18 years) with self-reported UEDs. Known psychological mechanisms of adult cognitive models of psychosis; negative life events, affect (anxiety and depression), reasoning (jumping to conclusions bias), and schemas were investigated using multiple linear regression models, alongside variables particularly associated with the development and severity of adolescent UEDs and UE type (dissociation, externalising/behavioural problems, managing emotions). RESULTS The psychological mechanisms of adult cognitive models of psychosis explained 89% of the total variance of adolescent UED severity, F (10, 106) = 99.34, p < .0005, r2 = 0.89, with schemas as the principal significant contributor. Variance explained 40 - 72% across each of the UE types (paranoia, hallucinations, delusions, paranormal thinking and grandiosity). CONCLUSIONS Findings suggest that the psychological components of adult cognitive models of psychosis, particularly schemas, are also implicated in adolescent UEDs.
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Affiliation(s)
- Kimberley Gin
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK.
| | | | - Chris Abbott
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Partha Banerjea
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | | | - Sophie Browning
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Majella Byrne
- King's College London, Department of Psychology, Institute of Psychiatry Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK
| | - Richard Emsley
- King's College London, Department of Psychology, Institute of Psychiatry Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK
| | - Cedric Ginestet
- King's College London, Department of Psychology, Institute of Psychiatry Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK
| | - Colette Hirsch
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK; King's College London, Department of Psychology, Institute of Psychiatry Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK
| | - Elizabeth Kuipers
- King's College London, Department of Psychology, Institute of Psychiatry Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK
| | - Kristin R Laurens
- King's College London, Department of Psychology, Institute of Psychiatry Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK; Queensland University of Technology (QUT), School of Psychology and Counselling, Victoria Park Road, Kelvin Grove, QLD 4059, Australia
| | - Juliana Onwumere
- King's College London, Department of Psychology, Institute of Psychiatry Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK
| | - Deborah Plant
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Lucia Valmaggia
- King's College London, Department of Psychology, Institute of Psychiatry Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK
| | - Suzanne Jolley
- King's College London, Department of Psychology, Institute of Psychiatry Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK
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Newitt L, Stewart C, Wei R. 1111 Shifting the Paradigm of Abscess Treatment – From Theatre to Clinic. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Treatment of skin and soft tissue abscesses forms a substantial part of the emergency general surgery workload. Abscesses account for approximately 2% of presentations to Accident and Emergency, with 0.9% of patients requiring surgical intervention. Incision and drainage is often performed in theatre and may necessitate admission to hospital, impacting bed space and theatre availability. This study aims to identify if the introduction of a clinic-based abscess service could reduce the number of abscess drainages in theatre without compromise to clinical outcomes.
Method
Retrospective data was collected for patients undergoing abscess treatment at Musgrove Park Hospital (Taunton) in September 2019. Subsequently, a Nurse-led abscess drainage pathway was initiated in Emergency Surgery Ambulatory Clinic (ESAC) encompassing initial assessment and drainage at the bedside. Prospective data was then collected for abscesses drained in theatre and ESAC during September 2020 and compared with data from 2019.
Result
22 abscess drainages were performed in September 2019 vs 25 in September 2020. 8 cases were carried out in theatre during September 2020, with the rest being treated in ESAC. Of those who were treated in clinic (n = 17), admission was prevented in 16 patients. Readmission rates were similar between ESAC (16%) and theatre (18.1%).
Conclusions
A clinic-based abscess service is achievable and prevents unnecessary use of theatres and hospital admissions, with comparable re-presentation rates. A nurse led approach also relieves pressure on Doctors during busy surgical on calls. Nonetheless, a larger data set would be needed to consolidate the findings from this study.
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Affiliation(s)
- L Newitt
- Musgrove Park Hospital, Taunton, United Kingdom
| | - C Stewart
- Musgrove Park Hospital, Taunton, United Kingdom
| | - R Wei
- Musgrove Park Hospital, Taunton, United Kingdom
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Baudinet J, Stewart C, Bennett E, Konstantellou A, Parham R, Smith K, Hunt K, Eisler I, Simic M. Radically open dialectical behaviour therapy adapted for adolescents: a case series. BMC Psychiatry 2021; 21:462. [PMID: 34551741 PMCID: PMC8456700 DOI: 10.1186/s12888-021-03460-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overcontrol is a transdiagnostic cluster of traits associated with excessive psychological, behavioural and social inhibitory control. It is associated with psychiatric diagnoses of depression, restrictive eating disorders and/or obsessive-compulsive personality disorder. Radically Open Dialectical Behaviour Therapy is a transdiagnostic treatment for maladaptive overcontrol. This case series evaluates an adolescent adaption (RO-A) for a transdiagnostic group of adolescents identified as overcontrolled. METHODS Twenty-eight adolescents were consecutively referred for RO-A from two different National and Specialist Child and Adolescent Mental Health Services between June 2017 and February 2020. Baseline self-report measures assessed overcontrol characteristics, relationship and attachment quality and mental health symptoms of depression and eating disorders, which were repeated at discharge. RESULTS Adolescents in this case series reported high rates of depression (78.6%), self-harm (64.3%) and eating disorders (78.6%). Most (85.7%) had two or more mental health diagnoses and all had previous mental health treatments before starting RO-A. The mean number of RO-A sessions attended was 18 group-based skills classes and 21 individual sessions over a mean period of 34 weeks. Significant improvements with medium and large effect sizes were reported in cognitive flexibility (d = 1.63), risk aversion (d = 1.17), increased reward processing (d = .79) and reduced suppression of emotional expression (d = .72). Adolescents also reported feeling less socially withdrawn (d = .97), more connected to others (d = 1.03), as well as more confident (d = 1.10) and comfortable (d = .85) in attachment relationships. Symptoms of depression (d = .71), eating disorders (d = 1.06) and rates of self-harm (V = .39) also significantly improved. Exploratory correlation analyses suggest improvements in overcontrol are moderately to strongly correlated with improvements in symptoms of depression and eating disorders. CONCLUSIONS This case series provides preliminary data that RO-A may be an effective new treatment for adolescents with overcontrol and moderate to severe mental health disorders like depression and eating disorders. RO-A led to improved management of overcontrol, improved relationship quality and reduced mental health symptoms. Further evaluation is indicated by this case series, particularly for underweight young people with eating disorders. More rigorous testing of the model is required as conclusions are only tentative due to the small sample size and methodological limitations.
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Affiliation(s)
- Julian Baudinet
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - Catherine Stewart
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Eleanor Bennett
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Anna Konstantellou
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Rhian Parham
- National and Specialist Child and Adolescent Dialectical Behaviour Therapy Service (N&S CAMHS DBT), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Keren Smith
- National and Specialist Child and Adolescent Dialectical Behaviour Therapy Service (N&S CAMHS DBT), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Katrina Hunt
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
- National and Specialist Child and Adolescent Dialectical Behaviour Therapy Service (N&S CAMHS DBT), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Ivan Eisler
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
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Stewart C, Konstantellou A, Kassamali F, McLaughlin N, Cutinha D, Bryant-Waugh R, Simic M, Eisler I, Baudinet J. Is this the 'new normal'? A mixed method investigation of young person, parent and clinician experience of online eating disorder treatment during the COVID-19 pandemic. J Eat Disord 2021; 9:78. [PMID: 34193291 PMCID: PMC8243044 DOI: 10.1186/s40337-021-00429-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/09/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Prior to the COVID-19 pandemic, research in virtual care for young people with eating disorders was preliminary and implementation rare. This study explored the experience of young people, parents and clinicians when therapy was transitioned to virtual provision as a result of the UK lockdown in March 2020. METHODS A mixed-method approach was used in this study. Online questionnaires that included a mixture of rating (Likert scale) and free-text response questions were completed by 53 young people with any eating disorder, 75 parents and 23 clinicians. Questions focused on the experience of online treatment as well as the impact on engagement, perceived treatment efficacy and preferences around treatment mode in the future. Likert scale questions were analysed using a summary approach. Free-text responses were analysed qualitatively using reflexive thematic analysis. RESULTS Responses to rating scale questions indicate satisfaction with treatment, good engagement and ability to manage technology. Young people who had transitioned care, rather than started care virtually in lockdown, rated therapy as less effective. However, individual accounts of experience were more varied. Reflexive thematic analysis of free-text responses identified key themes of 1) Making it work, 2) Home as a therapeutic space, and 3) Disrupted connection and 4) Into the future. CONCLUSIONS These results have implications for ongoing care during the pandemic and for future implementation of virtual care in the treatment of young people with eating disorders. Particular issues arising are the trade-off between accessibility and therapeutic engagement and depth and need for consideration of equal access to treatment in socially unequal societies.
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Affiliation(s)
- Catherine Stewart
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Anna Konstantellou
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Fatema Kassamali
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Natalie McLaughlin
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Darren Cutinha
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Rachel Bryant-Waugh
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Ivan Eisler
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Julian Baudinet
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK.
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
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Hibner M, Desir H, Catellanos M, Desai N, Stewart C, Doehrman P. 65 Association of obesity and autoimmune disease in chronic pelvic pain patients requiring pelvic mesh removal. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2021.04.090] [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: 11/29/2022]
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Nicholls J, Stewart C, Coulston J. 815 The Impact and Implications for The Workload for Vascular Surgery as A Result of the COVID-19 Lockdown. Br J Surg 2021. [PMCID: PMC8135867 DOI: 10.1093/bjs/znab134.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction The emergence of the coronavirus pandemic and subsequent UK lockdown resulted in a significant reduction in elective vascular surgery to increase critical care capacity. We aimed to ascertain the impact of lockdown on the workload of a busy vascular surgical unit. Method Data on all major vascular procedures performed between March 2020 and June 2020 were collected prospectively. Comparison to the same time period over the last 6 years was performed using a prospectively maintained database. Results 92 major cases were performed, a reduction of 30% compared with cases performed during similar periods (803 cases total, mean 133), with an increased proportion of unplanned & emergency cases(35.9% & 31.5% vs 31.4% & 20.5%). There was a significant reduction in aortic procedures (19 vs mean 36). Despite the reduction in cases there was a similar number of amputations performed (9 vs mean 10). Conclusions The lockdown period resulted in a 30% reduction in cases performed with far fewer aortic procedure performed and a similar number of amputations. These pending cases will need consideration, especially with critical care capacity to ensure they are completed within a timely period. Considerations for capacity are also pertinent given the approach of winter and the possibility of a second wave.
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Affiliation(s)
- J Nicholls
- Musgrove Park Hospital, Taunton, United Kingdom
| | - C Stewart
- Musgrove Park Hospital, Taunton, United Kingdom
| | - J Coulston
- Musgrove Park Hospital, Taunton, United Kingdom
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Stewart C, Loughrey PB, Lindsay JR. Osteopetrosis - A Case Series Exploring Complications and Multidisciplinary Management. J Endocr Soc 2021. [PMCID: PMC8089596 DOI: 10.1210/jendso/bvab048.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Osteopetrosis is a group of rare inherited skeletal dysplasias, with each variant sharing the hallmark of increased bone mineral density (BMD). Abnormal osteoclast activity produces overly dense bone predisposing to fracture and skeletal deformities. Whilst no cure for these disorders exists, endocrinologists play an important role in surveillance and management of complications. Clinical Cases: A 43-year-old female had findings suggestive of increased BMD on radiographic imaging performed to investigate shoulder and back pain. X-ray of lumbar spine demonstrated a ‘rugger jersey’ spine appearance, while shoulder X-ray revealed mixed lucency and sclerosis of the humeral head. DXA scan showed T-scores of +11 at the hip and +12.5 at the lumbar spine. MRI of head displayed bilateral narrowing and elongation of the internal acoustic meatus and narrowing of the orbital foramina. Genetic assessment confirmed autosomal dominant osteopetrosis with a CLCN7 variant. Oral colecalciferol supplementation was commenced and multi-disciplinary management instigated with referral to ophthalmology and ENT teams. A 25-year-old male presented with a seven-year history of low back pain and prominent bony swelling around the tibial tuberosities and nape of neck. Past medical history included repeated left scaphoid fracture in 2008 and 2018. Recovery from his scaphoid fracture was complicated by non-union requiring bone grafting with open reduction and fixation. Plain X-rays of the spine again demonstrated ‘rugger jersey’ spine. DXA scan was notable for elevated T scores; +2.9 at hip and +5.8 lumbar spine. MRI spine showed vertebral endplate cortical thickening and sclerosis at multiple levels. The patient declined genetic testing and is under clinical review. A 62-year-old male was referred to the bone metabolism service following a DXA scan showing T scores of +11. 7 at the hip and +13 at the lumbar spine. His primary complaint was of neck pain and on MRI there was multi-level nerve root impingement secondary to facet joint hypertrophy. Past medical history was significant for a long history of widespread joint pains; previous X-ray reports described generalized bony sclerosis up to 11 years previously. Clinical and radiological monitoring continues. Conclusion: Individuals with osteopetrosis require a multidisciplinary approach to management. There is no curative treatment and mainstay of therapy is supportive with active surveillance for complications.
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Affiliation(s)
- Catherine Stewart
- Musgrave Park & Mater Infirmorum Hospitals, Belfast Health & Social Care Trust, Belfast, Belfast, United Kingdom
| | - Paul Benjamin Loughrey
- Musgrave Park & Mater Infirmorum Hospitals, Belfast Health & Social Care Trust, Belfast, Belfast, United Kingdom
| | - John R Lindsay
- Musgrave Park & Mater Infirmorum Hospitals, Belfast Health & Social Care Trust, Belfast, Belfast, United Kingdom
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Stein MD, Phillips KT, Herman DS, Keosaian J, Stewart C, Anderson BJ, Weinstein Z, Liebschutz J. Skin-cleaning among hospitalized people who inject drugs: a randomized controlled trial. Addiction 2021; 116:1122-1130. [PMID: 32830383 DOI: 10.1111/add.15236] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/31/2020] [Accepted: 08/17/2020] [Indexed: 01/29/2023]
Abstract
AIMS To test the hypothesis that among hospitalized people who inject drugs (PWID), a brief intervention in skin-cleaning would result in greater reductions in follow-up emergency department (ED) or hospitalization rates compared with a usual care condition. DESIGN Randomized, two-group (intervention, n = 128; usual care, n = 124), single-site clinical trial with12-month follow-up. SETTING Hospital inpatient services in Boston, Massachusetts, United States. PARTICIPANTS People who injected drugs on at least 3 days each week prior to hospital admission (n = 252). Participants averaged 37.9 (± 10.7) years of age; 58.5% were male, 59.3% were white and 61.1% had a diagnosis related to skin infection at enrollment. INTERVENTION AND COMPARATOR Intervention was a skin hygiene education and skills-training behavioral intervention [short-term efficacy data on a behavioral intervention (SKIN)] consisting of two education- and skills-based skin-cleaning sessions, one during hospitalization and another 4 weeks later. The comparator was treatment as usual: an informational brochure about substance use treatment options and needle exchange programs in the area and follow-up clinical appointments as arranged by the inpatient medical staff. MEASUREMENTS Electronic medical records were reviewed and discharge diagnoses for each ED visit and hospital admission were categorized into injection-related bacterial events (e.g. cellulitis) and non-injection-related events. Negative binomial regression was used to test the intervention effects for the primary outcome and total ED visits, as well as the secondary outcomes, total number of hospitalizations, injection drug use-related (IDU-related) ED visits and IDU-related hospitalizations. We also tested whether the outcomes were moderated by whether the initial hospitalization was IDU-related. FINDINGS Of people assigned to SKIN, 66 completed two sessions, 55 completed one session and seven completed zero sessions. Adjusting for baseline covariates, the mean rate of total ED visits in the next 12 months was non-significantly higher [incidence rate ratio (IRR) = 1.13, 95% confidence interval (CI) = 0.96, 1.33, P = 0.152] compared with usual treatment. The intervention did not significantly reduce total hospitalizations or IDU-related hospitalizations. Adjusting for baseline covariates, the mean rate of injection drug use-related ED visits in the next 12 months was lower (IRR = 0.57, 95% CI = 0.35, 0.91, P = 0.019) compared with treatment as usual. CONCLUSIONS A skin-cleaning intervention for people who inject drugs delivered during a hospitalization did not significantly reduce either overall emergency department use or hospitalization. There was some evidence that it may have reduced injection drug use-related emergency department visits.
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Affiliation(s)
- Michael D Stein
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA.,Boston University School of Public Health, Boston, MA,, USA
| | - Kristina T Phillips
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Debra S Herman
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA.,Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Julia Keosaian
- Boston University School of Public Health, Boston, MA,, USA
| | | | - Bradley J Anderson
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
| | - Zoe Weinstein
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jane Liebschutz
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
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Kumaravel B, Stewart C, Ilic D. Development and evaluation of a spiral model of assessing EBM competency using OSCEs in undergraduate medical education. BMC Med Educ 2021; 21:204. [PMID: 33838686 PMCID: PMC8035769 DOI: 10.1186/s12909-021-02650-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/05/2021] [Indexed: 05/04/2023]
Abstract
BACKGROUND Medical students often struggle to understand the relevance of Evidence Based Medicine (EBM) to their clinical practice, yet it is a competence that all students must develop prior to graduation. Objective structured clinical examinations (OSCEs) are a valued assessment tool to assess critical components of EBM competency, particularly different levels of mastery as they progress through the course. This study developed and evaluated EBM based OSCE stations with an aim to establish a spiral approach for EBM OSCE stations for undergraduate medical students. METHODS OSCE stations were developed with increasingly complex EBM tasks. OSCE stations were classified according to the classification rubric for EBP assessment tools (CREATE) framework and mapped against the recently published core competencies for evidence-based practice (EBP). Performance data evaluation was undertaken using Classical Test Theory analysing mean scores, pass rates, and station item total correlation (ITC) using SPSS. RESULTS Six EBM based OSCE stations assessing various stages of EBM were created for use in high stakes summative OSCEs for different year groups across the undergraduate medical degree. All OSCE stations, except for one, had excellent correlation coefficients and hence a high reliability, ranging from 0.21-0.49. The domain mean score ranged from 13.33 to 16.83 out of 20. High reliability was demonstrated for the each of the summative OSCE circuits (Cronbach's alpha = 0.67-0.85). In the CREATE framework these stations assessed knowledge, skills, and behaviour of medical students in asking, searching, appraising, and integrating evidence in practice. The OSCE stations were useful in assessing six core evidence-based practice competencies, which are meant to be practiced with exercises. A spiral model of OSCEs of increasing complexity was proposed to assess EBM competency as students progressed through the MBChB course. CONCLUSIONS The use of the OSCEs is a feasible method of authentically assessing leaner EBM performance and behaviour in a high stakes assessment setting. Use of valid and reliable EBM-based OSCE stations provide evidence for continued development of a hierarchy of assessing scaffolded learning and mastery of EBM competency. Further work is needed to assess their predictive validity.
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Affiliation(s)
- B Kumaravel
- The University of Buckingham Medical School, Hunter Street, Buckingham, MK18 1EG, UK.
| | - C Stewart
- University of Nottingham, Nottingham, UK
| | - D Ilic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Galuchie L, Stewart C, Meloni F. Protocol Deviations: A Holistic Approach from Defining to Reporting. Ther Innov Regul Sci 2021; 55:733-742. [PMID: 33782921 PMCID: PMC8238759 DOI: 10.1007/s43441-021-00269-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/25/2021] [Indexed: 11/28/2022]
Abstract
Improving interpretation of existing guidelines and management of protocol deviation processes could increase process efficiencies and help reduce noise to support rapid identification of important protocol deviations. Towards this end, TransCelerate identified key principles to build upon and clarify the definition of a protocol deviation and developed a holistic approach to protocol deviation management. The approaches are flexible to suit a variety of indications, study designs, and investigational agents while also supporting consistent application within a study, program or organization.
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Affiliation(s)
- Laura Galuchie
- Global Clinical Trial Operations, Merck Research Laboratories, 126 East Lincoln Ave, Rahway, NJ, 07065, USA.
| | - Catherine Stewart
- Clinical Development & Operations, Pfizer R&D UK Ltd, Sandwich, Kent, UK
| | - Frank Meloni
- Regulatory Medical Writing, Janssen Research & Development, Spring House, PA, USA
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Ryan TG, Juniat V, Stewart C, Malhotra R, Hardy TG, McNab AA, Davis G, Selva D. Clinico-radiological findings of neuroendocrine tumour metastases to the orbit. Orbit 2021; 41:44-52. [PMID: 33729098 DOI: 10.1080/01676830.2021.1895845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: We present the clinico-radiological findings of neuroendocrine tumour metastases to the orbit.Methods: This was a multicentre, retrospective study of patients with neuroendocrine tumour metastases to the orbit. Data was collected from medical records across five different sites within Australia and the United Kingdom.Results: Nine patients (eleven lesions) were identified. The most common presenting complaint was diplopia (5/9, 56%). Disease occurred bilaterally in two patients. Seven patients (78%) had extraocular muscle involvement. The lateral recti (4/9, 44%) and superior recti (2/9, 22%) were the most commonly affected. Ocular presentation preceded primary tumour diagnosis in three patients (33%). On orbital imaging, metastases were most commonly reported as well circumscribed, ovoid or round, heterogeneous, contrast-enhancing masses. Features of intralesional haemorrhage and bony invasion are uncommonly reported.Conclusions: Neuroendocrine tumour metastasis to the orbit is uncommon. Metastases have a propensity for the extraocular muscles, commonly presenting as heterogeneous, well circumscribed, contrast-enhancing lesions on neuroimaging. New ocular symptoms, a history of neuroendocrine tumours, and these radiological findings, should lead to high clinical suspicion of metastatic disease. Atypical findings warrant biopsy to exclude other causes of orbital lesions.
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Affiliation(s)
- T G Ryan
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - V Juniat
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - C Stewart
- Department of Ophthalmology, Gold Coast University Hospital, Gold Coast, Australia
| | - R Malhotra
- Oculoplastics Unit, East Grinstead Hospital, East Sussex, UK
| | - T G Hardy
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - A A McNab
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Centre for Eye Research Australia Ltd, University of Melbourne, East Melbourne, Australia
| | - G Davis
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - D Selva
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Gault A, Anderson A, Plummer R, Stewart C, Pratt A, Rajan N. Cutaneous immune‐related adverse events in patients with melanoma treated with checkpoint inhibitors. Br J Dermatol 2021; 185:263-271. [DOI: 10.1111/bjd.19750] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 12/24/2022]
Affiliation(s)
- A. Gault
- Translational and Clinical Research Institute Newcastle University Newcastle upon Tyne UK
- Northern Centre for Cancer Care Freeman Hospital Newcastle Upon Tyne UK
| | - A.E. Anderson
- Translational and Clinical Research Institute Newcastle University Newcastle upon Tyne UK
| | - R. Plummer
- Translational and Clinical Research Institute Newcastle University Newcastle upon Tyne UK
- Northern Centre for Cancer Care Freeman Hospital Newcastle Upon Tyne UK
| | - C. Stewart
- Translational and Clinical Research Institute Newcastle University Newcastle upon Tyne UK
| | - A.G. Pratt
- Translational and Clinical Research Institute Newcastle University Newcastle upon Tyne UK
| | - N. Rajan
- Translational and Clinical Research Institute Newcastle University Newcastle upon Tyne UK
- Department of Dermatology Royal Victoria Infirmary Newcastle upon Tyne UK
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Jawa R, Stein M, Anderson B, Liebschutz JM, Stewart C, Keosaian J, Barocas JA. 1549. Association of Skin Infections with Sharing of Injection Drug Preparation Equipment among People who Inject Drugs. Open Forum Infect Dis 2020. [PMCID: PMC7778059 DOI: 10.1093/ofid/ofaa439.1729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Sharing needles and injection drug preparation equipment (IDPE) among people who inject drugs (PWID) are well-established risk factors for viral transmission. Shared needles and IDPE may be a reservoir for bacteria and serve as a nidus for skin and soft tissue infections (SSTI). Given the rising rates of SSTIs in PWID, we investigated the association of needle and IDPE sharing on history and incidence of SSTI in a cohort of PWID. Methods Active inpatient PWID were recruited to a randomized control trial of a risk reduction intervention aimed at reducing bacterial and viral infections. A subset of participants (N=252) who injected drugs were included in the analysis. The primary dependent variable in this cross-sectional cohort study was self-reported incidence of SSTI one year post-hospitalization. We assessed three self-reported independent variables from baseline enrollment: 1) sharing needles, 2) sharing IDPE, and 3) sharing needles or IDPE and compared these groups separately to persons who reported not sharing via univariate and multi-level Poisson regression model estimating the adjusted effect of baseline sharing on incidence of SSTI during follow up. Results Participant characteristics: 37.9 years [mean]; 58% male; 90% primarily inject opioids, 43% inject with others, 13% shared IDPE only, 50% shared needles or IDPE. In general, persons who shared IDPE only compared to those who did not share were younger, more likely female, more likely Caucasian, were less likely to primarily inject opioids, and had a higher mean on the knowledge scale. We found no significant differences of prior self-reported SSTI. Adjusted for those randomized in the behavioral intervention arm for skin cleaning, persons who shared needles only and needles or IDPE had a higher incidence of SSTI compared with persons who did not share (IRR 1.90, 95% CI1.03-3.51, p=0.04; IRR 2.14, 95% CI 1.23-3.72 p=0.007). Persons who shared IDPE only did not have a statistically significant higher incidence of SSTI compared with persons who did not share (IRR 1.3, 95%CI 0.89-1.95 p=0.157). Conclusion In this cohort of hospitalized active PWID, we found a significant association between baseline sharing of needles or IDPE but not IDPE only with incidence of self-reported SSTI. Disclosures All Authors: No reported disclosures
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Affiliation(s)
| | - Michael Stein
- Boston University School of Public Health, Boston, Massachusetts
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Baudinet J, Simic M, Griffiths H, Donnelly C, Stewart C, Goddard E. Targeting maladaptive overcontrol with radically open dialectical behaviour therapy in a day programme for adolescents with restrictive eating disorders: an uncontrolled case series. J Eat Disord 2020; 8:68. [PMID: 33292696 PMCID: PMC7663904 DOI: 10.1186/s40337-020-00338-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/14/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Radically Open Dialectical Behaviour Therapy (RO-DBT) was developed to target maladaptive overcontrol, a proposed core difficulty of restrictive eating disorders. RO-DBT is now the main group treatment model at the Intensive day Treatment Programme (ITP), Maudsley Hospital. This ITP case series aimed to investigate whether overcontrol is associated with restrictive eating disorder symptoms in adolescents and to evaluate ITP outcomes since RO-DBT skills classes were introduced. METHOD Self-report measures of eating disorder symptoms and temperament, personality and social characteristics linked to overcontrol were collected at assessment and discharge from ITP for all consecutive adolescents who attended between February 2015 and January 2019 (N = 131). Weight change, global outcomes and treatment needs post-ITP were also recorded. RESULTS Eating disorder symptoms at assessment were significantly correlated with overcontrol factors, including social connectedness (r = -.67), reward responsivity (r = -.54), and cognitive inflexibility (r = .52). Adolescents stayed in ITP on average 13.40 weeks. 70.8% had a Good-Intermediate outcome on Morgan-Russell scale. 4.6% did not respond and were referred to inpatient treatment from ITP. Significant improvements in drive for thinness (d = .33), depressive mood (d = .41), social connectedness (d = .48), and emotional expressiveness (d = .97) were reported at discharge. No changes were observed in perfectionism or negative temperament. CONCLUSIONS This study offers preliminary evidence that eating disorder symptoms are associated with overcontrol factors in adolescence and that they can improve with RO-DBT informed day programme treatment. RO-DBT is a promising treatment that offers a new way of conceptualising treatment targets and recovery for adolescent restrictive eating disorders.
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Affiliation(s)
- Julian Baudinet
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK.
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Helena Griffiths
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Cecily Donnelly
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Catherine Stewart
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Elizabeth Goddard
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
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Gin K, Stewart C, Jolley S. A systematic literature review of childhood externalizing psychopathology and later psychotic symptoms. Clin Psychol Psychother 2020; 28:56-78. [DOI: 10.1002/cpp.2493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Kimberley Gin
- King's College London, Department of Psychology Institute of Psychiatry Psychology and Neuroscience London UK
| | - Catherine Stewart
- South London and Maudsley NHS Foundation Trust United Kingdom of Great Britain and Northern Ireland London UK
| | - Suzanne Jolley
- King's College London, Department of Psychology Institute of Psychiatry Psychology and Neuroscience London UK
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Kinnaird E, Dandil Y, Li Z, Smith K, Pimblett C, Agbalaya R, Stewart C, Tchanturia K. Pragmatic Sensory Screening in Anorexia Nervosa and Associations with Autistic Traits. J Clin Med 2020; 9:E1182. [PMID: 32326069 PMCID: PMC7230430 DOI: 10.3390/jcm9041182] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Research suggests that people with anorexia nervosa (AN) experience subjective hypersensitivity to external sensations that may require consideration in treatment. These difficulties may be particularly pronounced in people with AN and high autistic traits. The purpose of this pilot study was to explore the use of a brief screening tool to assess sensory sensitivity in individuals receiving treatment for AN, and to assess if self-rated sensitivity in AN is related to autistic traits. METHODS 47 individuals receiving treatment for AN completed a brief sensory screening tool and self-rated their autistic traits. Individuals were also asked to give qualitative feedback on the screening tool. RESULTS People with AN and high autistic traits rated themselves as more hypersensitive compared to people with AN and low autistic traits. Feedback surrounding the use of the screener was positive. CONCLUSIONS The results of this study suggest that the use of this screener may be beneficial in eating disorder settings to help adjust and calibrate treatment to personal needs, although further research and psychometric evaluation around the clinical use of the screener is required. The finding that people with AN and high autistic traits may experience elevated hypersensitivity also warrants further exploration in future research.
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Affiliation(s)
- Emma Kinnaird
- King’s College London, Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, London SE5 8AZ, UK
| | - Yasemin Dandil
- King’s College London, Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, London SE5 8AZ, UK
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London BR3 3BX, UK
| | - Zhuo Li
- King’s College London, Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, London SE5 8AZ, UK
| | - Katherine Smith
- King’s College London, Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, London SE5 8AZ, UK
| | - Caroline Pimblett
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London BR3 3BX, UK
| | - Rafiu Agbalaya
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London BR3 3BX, UK
| | - Catherine Stewart
- Child and Adolescent Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Kate Tchanturia
- King’s College London, Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, London SE5 8AZ, UK
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London BR3 3BX, UK
- Department of Psychology, Illia State University, Tbilisi 0162, Georgia
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Abstract
BACKGROUND There is a heightened prevalence of autism in anorexia nervosa (AN) compared to the general population. Autistic people with AN experience a longer illness duration and poorer treatment outcomes. Whether sensory differences in autism could contribute to altered taste and smell as a potential maintaining factor in AN is under-explored. The aim of this study was to explore whether autistic traits are associated with taste and olfaction differences in AN. METHODS The study recruited n = 40 people with AN, and n = 40 healthy controls (HC). Smell sensitivity was measured using the Sniffin' Sticks test. Taste sensitivity was measured using taste strips. Participants self-rated their autistic traits using the Autism Spectrum Quotient. RESULTS There were no significant differences on taste and olfactory outcomes between people with AN and HC. These findings did not change after controlling for the heightened levels of autistic traits in the AN group. No relationship between taste and smell outcomes and autistic traits were identified within the AN group. LIMITATIONS The current study is not able to draw conclusions about taste and smell processing in co-occurring autism and AN as it only measured levels of autistic traits, rather than comparing people with and without an autism diagnosis. CONCLUSIONS No significant associations between autistic traits and taste and smell processing in AN were identified. Future research should consider further exploring this area, including by comparing autistic women to women with AN.
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Affiliation(s)
- Emma Kinnaird
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
| | - Catherine Stewart
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK.
- Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK.
- Department of Psychology, Illia State University, Tbilisi, Georgia.
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McClelland J, Simic M, Schmidt U, Koskina A, Stewart C. Defining and predicting service utilisation in young adulthood following childhood treatment of an eating disorder. BJPsych Open 2020; 6:e37. [PMID: 32248870 PMCID: PMC7176893 DOI: 10.1192/bjo.2020.13] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Eating disorder services are often separated into child and adolescent eating disorder services (CAEDSs) and adult eating disorder services (AEDSs). Most patients in CAEDSs present with first-episode illness of short duration, which with appropriate treatment, have a good prognosis. However, some individuals receive further treatment as adults. Little is known about service utilisation in adulthood following childhood/adolescent treatment of an eating disorder. AIMS This study aims (a) to estimate the proportion of patients in a CAEDS who use mental health services as young adults, (b) to delineate service utilisation following treatment in CAEDSs and (c) to identify factors in CAEDSs that predict service utilisation in young adulthood. METHOD A consecutive cohort of 322 patients (aged 13-17 years) seen in a CAEDS in the UK over a 5-year period were included in this audit. Data regarding their use of UK-wide adult mental health services as young adults (i.e. when aged 18-25) were extracted from local and national hospital records. RESULTS A total of 68.3% of CAEDS patients received no mental health treatment as young adults. Although 13% of people seen in a CAEDS had brief eating disorder treatment as young adults, 10% received longer/or more intensive eating disorder treatment. Overall, 10.8% transitioned directly to an AEDS and 7.6% were re-referred following discharge from CAEDS. In our sample, older age and increased use of CAEDSs predicted increased eating disorder treatment in young adulthood. CONCLUSIONS Our results indicate that most people seen in CAEDSs do not receive further mental health treatment as young adults. Several features in CAEDSs distinguish mental health service utilisation in young adulthood, which were identified clinically and could be targeted during treatment.
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Affiliation(s)
- Jessica McClelland
- South London and Maudsley NHS Foundation Trust, UK; and Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, UK; and Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Ulrike Schmidt
- South London and Maudsley NHS Foundation Trust, UK; and Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Antonia Koskina
- South London and Maudsley NHS Foundation Trust, UK; and Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Catherine Stewart
- South London and Maudsley NHS Foundation Trust, UK; and Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Kinnaird E, Stewart C, Tchanturia K. Interoception in Anorexia Nervosa: Exploring Associations With Alexithymia and Autistic Traits. Front Psychiatry 2020; 11:64. [PMID: 32153442 PMCID: PMC7047099 DOI: 10.3389/fpsyt.2020.00064] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/24/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Previous research on whether interoception is altered in anorexia nervosa (AN) using the heartbeat tracking task has yielded inconsistent results. However, no previous research has examined whether interoception is associated with alexithymia and autistic traits in AN, conditions which are more prevalent in this population and thought to be related to performance in this task. The aim of this study was to explore whether altered interoception in AN is associated with alexithymia and autistic traits. METHODS We assessed interoceptive accuracy using the heartbeat tracking task in n = 37 people with AN, and n = 37 age and gender matched healthy controls (HC), and explored within the AN group if interoceptive accuracy was related to self-rated alexithymia or autistic traits. We also assessed self-reported interoceptive ability, and the relationship between subjective and actual performance. RESULTS Heartbeat tracking task performance was not found to be altered in the AN group compared to the HC group. However, confidence ratings in task performance in the AN group were lower compared to the HC group. Unlike the HC group, confidence ratings in the AN group did not correlate with task performance. Within the AN group there was no relationship between interoceptive accuracy, alexithymia, and autistic traits, after controlling for the potential confounders of anxiety and depression. There was a relationship between confidence ratings and illness severity in the AN group. CONCLUSION The results found no differences between heartbeat tracking task performance in people with AN compared to HC. There was no association between task performance, alexithymia and autistic traits in AN. Results do suggest that people with AN exhibit lowered confidence in their task performance, and that they may lack insight into this performance compared to HC. The findings are discussed in the context of potential significant limitations of the heartbeat tracking task, with recommendations for future research into interoception in AN.
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Affiliation(s)
| | - Catherine Stewart
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Kate Tchanturia
- Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Psychology, Ilia State University, Tbsili, Georgia
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Broomfield A, Davison J, Roberts J, Stewart C, Hensman P, Beesley C, Tylee K, Rust S, Schwahn B, Jameson E, Vijay S, Santra S, Sreekantam S, Ramaswami U, Chakrapani A, Raiman J, Cleary MA, Jones SA. Ten years of enzyme replacement therapy in paediatric onset mucopolysaccharidosis II in England. Mol Genet Metab 2020; 129:98-105. [PMID: 31383595 DOI: 10.1016/j.ymgme.2019.07.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 06/20/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 11/23/2022]
Abstract
The outcome of 110 patients with paediatric onset mucopolysaccharidosis II (MPS II) since the commercial introduction of enzyme replacement therapy (ERT) in England in 2007 is reported. Median length of follow up was 10 years 3 months (range = 1 y 2 m to 18 years 6 month). 78 patients were treated with ERT, 18 had no ERT or disease modifying treatment 7 had haematopoietic stem cell transplant, 4 experimental intrathecal therapy and 3 were lost to follow up. There is clear evidence of improved survival (median age of death of ERT treated (n = 16) = 15.13 years (range = 9.53 to 20.58 y), and untreated (n = 17) = 11.43 y (0.5 to 19.13 y) p = .0005). Early introduction of ERT improved respiratory outcome at 16 years, the median FVC (% predicted) of those in whom ERT initiated <8 years = 69% (range = 34-86%) and 48% (25-108) (p = .045) in those started >8 years. However, ERT appears to have minimal impact on hearing, carpal tunnel syndrome or progression of cardiac valvular disease. Cardiac valvular disease occurred in 18/46 (40%), with progression occurring most frequently in the aortic valve 13/46 (28%). The lack of requirement for neurosurgical intervention in the first 8 years of life suggests that targeted imaging based on clinical symptomology would be safe in this age group after baseline assessments. There is also emerging evidence that the neurological phenotype is more nuanced than the previously recognized dichotomy of severe and attenuated phenotypes in patients presenting in early childhood.
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Affiliation(s)
- A Broomfield
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Foundation Trust, Manchester M13 9WL, UK.
| | - J Davison
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - J Roberts
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Foundation Trust, Manchester M13 9WL, UK
| | - C Stewart
- Department of Inherited Metabolic Disorders, Birmingham Women's and Children's Hospital Foundation Trust, Steelhouse Lane, Birmingham, UK
| | - P Hensman
- Department of Physiotherapy, Royal Manchester Children's Hospital, Manchester Foundation Trust, Manchester M13 9WL, UK
| | - C Beesley
- Regional Genetics Laboratories, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - K Tylee
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Foundation Trust, Manchester M13 9WL, UK
| | - S Rust
- Department of Psychology, Royal Manchester Children's Hospital, Manchester Foundation Trust, Manchester M13 9WL, UK
| | - B Schwahn
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Foundation Trust, Manchester M13 9WL, UK
| | - E Jameson
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Foundation Trust, Manchester M13 9WL, UK
| | - S Vijay
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - S Santra
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - S Sreekantam
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - U Ramaswami
- Lysosomal Disorders Unit, Institute of Immunity and Transplantation, Royal Free London NHS Foundation Trust, Pond Street, London NW32QG, UK
| | - A Chakrapani
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - J Raiman
- Department of Inherited Metabolic Disorders, Birmingham Women's and Children's Hospital Foundation Trust, Steelhouse Lane, Birmingham, UK
| | - M A Cleary
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - S A Jones
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Foundation Trust, Manchester M13 9WL, UK
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Monteiro J, Phillips KT, Herman DS, Stewart C, Keosaian J, Anderson BJ, Stein MD. Self-treatment of skin infections by people who inject drugs. Drug Alcohol Depend 2020; 206:107695. [PMID: 31786397 DOI: 10.1016/j.drugalcdep.2019.107695] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/17/2019] [Accepted: 10/19/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Persons who inject drugs (PWID) experience high rates of skin and soft tissue infections (SSTI) and often access emergency or inpatient treatment. However, many PWID do not seek care and self-treat some or all of their infections. The goal of the current study was to examine predictors of self-treatment of SSTI in a sample of hospitalized PWID, and describe methods of and reasons for self-treatment. METHODS PWID (N = 252) were recruited from inpatient medical units at an urban safety-net hospital to join a behavioral intervention trial. The baseline interview focused on past-year SSTI incidence and related treatment, including reasons for not accessing medical care and methods of self-treatment. RESULTS Of study participants, 162 (64%) reported having at least one SSTI in the past year. This subset was 59.9% White/Caucasian with a mean age of 38.0 (SD + 10.5). One-third of these participants (32.3%) reported ever self-treating SSTI in the past year. In a logistic regression model, number of past-year infections (OR = 1.81, p < .001) and positive outlook (OR = 2.46, p < .001) were associated with self-treatment of SSTI. Common methods of self-treatment included mechanically draining sores, applying heat/warm compress, and cleaning affected areas. Continued drug use and belief that infections were not serious and could be self-treated were two main reasons for not seeking professional medical care. CONCLUSIONS Interventions targeting SSTI among PWID should include education on when to seek medical care and the risks of serious infection, and could be implemented at local clinics or harm reduction programs to increase access.
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Affiliation(s)
- Jordanna Monteiro
- Boston University School of Public Health and Boston Medical Center, 715 Albany Street, 2nd Floor, Boston, MA 02118, USA.
| | - Kristina T Phillips
- Center for Integrated Health Care Research (CIHR), Kaiser Permanente 501 Alakawa Street, Suite 201, Honolulu, Hawaii 96817 USA.
| | - Debra S Herman
- Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906 USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Catherine Stewart
- Boston University School of Public Health and Boston Medical Center, 715 Albany Street, 2nd Floor, Boston, MA 02118, USA.
| | - Julia Keosaian
- Boston University School of Public Health and Boston Medical Center, 715 Albany Street, 2nd Floor, Boston, MA 02118, USA.
| | | | - Michael D Stein
- Boston University School of Public Health and Boston Medical Center, 715 Albany Street, 2nd Floor, Boston, MA 02118, USA; Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906 USA.
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Abstract
Background Although research suggests a relationship between restrictive eating disorders (EDs) and autism, there is a lack of research in this area from the perspective of autistic men. Our aim was to explore whether ED symptoms are heightened in autistic men compared with nonautistic men. Methods We recruited 103 autistic and nonautistic participants through an online study. We assessed ED symptoms, autistic features, anxiety, depression, and body mass index (BMI) using self-report measures. Results Autistic men (n = 54) exhibited significantly higher levels of ED symptoms in the areas of eating (p < 0.001), shape (p = 0.005), and weight (p = 0.001) concerns, and the global score (p = 0.046) than nonautistic men (n = 49). However, autistic men scored significantly lower in the area of dietary restraint (p = 0.032). Global ED scores did not correlate with autistic traits, but did correlate with anxiety (p < 0.001) and BMI (p < 0.001) in the autistic group. Conclusions This exploratory study suggests that heightened ED symptoms in autistic men may be related to heightened levels of anxiety and higher BMIs, rather than autistic traits. It also highlights that autistic men may experience symptoms not relating to dietary restraint. Future research should consider further exploring the relationship between anxiety, BMI, and disordered eating in autism. Lay Summary Why was this study done?: There is a lot of interest in the relationship between autism and eating disorders (EDs). Research suggests that as many as one in four people with anorexia could be autistic. However, most research has been done (1) on women and (2) looking at autistic traits in women with anorexia. There is less research looking at the relationship from the perspective (1) of men and (2) looking at ED symptoms in autistic people.What was the purpose of this study?: We aimed to explore whether autistic men experience more ED symptoms than nonautistic men.What did the researchers do?: This was an online study. We asked participants to fill out self-report measures of autistic traits and ED symptoms. We also asked participants to self-report whether they were autistic, and whether they had been previously diagnosed with an ED. We included 54 autistic men and 49 nonautistic men.What were the results of the study?: We found that although autistic men did experience higher levels of ED symptoms than nonautistic men, this did not appear to be related to autistic traits. Instead ED symptoms were related to anxiety and higher rates of being overweight or obese. In addition, autistic men in fact experienced significantly lower levels of ED symptoms associated with dietary restraint than nonautistic men.What do these findings add to what was already known?: Our findings reflect some previous research findings that ED symptoms may be heightened in autistic people. They also suggest that these symptoms are related to higher levels of anxiety or body mass indexes (BMIs) in autistic people, rather than autistic traits themselves. Also, most previous research has focused on symptoms of restraint in EDs and autism, for example, limiting the amount you eat or not eating certain foods. In our study, restraint was not found to be heightened, suggesting that focusing on restraint symptoms might be less relevant to autistic men.What are potential weaknesses in the study?: One key weakness is our use of self-report measures, particularly asking participants to self-report their autism diagnosis. An additional limitation is the small sample size, which makes it hard to generalize findings.How will these findings help autistic adults now or in the future?: More research is needed to understand the relationship between anxiety, BMI, autism, and ED symptoms. Our findings could help our understanding of disordered eating in autistic adults as they suggest we need to pay more attention to autistic adults experiencing ED symptoms that are not related to dietary restriction, such as binge eating.
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Affiliation(s)
- Emma Kinnaird
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Felicity Sedgewick
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Catherine Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Illia State University, Tbilisi, Georgia
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Alkhalil M, Kearney A, Hegarty M, Stewart C, Devlin P, Owens CG, Spence MS. Eosinopenia as an Adverse Marker of Clinical Outcomes in Patients Presenting with Acute Myocardial Infarction. Am J Med 2019; 132:e827-e834. [PMID: 31152721 DOI: 10.1016/j.amjmed.2019.05.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/12/2019] [Accepted: 05/14/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Eosinopenia is considered a surrogate of inflammation in several disease settings. Following ST-segment elevation myocardial infarction, eosinopenia is presumed to be a marker of infarct severity. We sought to study the relationship between eosinopenia and infarct severity and how this relationship determined the long-term outcomes following ST-segment elevation myocardial infarction. METHODS Six hundred and six consecutive patients undergoing primary percutaneous coronary interventions from a large volume single center were enrolled. Low eosinophil count was defined as < 40 cells/mL from samples within 2 hours after reperfusion. Primary endpoint was defined as composite of death, myocardial infarction, stroke, unplanned revascularization, and readmission for heart failure over 3.5 years' follow-up. RESULTS Sixty-five percent of the patients had eosinopenia. Patients in the low eosinophil group had larger infarct size as measured by troponin value (2934 vs 1177 ng/L, P < .001) and left ventricle systolic function on echocardiography (48% vs 50%, P = 0.029). There was a weak correlation between eosinophil count and both troponin (r = -0.25, P < 0.001) and ejection fraction (r = 0.10, P = .017). The primary endpoint was higher in eosinopenic patients (28.8% vs. 20.4%; hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.05 to 2.13, P = .023). A discordance between eosinopenia and severe left ventricle systolic dysfunction was observed in 55.6% of cases. Compared with normal count, eosinopenia was associated with worse clinical outcomes in patients with non-severe left ventricle dysfunction (24.1% vs 16.2%; HR 1.58, 95% CI 1.01 to 2.45, P = .044) but not in those with severe left ventricle dysfunction (42.3% vs. 38.9%; HR 1.10, 95% CI 0.59 to 2.03, P = .77) (P < .01 for interaction). CONCLUSIONS Eosinopenia is an easily determined marker that reflects worse clinical outcomes over long-term follow-up.
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Affiliation(s)
| | - Aileen Kearney
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
| | - Mairead Hegarty
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
| | | | - Peadar Devlin
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
| | - Colum G Owens
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
| | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
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Gay C, Diao L, Stewart C, Xi Y, Cardnell R, Swisher S, Roth J, Glisson B, Wang J, Heymach J, Byers L. OA03.06 ASCL1, NEUROD1, and POU2F3 Drive Distinct Subtypes of Small Cell Lung Cancer with Unique Therapeutic Vulnerabilities. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.421] [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: 10/25/2022]
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Kinnaird E, Norton C, Pimblett C, Stewart C, Tchanturia K. "There's nothing there for guys". Do men with eating disorders want treatment adaptations? A qualitative study. Eat Weight Disord 2019; 24:845-852. [PMID: 31471886 PMCID: PMC6751275 DOI: 10.1007/s40519-019-00770-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/12/2019] [Accepted: 08/21/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Men with eating disorders may experience unique issues compared to their female counterparts, and there is a growing interest in how these differences should be addressed in clinical practice. However, the views of male patients on potential treatment adaptations remain under-explored. The purpose of this study was to explore the experiences of men who have experienced treatment for eating disorders. METHODS Men who had experienced eating disorder treatment were recruited through UK National Health Service eating disorder services and online advertising. 14 participants took part in semi-structured interviews discussing their experiences of treatment, and their views on the need for adaptations. Interviews were analysed using thematic analysis. RESULTS Three main themes were identified from the analysis: a preference for person-centred, rather than gender-centred treatment, a feeling of being "the odd one out" as men in current treatment environments, and recommendations for treatment adaptations. CONCLUSIONS Participants described wanting to be treated as individuals and not defined by their gender. Whilst existing treatment approaches were mostly felt to achieve this individual focus, the actual treatment setting may inadvertently reinforce a perception of atypicality due to being men in a female-dominated environment. Adaptations may therefore be required to make the treatment environment more male friendly. Clinical recommendations are outlined. LEVEL OF EVIDENCE V. Qualitative study.
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Affiliation(s)
- Emma Kinnaird
- Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 103 Denmark Hill, SE5 8AZ, London, UK
| | | | | | - Catherine Stewart
- Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 103 Denmark Hill, SE5 8AZ, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Kate Tchanturia
- Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 103 Denmark Hill, SE5 8AZ, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
- Illia State University, Tbilisi, Georgia.
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