1
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Lewis NM, Smeltzer RP, Baker TJ, Sahovey AC, Baez J, Hensel E, Poole B, Stewart C, Cogan AG, Bullard M, Taylor JL. Feasibility of paying people who use drugs cash to distribute naloxone within their networks. Harm Reduct J 2024; 21:42. [PMID: 38365734 PMCID: PMC10870496 DOI: 10.1186/s12954-024-00947-6] [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: 12/21/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Immediate access to naloxone is needed to prevent fatal opioid-related overdoses in the presence of fentanyl analogs saturating the opioid supply. Peer models engage impacted populations who are not accessing naloxone through standard venues, yet compensating peers who utilize syringe service programs with cash stipends to distribute naloxone within networks of people who use drugs is not well described. METHODS As part of the HEALing Communities Study, syringe service program-based interventions were developed in Holyoke and Gloucester, MA, which paid people who use drugs ("peers") cash to distribute naloxone. Early program outcomes were evaluated for the time each program was funded within the HCS study period. RESULTS During 22 study-months of observation, peers in two communities distributed 1104 naloxone kits. The total cost of peer compensation for program delivery was $10,510. The rate of peer-distributed naloxone per 100 K population reached 109 kits/mo and 222 kits/mo in the two communities. Participating peers addressed gaps in harm reduction outreach and distributed naloxone and other harm reduction equipment to individuals who were not syringe service program participants, expanding organizational reach. Being compensated with unrestricted cash stipends supported dignity and acknowledged peers' work in overdose prevention. CONCLUSION The underutilization of compensated peer models is often attributed to funding and organizational barriers. These programs demonstrate that providing cash stipends to peers is feasible and expanded naloxone distribution at two existing syringe service programs. Providing cash stipends for peers who engage in secondary naloxone distribution offers promise in delivering naloxone to people not accessing syringe services.
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Affiliation(s)
- Nikki M Lewis
- Berkshire Regional Planning Commission, Pittsfield, MA, USA.
| | - Rebecca P Smeltzer
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Trevor J Baker
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Andrea C Sahovey
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Justine Baez
- ONESTOP Harm Reduction Center, Gloucester, MA, USA
| | | | | | | | - Allyson G Cogan
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Mackenzie Bullard
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Jessica L Taylor
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Boston University, Chobanian and Avedisian School of Medicine, Boston, MA, USA
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2
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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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3
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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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4
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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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5
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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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6
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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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7
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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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8
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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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9
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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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10
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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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11
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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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12
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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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13
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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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14
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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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15
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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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16
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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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17
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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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18
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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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19
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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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20
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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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21
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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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22
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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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23
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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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24
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Zwakhalen S, Docking RE, Gnass I, Sirsch E, Stewart C, Allcock N, Schofield P. Pain in older adults with dementia : A survey across Europe on current practices, use of assessment tools, guidelines and policies. Schmerz 2019; 32:364-373. [PMID: 29931391 DOI: 10.1007/s00482-018-0290-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND We aimed to explore the existing use of pain assessment tools and guidelines, and develop understanding of the practical considerations required to facilitate their use within the nursing home, hospital and community settings. METHODS A self-administered web-based survey was conducted with nurses, health and social care workers with an interest in the assessment of pain in older adults with cognitive impairment. The survey was distributed to participants in Austria, Belgium, Denmark, Germany, The Netherlands, Switzerland and United Kingdom. RESULTS Only a minority of staff reported use of (inter-)national or local standards or specific pain assessment tools in daily practice. A range of tools were reported as being used, which varied across country. While participants generally reported that these pain assessment tools were easy/very easy to use, many participants reported that they were difficult to interpret. Assessment is generally performed whilst providing nursing care. This was highlighted in 70-80% of all participating countries. While many of these tools rely on facial expression of pain, facial expressions were considered to be the least useful in comparison to other items. Furthermore findings showed that nurses employed in long-term care settings did not feel that they were educated enough in pain assessment and management. CONCLUSION Our findings suggest that pain education is required across all countries surveyed. This should include a focus on guidelines and standards for assessment and subsequent management of pain. Findings suggest that clinical staff find interpreting facial expressions in relation to pain more difficult.
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Affiliation(s)
- S Zwakhalen
- School for Public Health and Primary Care (CAPHRI), Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.,Faculty of Education and Health, Department of Adult Nursing and Paramedic Sciences, University of Greenwich, London, UK
| | - R E Docking
- Faculty of Education and Health, Department of Adult Nursing and Paramedic Sciences, University of Greenwich, London, UK
| | - I Gnass
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
| | - E Sirsch
- Faculty of Nursing Science, Philosophisch-Theologische Hochschule Vallendar (Catholic University), Vallendar, Germany
| | - C Stewart
- NHS Research Scotland, The Golden Jubilee National Hospital, Clydebank, UK
| | - N Allcock
- Professional and Clinical Development Lead, InHealth Pain Management Solutions Limited, Barnsley, UK
| | - P Schofield
- Faculty of Education and Health, Department of Adult Nursing and Paramedic Sciences, University of Greenwich, London, UK
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25
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Holden A, Stewart C. A review of the law of consent in dentistry. Aust Dent J 2019; 64:208-212. [PMID: 31264231 DOI: 10.1111/adj.12707] [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] [Accepted: 06/26/2019] [Indexed: 12/01/2022]
Abstract
The development of the law of consent has led to much discussion within the dental literature as to how these changes might impact practice. The move from a practitioner-focused standard of consent to a patient-focused standard has altered the nature of the framework required to support a patient's decision-making to avoid an allegation or finding of a negligent consent process. Contrastingly, there has been little in the way of exploration as to how the law of battery (in civil matters) and assault (in criminal cases), where consent is entirely absent, might apply to dentistry and the practice of the profession. This article considers the law of consent, using several key examples from dentistry, as well as providing an update of recent case law of relevance to dental practice.
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Affiliation(s)
- Acl Holden
- Faculty of Medicine and Health, The University of Sydney School of Dentistry, Westmead, New South Wales, Australia
| | - C Stewart
- The University of Sydney Law School, Law School Building, The University of Sydney, Sydney, New South Wales, Australia
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26
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Roberts SA, Brabin L, Diallo S, Gies S, Nelson A, Stewart C, Swinkels DW, Geurts-Moespot AJ, Kazienga A, Ouedraogo S, D'Alessandro U, Tinto H, Brabin BJ. Mucosal lactoferrin response to genital tract infections is associated with iron and nutritional biomarkers in young Burkinabé women. Eur J Clin Nutr 2019; 73:1464-1472. [PMID: 31168085 PMCID: PMC6842079 DOI: 10.1038/s41430-019-0444-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/29/2019] [Accepted: 05/19/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVES The iron-binding affinity of vaginal lactoferrin (Lf) reduces iron available to genital pathogens. We describe host reproductive, nutritional, infection and iron biomarker profiles affecting vaginal Lf concentration in young nulliparous and primigravid women in Burkina Faso. SUBJECTS/METHODS Vaginal eluates from women who had participated in a randomized, controlled periconceptional iron supplementation trial were used to measure Lf using a competitive double-sandwich ELISA. For this analysis samples from both trial arms were combined and pregnant and non-pregnant cohorts compared. Following randomization Lf was measured after 18 months (end assessment) for women remaining non-pregnant, and at two antenatal visits for those becoming pregnant. Associations between log Lf levels and demographic, anthropometric, infection and iron biomarker variables were assessed using linear mixed models. RESULTS Lf samples were available for 712 non-pregnant women at end assessment and for 303 women seen at an antenatal visit. Lf concentrations of pregnant women were comparable to those of non-pregnant, sexually active women. Lf concentration increased with mid-upper-arm circumference, (P = 0.047), body mass index (P = 0.018), Trichomonas vaginalis (P < 0.001) infection, bacterial vaginosis (P < 0.001), serum C-reactive protein (P = 0.048) and microbiota community state types III/IV. Adjusted Lf concentration was positively associated with serum hepcidin (P = 0.047), serum ferritin (P = 0.018) and total body iron stores (P = 0.042). There was evidence that some women maintained persistently high or low Lf concentrations from before, and through, pregnancy. CONCLUSION Lf concentrations increased with genital infection, higher BMI, MUAC, body iron stores and hepcidin, suggesting nutritional and iron status influence homeostatic mechanisms controlling vaginal Lf responses.
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Affiliation(s)
- S A Roberts
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - L Brabin
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - S Diallo
- Clinical Research Unit of Nanoro (URCN/IRSS), Nanoro, Burkina Faso
| | - S Gies
- Department of Biomedical Sciences, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium and Medical Mission Institute, Würzburg, Germany
| | - A Nelson
- Faculty of Health and Life Sciences, University of Northumbria, Northumberland Building, Newcastle-upon-Tyne, UK
| | - C Stewart
- Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - D W Swinkels
- Department of Laboratory Medicine (TLM 830), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.,Hepcidinanalysis.com., Nijmegen, The Netherlands
| | - A J Geurts-Moespot
- Department of Laboratory Medicine (TLM 830), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - A Kazienga
- Clinical Research Unit of Nanoro (URCN/IRSS), Nanoro, Burkina Faso
| | - S Ouedraogo
- Clinical Research Unit of Nanoro (URCN/IRSS), Nanoro, Burkina Faso
| | - U D'Alessandro
- Medical Research Council Unit (MRC), Fajara, The Gambia.,London School of Hygiene and Tropical Medicine, London, UK
| | - H Tinto
- Clinical Research Unit of Nanoro (URCN/IRSS), Nanoro, Burkina Faso
| | - B J Brabin
- Liverpool School of Tropical Medicine, and Institute of Infection and Global Health, University of Liverpool, Liverpool, UK. .,Global Child Health Group, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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27
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Waldby C, Hendl T, Munsie M, Lysaght T, Lipworth W, Kerridge I, Stewart C. Autologous stem cell-based interventions in Australia: exploring patient experience in light of regulatory exceptionalism. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.324] [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: 10/26/2022]
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28
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Stutts K, Brindza E, Anderson M, Stewart C. PSXV-29 Growth and development of bottle-fed white-tailed deer (Odocoileus virginianus) fawns consuming different milk replacers. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.1036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Stutts
- Sam Houston State University,Huntsville, AL, United States
| | - E Brindza
- Sam Houston State University,Huntsville, TX, United States
| | - M Anderson
- Sam Houston State University,Huntsville, TX, United States
| | - C Stewart
- Sam Houston State University,Huntsville, TX, United States
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29
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Tsimberidou AM, Ma H, Stewart C, Schoor O, Maurer D, Mendrzyk R, Satelli A, Fritsche J, Stephens G, Mohamed A, Hwu P, Yee C, Reinhardt C, Weinschenk T, Gharpure K, Stungis A, Vining D, Singh H, Walter S, Andersson B. Phase I adoptive cellular therapy trial with ex-vivo stimulated autologous CD8+ T-cells against multiple targets (ACTolog® IMA101) in patients with relapsed and/or refractory solid cancers. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy288.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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30
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Hurley E, Stewart C, Gallagher C, Kinirons M. Decisions on repositioning of intruded permanent incisors; a review and case presentation. Eur J Paediatr Dent 2018; 19:101-104. [PMID: 29790773 DOI: 10.23804/ejpd.2018.19.02.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Traumatic intrusion is a luxation type of injury where the tooth is displaced along the axis of the tooth, into the alveolus. This injury is regarded as serious because of the tissue damage that it causes. The traumatic movement is associated with severe damage to the periodontal ligament, pulpal tissue, root and alveolar socket. Despite its severity, the rare occurrence of this injury in permanent teeth has resulted in limited studies of immature and mature permanent incisors. The purpose of this paper is to review this luxation injury of permanent immature incisors, and to describe its diagnosis, treatment and management. In particular, we describe the repositioning strategies used in cases of intrusion injury. These include (i) monitoring spontaneous re-eruption, (ii) active orthodontic repositioning and (iii) surgical repositioning. Firstly, monitoring spontaneous re-eruption is observing and waiting for the intruded tooth to return to its original position. This process is not a normal developmental eruption and the outcome is not always predictable, nor is the time needed for this to happen. Secondly, active orthodontic repositioning is used to describe the process of rapidly moving the intruded tooth to its original position with the aid of an orthodontic appliance. Active orthodontic repositioning is often misunderstood as normal orthodontic movement. Orthodontic movement allows for periodontal ligament remodelling, using light intermittent forces. In contrast the active orthodontic repositioning used to move intruded incisors is rapid, and the primary aim is to achieve correct tooth position as rapidly as possible. Thirdly, surgical repositioning uses surgical intervention to bring the tooth back to its original position. A case of an intruded immature permanent incisor is presented, with a particular emphasis on these critical decisions on repositioning and showing the use of the three modalities of treatment in sequence, in order to achieve an outcome.
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Affiliation(s)
- E Hurley
- Cork University Dental School & Hospital, University College Cork, Ireland
| | - C Stewart
- Cork University Dental School & Hospital, University College Cork, Ireland
| | - C Gallagher
- Cork University Dental School & Hospital, University College Cork, Ireland
| | - M Kinirons
- Cork University Dental School & Hospital, University College Cork, Ireland
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31
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Stewart C, Bench S. Evaluating the implementation of confusion assessment method-intensive care unit using a quality improvement approach. Nurs Crit Care 2018; 23:172-178. [PMID: 29766622 DOI: 10.1111/nicc.12354] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/22/2018] [Accepted: 03/21/2018] [Indexed: 02/01/2023]
Abstract
Quality improvement (QI) is a way through which health care delivery can be made safer and more effective. Various models of quality improvement methods exist in health care today. These models can help guide and manage the process of introducing changes into clinical practice. The aim of this project was to implement the use of a delirium assessment tool into three adult critical care units within the same hospital using a QI approach. The objective was to improve the identification and management of delirium. Using the Model for Improvement framework, a multidisciplinary working group was established. A delirium assessment tool was introduced via a series of educational initiatives. New local guidelines regarding the use of delirium assessment and management for the multidisciplinary team were also produced. Audit data were collected at 6 weeks and 5 months post-implementation to evaluate compliance with the use of the tool across three critical care units within a single hospital in London. At 6 weeks, in 134 assessment points out of a possible 202, the tool was deemed to be used appropriately, meaning that 60% of patients received timely assessment; 18% of patients were identified as delirious in audit one. Five months later, only 95 assessment points out of a possible 199 were being appropriately assessed (47%); however, a greater number (32%) were identified as delirious. This project emphasizes the complexity of changing practice in a large busy critical care centre. Despite an initial increase in delirium assessment, this was not sustained over time. The use of a QI model highlights the continuous process of embedding changes into clinical practice and the need to use a QI method that can address the challenging nature of modern health care. QI models guide changes in practice. Consideration should be given to the type of QI model used.
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Affiliation(s)
- C Stewart
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - S Bench
- School of Health and Social Care, London South Bank University, London, UK
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32
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Lysaght T, Munsie M, Hendl T, Tan L, Kerridge I, Stewart C. Selling stem cells with tokens of legitimacy: An analysis of websites in Japan and Australia. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.218] [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: 10/17/2022]
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Petit G, Maillet G, Nault-Horvath E, Stewart C, O'Sullivan T. The Lac-Mégantic Photovoice Initiative. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx186.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Petit
- University of Sherbrooke/Department of Public Health Estrie, Lac-Méantic, Canada
| | - G Maillet
- University of Sherbrooke/Department of Public Health Estrie, Lac-Méantic, Canada
| | | | - C Stewart
- Department of Public Health Estrie, Lac-Mégantic, Canada
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O'Neil D, Stewart C, Chu D, Goodspeed D, Gonzalez-Rodriguez P, Aagaard K. The hepatic expressed circadian gene Npas2 influences the metabolic response to a restricted feeding diet and the developing gut microbiome. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.763] [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: 10/18/2022]
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35
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Scanlan CL, Stewart C, Kerridge I. Trust, not education, is the key to consent in hematopoietic cell transplant: in response to D'Souza, Pasquini and Spellecy. Bone Marrow Transplant 2017; 52:1658. [PMID: 28692023 DOI: 10.1038/bmt.2017.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- C L Scanlan
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia
| | - C Stewart
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia.,Sydney Law School, University of Sydney, Sydney, NSW, Australia
| | - I Kerridge
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia.,Haematology Department, Royal North Shore Hospital, Sydney, NSW, Australia
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36
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Wen F, Stewart C, Armstrong G, Burke G, Land L, Miller C, Clifton B. PREDICTORS OF SATISFACTION WITH AGING IN PLACE: THE ROLE OF HOME- AND COMMUNITY-BASED SERVICES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F. Wen
- Family and Community Medicine, OU-TU School of Community Medicine, Tulsa, Oklahoma,
| | - C. Stewart
- College of Nursing, University of Oklahoma Health Sciences Center, Tulsa, Oklahoma,
| | - G. Armstrong
- Family and Community Medicine, OU-TU School of Community Medicine, Tulsa, Oklahoma,
| | - G. Burke
- Morton Comprehensive Health Services, Tulsa, Oklahoma,
| | - L. Land
- LIFE Senior Services, Tulsa, Oklahoma,
| | - C. Miller
- INCOG Area Agency on Aging, Tulsa, Oklahoma,
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37
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Wu JJ, Penfold RB, Primatesta P, Fox TK, Stewart C, Reddy SP, Egeberg A, Liu J, Simon G. The risk of depression, suicidal ideation and suicide attempt in patients with psoriasis, psoriatic arthritis or ankylosing spondylitis. J Eur Acad Dermatol Venereol 2017; 31:1168-1175. [PMID: 28214371 DOI: 10.1111/jdv.14175] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/25/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Sparse information is available concerning mental health issues in psoriasis, psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients. OBJECTIVE To estimate risk of depression, suicidal ideation and suicide attempt in patients with psoriasis, PsA and AS, respectively, compared with the general population. METHODS This population-based cohort study analysed 36 214 psoriasis patients, 5138 PsA patients and 1878 AS patients who were frequency-matched with a general population cohort. Annual incidence rate of depression, suicidal ideation and suicide attempt was calculated separately for psoriasis, PsA and AS. RESULTS There was an increased risk of depression in the three cohorts; adjusted IRR: psoriasis, 1.14 (95% CI, 1.11, 1.17); PsA, 1.22 (95% CI, 1.16, 1.29); AS, 1.34 (95% CI, 1.23, 1.47). There was no significantly increased risk for suicidal ideations or suicide attempt among psoriasis, PsA or AS patients. LIMITATIONS Patients were not excluded if previously diagnosed with depression, suicidal ideation or suicide attempt. Suicide attempt and completed suicide analyses were not adjusted for presence of depression. Use of systemic psoriasis treatment to measure severe psoriasis could lead to psoriasis severity misclassification. CONCLUSION The risk of depression, but not suicidal ideation or suicide attempt, was significantly increased in patients with psoriasis, PsA and AS.
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Affiliation(s)
- J J Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - R B Penfold
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA
| | - P Primatesta
- Quantitative Safety & Epidemiology, Novartis Pharma AG, Basel, Switzerland
| | - T K Fox
- Global Medical Affairs, Novartis Pharma AG, Basel, Switzerland
| | - C Stewart
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA
| | - S P Reddy
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - A Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - J Liu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - G Simon
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA
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Fitzsimons D, Mullan D, Wilson J, Chew E, Conway B, Corcoran B, Gamble J, Hanna L, Mcmullan G, Mcma-Hon M, Mulholland P, Stewart C, Stockdale P. 1375: The palliative care needs of patients with heart failure from the perspective of the patient, carer and clinical team. Eur J Cardiovasc Nurs 2017. [DOI: 10.1177/14745151060050s163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- D. Fitzsimons
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
- Institute of Nursing Research, University of Ulster
| | - D. Mullan
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - J. Wilson
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - E. Chew
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - B. Conway
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - B. Corcoran
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - J. Gamble
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - L. Hanna
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - G. Mcmullan
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - M. Mcma-Hon
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - P. Mulholland
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - C. Stewart
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - P. Stockdale
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
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Yafi F, DeLay K, Stewart C, Chiang J, Sangkum P, Hellstrom W. 007 Device Survival Following Primary Implantation of the AMS 800 Artificial Urinary Sphincter for Male Stress Urinary Incontinence. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2016.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ireland G, Higgins S, Goorney B, Ward C, Ahmad S, Stewart C, Simmons R, Lattimore S, Lee V. Evaluation of hepatitis C testing in men who have sex with men, and associated risk behaviours, in Manchester, UK. Sex Transm Infect 2017; 93:404-409. [PMID: 28130506 DOI: 10.1136/sextrans-2016-052876] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/03/2017] [Accepted: 01/08/2017] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To determine the prevalence of newly diagnosed hepatitis C virus (HCV) and associated risk behaviours among men who have sex with men (MSM) in Manchester. METHOD A survey among MSM attending four genitourinary medicine clinics in Manchester was carried out over 9 months in 2013. Participants were asked about recent sexual behaviour, recreational drug use and HIV status. All men were offered an HCV test. RESULTS Overall, 2030 MSM completed a questionnaire and accepted an HCV test. Of whom, 0.9% (18) were newly diagnosed with HCV, including 1.8% (13/735) of HIV-positive MSM, 0.7% (3/440) of MSM of unknown HIV status and 0.2% (2/855) of HIV-negative MSM. HCV positivity was significantly associated with HIV status (p<0.001). When compared with HIV-negative MSM, HIV-positive MSM had higher rates of sharing snorting drug equipment, injecting drugs/'slamming' and using recreational drugs (all p<0.05) but lower rates of five or more sexual partners and insertive unprotected anal intercourse (p<0.05). MSM newly diagnosed with HCV had significantly higher prevalence of unprotected sex, sex with someone HCV positive, fisting, group sex, ever injecting drugs/'slamming' and recreational drug use (p<0.002). CONCLUSIONS In this survey, HIV-positive MSM had significantly different drug use behaviour which may explain the higher HCV burden. However, HCV was also associated with HIV-negative MSM engaging in high-risk sexual practices. All MSM attending sexual health clinics must have a risk assessment and HCV screening should be offered based on the risk. Further studies are warranted to explore the interplay between HCV and HIV risk associated with drug use versus sexual practices.
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Affiliation(s)
- G Ireland
- National Infection Service, Public Health England, London, UK
| | - S Higgins
- Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - B Goorney
- Salford Royal NHS Foundation Trust, Manchester, UK
| | - C Ward
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - S Ahmad
- University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - C Stewart
- Salford Royal NHS Foundation Trust, Manchester, UK
| | - R Simmons
- National Infection Service, Public Health England, London, UK
| | - S Lattimore
- National Infection Service, Public Health England, London, UK
| | - V Lee
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Yafi F, DeLay K, Stewart C, Chiang J, Sangkum P, Hellstrom W. 167 Device Survival Following Primary Implantation of the Ams 800 Artificial Urinary Sphincter for Male Stress Urinary Incontinence. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2016.11.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Martin GA, Tsim S, MacLay J, Stewart C, Blyth KG. P6 Significance of minimal pleural effusion in non-small cell lung cancer. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Stewart C, Leyland AH. Deterioration in educational attainment as a predictor of suicidal behaviour in young adulthood. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw166.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fleming J, Critchley C, Otlowski M, Stewart C, Kerridge I. Attitudes of the general public towards the disclosure of individual research results and incidental findings from biobank genomic research in Australia. Intern Med J 2016; 45:1274-9. [PMID: 26390363 DOI: 10.1111/imj.12911] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 09/11/2015] [Accepted: 09/15/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Over the past decade, managing the disclosure of findings of genomic research has been the subject of extensive scientific, ethical and legal commentary and is a major challenge for biobanks. AIMS To examine views of the general Australian public about the disclosure of individual research results (IRR) and incidental findings (IF) from biobank genomic research. METHODS A national computer assisted telephone interview was conducted amongst a representative sample of (n = 800) adult residents across each Australian State and Territory. RESULTS The majority of the Australian general public would be interested in receiving IRR and IF if they allowed their blood/tissue to be used in research; 94.4% (n = 800) reported that they would like to receive 'specific information obtained from your sample that may be important to your health or treatment', and 83.4% their 'potential genetic risk of an inherited disease'. Although fewer desired to receive 'any IF that were not directly related to your (potential) diagnosed condition' (70.0%), most would still like to receive IF. A latent class analysis on the desire to receive (or not) all types of results revealed differences in preferences in the information they wished to receive. CONCLUSION The majority of Australians desire to receive most information arising from research involving their tissue, including IRR and IF. Differences in the extent and type of information they desire to receive are noted. Biobanks must establish strategies to identify information needs of donors, assess research data and communicate with donors and donor families. Processes need to take account of differences in donor preferences and in the clinical or research context(s).
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Affiliation(s)
- J Fleming
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - C Critchley
- Department of Psychology, University of Swinburne, Melbourne, Victoria, Australia
| | - M Otlowski
- Centre for Law and Genetics, University of Tasmania, Hobart, Tasmania, Australia
| | - C Stewart
- Faculty of Law, University of Sydney, Sydney, New South Wales, Australia
| | - I Kerridge
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Fehniger J, Jewell A, Shea K, Lee P, Stewart C, Liao C, Lengyel E, Yamada S. Ovarian cancer patients treated with intraperitoneal/intravenous chemotherapy do not experience increased toxicity at recurrence. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.497] [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: 10/21/2022]
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Wen S, Dooner M, Cheng Y, Papa E, Del Tatto M, Pereira M, Deng Y, Goldberg L, Aliotta J, Chatterjee D, Stewart C, Carpanetto A, Collino F, Bruno S, Camussi G, Quesenberry P. Mesenchymal stromal cell-derived extracellular vesicles rescue radiation damage to murine marrow hematopoietic cells. Leukemia 2016; 30:2221-2231. [PMID: 27150009 PMCID: PMC5093052 DOI: 10.1038/leu.2016.107] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/05/2016] [Accepted: 04/11/2016] [Indexed: 12/20/2022]
Abstract
Mesenchymal stromal cells (MSCs) have been shown to reverse radiation damage to marrow stem cells. We have evaluated the capacity of MSC-derived extracellular vesicles (MSC-EVs) to mitigate radiation injury to marrow stem cells at 4 h to 7 days after irradiation. Significant restoration of marrow stem cell engraftment at 4, 24 and 168 h post irradiation by exposure to MSC-EVs was observed at 3 weeks to 9 months after transplant and further confirmed by secondary engraftment. Intravenous injection of MSC-EVs to 500cGy exposed mice led to partial recovery of peripheral blood counts and restoration of the engraftment of marrow. The murine hematopoietic cell line, FDC-P1 exposed to 500cGy, showed reversal of growth inhibition, DNA damage and apoptosis on exposure to murine or human MSC-EVs. Both murine and human MSC-EVs reverse radiation damage to murine marrow cells and stimulate normal murine marrow stem cell/progenitors to proliferate. A preparation with both exosomes and microvesicles was found to be superior to either microvesicles or exosomes alone. Biologic activity was seen in freshly isolated vesicles and in vesicles stored for up to 6 months in 10% dimethyl sulfoxide at -80 °C. These studies indicate that MSC-EVs can reverse radiation damage to bone marrow stem cells.
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Affiliation(s)
- S Wen
- Division of Hematology/Oncology, Brown University, Rhode Island Hospital, Providence, RI, USA
| | - M Dooner
- Division of Hematology/Oncology, Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Y Cheng
- Division of Hematology/Oncology, Brown University, Rhode Island Hospital, Providence, RI, USA
| | - E Papa
- Division of Hematology/Oncology, Brown University, Rhode Island Hospital, Providence, RI, USA
| | - M Del Tatto
- Division of Hematology/Oncology, Brown University, Rhode Island Hospital, Providence, RI, USA
| | - M Pereira
- Division of Hematology/Oncology, Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Y Deng
- Division of Hematology/Oncology, Brown University, Rhode Island Hospital, Providence, RI, USA
| | - L Goldberg
- Division of Hematology/Oncology, Brown University, Rhode Island Hospital, Providence, RI, USA
| | - J Aliotta
- Division of Hematology/Oncology, Brown University, Rhode Island Hospital, Providence, RI, USA
| | - D Chatterjee
- Division of Hematology/Oncology, Brown University, Rhode Island Hospital, Providence, RI, USA
| | - C Stewart
- Division of Hematology/Oncology, Brown University, Rhode Island Hospital, Providence, RI, USA
| | - A Carpanetto
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - F Collino
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - S Bruno
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - G Camussi
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - P Quesenberry
- Division of Hematology/Oncology, Brown University, Rhode Island Hospital, Providence, RI, USA
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Yafi F, Pinsky M, Stewart C, Sangkum P, Ates E, Trost L, Sikka S, Hellstrom W. 113 The Effect of Duration of Daily Penile Traction in Patients Undergoing Intralesional Injection Therapy for Peyronie's Disease. J Sex Med 2016. [DOI: 10.1016/j.jsxm.2016.02.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Broomfield A, Fletcher J, Davison J, Finnegan N, Fenton M, Chikermane A, Beesley C, Harvey K, Cullen E, Stewart C, Santra S, Vijay S, Champion M, Abulhoul L, Grunewald S, Chakrapani A, Cleary MA, Jones SA, Vellodi A. Response of 33 UK patients with infantile-onset Pompe disease to enzyme replacement therapy. J Inherit Metab Dis 2016; 39:261-71. [PMID: 26497565 DOI: 10.1007/s10545-015-9898-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 09/29/2015] [Accepted: 09/30/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Enzyme replacement therapy (ERT) for infantile-onset Pompe disease has been commercially available for almost 10 years. We report the experience of its use in a cohort treated at three specialist lysosomal treatment centres in the UK. METHODS A retrospective case-note review was performed, with additional data being gathered from two national audits on all such patients treated with ERT. The impact on the outcome of various characteristics, measured just prior to the initiation of ERT (baseline), was evaluated using logistic regression. RESULTS Thirty-three patients were identified; 13/29 (45%) were cross-reactive immunological material (CRIM) negative, and nine were immunomodulated. At baseline assessment, 79% were in heart failure, 66% had failure to thrive and 70% had radiological signs of focal pulmonary collapse. The overall survival rate was 60%, ventilation-free survival was 40% and 30% of patients were ambulatory. Median follow-up of survivors was 4 years, 1.5 months (range 6 months to 13.5 years). As with previous studies, the CRIM status impacted on all outcome measures. However, in this cohort, baseline failure to thrive was related to death and lack of ambulation, and left ventricular dilatation was a risk factor for non-ventilator-free survival. CONCLUSION The outcome of treated patients remains heterogeneous despite attempts at immunomodulation. Failure to thrive at baseline and left ventricular dilation appear to be associated with poorer outcomes.
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Affiliation(s)
- A Broomfield
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospital Foundation Trust, Oxford Road, Manchester, UK.
| | - J Fletcher
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospital Foundation Trust, Oxford Road, Manchester, UK
| | - J Davison
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - N Finnegan
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M Fenton
- Cardiology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - A Chikermane
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
| | - C Beesley
- Regional Genetics Laboratories, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - K Harvey
- Enzyme Unit, Chemical Pathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - E Cullen
- Enzyme Unit, Chemical Pathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - C Stewart
- Department of Inherited Metabolic Disorders, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
| | - S Santra
- Department of Inherited Metabolic Disorders, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
| | - S Vijay
- Department of Inherited Metabolic Disorders, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
| | - M Champion
- Department of Inherited Metabolic Disease, Guy's and St Thomas' NHS Foundation Trusts, Evelina London Children's Hospital, Westminster Bridge Road, London, UK
| | - L Abulhoul
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - S Grunewald
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - A Chakrapani
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M A Cleary
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - S A Jones
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospital Foundation Trust, Oxford Road, Manchester, UK
| | - A Vellodi
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Jewell A, Fehniger J, Stewart C, Lengyel E, Yamada S. Subsequent chemotherapy is well tolerated in patients who underwent primary adjuvant intraperitoneal chemotherapy for ovarian, fallopian and primary peritoneal cancers. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.07.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Stewart C, Leyland AH. Educational inequalities in offspring birthweight: cohort study of young mothers in Scotland, 2007–12. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv170.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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