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Thiel PS, Donders F, Kobylianskii A, Maheux-Lacroix S, Matelski J, Walsh C, Murji A. The Effect of Hormonal Treatment on Ovarian Endometriomas: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2024; 31:273-279. [PMID: 38190884 DOI: 10.1016/j.jmig.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To evaluate the effect of hormonal suppression of endometriosis on the size of endometriotic ovarian cysts. DATA SOURCES The authors searched MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov from January 2012 to December 2022. METHODS OF STUDY SELECTION We included studies of premenopausal women undergoing hormonal treatment of endometriosis for ≥3 months. The authors excluded studies involving surgical intervention in the follow-up period and those using hormones to prevent endometrioma recurrence after endometriosis surgery. Risk of bias was assessed with the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. The protocol was registered in PROSPERO (CRD42022385612). TABULATION, INTEGRATION, AND RESULTS The primary outcome was the mean change in endometrioma volume, expressed as a percentage, from baseline to at least 6 months. Secondary outcomes were the change in volume at 3 months and analyses by class of hormonal therapy. The authors included 16 studies (15 cohort studies, 1 randomized controlled trial) of 888 patients treated with dienogest (7 studies), other progestins (4), combined hormonal contraceptives (2), and other suppressive therapy (3). Globally, the decrease in endometrioma volume became statistically significant at 6 months with a mean reduction of 55% (95% confidence interval, -40 to -71; 18 treatment groups; 730 patients; p <.001; I2 = 96%). The reduction was the greatest with dienogest and norethindrone acetate plus letrozole, followed by relugolix and leuprolide acetate. The volume reduction was not statistically significant with combined hormonal contraceptives or other progestins. There was high heterogeneity, and studies were at risk of selection bias. CONCLUSION Hormonal suppression can substantially reduce endometrioma size, but there is uncertainty in the exact reduction patients may experience.
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Affiliation(s)
- Peter S Thiel
- Department of Obstetrics and Gynecology (Drs. Thiel, Kobylianskii, and Murji), Mount Sinai Hospital, Toronto, ON, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada (Drs. Thiel, Kobylianskii, and Murji)
| | - Francesca Donders
- Department of Obstetrics, Gynecology, and Reproduction, Université Laval, Quebec City, QC, Canada (Drs. Donders and Maheux-Lacroix)
| | - Anna Kobylianskii
- Department of Obstetrics and Gynecology (Drs. Thiel, Kobylianskii, and Murji), Mount Sinai Hospital, Toronto, ON, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada (Drs. Thiel, Kobylianskii, and Murji)
| | - Sarah Maheux-Lacroix
- Department of Obstetrics, Gynecology, and Reproduction, Université Laval, Quebec City, QC, Canada (Drs. Donders and Maheux-Lacroix)
| | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada (Matelski)
| | - Chris Walsh
- Library Services (Dr. Walsh), Mount Sinai Hospital, Toronto, ON, Canada
| | - Ally Murji
- Department of Obstetrics and Gynecology (Drs. Thiel, Kobylianskii, and Murji), Mount Sinai Hospital, Toronto, ON, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada (Drs. Thiel, Kobylianskii, and Murji).
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Zhao DW, Robinson SG, Pozzar R, Leiter R, Walsh C, Siemens I, Lovrics E, Cellarius V, Mahtani R, Jia Z. The Evolving Roles and Expectations of Inpatient Palliative Care Through COVID-19: a Systematic Review and Meta-synthesis. J Gen Intern Med 2024; 39:661-682. [PMID: 38100009 DOI: 10.1007/s11606-023-08564-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/01/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Palliative care performed a central role in responding to the systemic suffering incurred by the COVID-19 pandemic. Yet, few studies have elucidated the inpatient palliative care specialists' experiences and perceptions. OBJECTIVE Systematically review and synthesize the evolving roles and expectations of inpatient palliative care specialists in response to COVID-19. DESIGN A systematic review and meta-synthesis informed by Thomas and Harden's framework and Pozzar et al.'s approach was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. DATA SOURCES MEDLINE, EMBASE, CINAHL, and PubMed were systematically searched for articles published between December 2019 and March 2023. We included all peer-reviewed qualitative and mixed-method literature studying the roles and expectations of inpatient palliative care specialists. A mixed-method appraisal tool was used for quality assessment. RESULTS Of 3869 unique articles, 52 were included. Studies represented North American (n = 23), European (n = 16), South American (n = 4), Oceanic (n = 2), Asian (n = 2), West African (n = 1), Middle Eastern (n = 1), and inter-continental settings (n = 3). Most were reported in English (n = 50), conducted in 2020 (n = 28), and focused on the perspectives of inpatient palliative care clinicians (n = 28). Three descriptive themes captured the roles and expectations of inpatient palliative care specialists: shifting foundations, reorienting to relationships, and evolving identity. Two analytical themes were synthesized: palliative care propagates compassion through a healing presence, and palliative care enhances the systemic response to suffering through nimble leadership. CONCLUSION Inpatient palliative care specialists responded to the COVID-19 pandemic by establishing their healing presence and leading with their adaptability. To develop institutionally tailored and collaborative responses to future pandemics, future studies are needed to understand how inpatient palliative care clinicians are recognized and valued within their institutions.
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Affiliation(s)
- Dylan Weisman Zhao
- Department of Translational Medicine, School of Medicine, Queen's University, Kingston, Ontario, Canada.
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada.
| | - Shahar Geva Robinson
- Faculty of Health Sciences, Ben-Gurion University of Negev, Soroka University Medical Centre, Beer Sheva, Israel
| | - Rachel Pozzar
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Richard Leiter
- Harvard Medical School, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Chris Walsh
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
| | - Isaac Siemens
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Emily Lovrics
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Victor Cellarius
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ramona Mahtani
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zhimeng Jia
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Program in Global Palliative Care, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Yap A, Johanesen P, Walsh C. Moderators uncertainty tolerance (UT) in healthcare: a systematic review. Adv Health Sci Educ Theory Pract 2023; 28:1409-1440. [PMID: 37097482 DOI: 10.1007/s10459-023-10215-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/03/2022] [Accepted: 02/04/2023] [Indexed: 06/19/2023]
Abstract
Uncertainty tolerance (UT) is integral to healthcare. Providers' responses to medical uncertainty has ramifications on the healthcare system, the healthcare provider and the patient. Understanding healthcare providers' UT, is important for improving patient-care outcomes. Understanding whether and to what extent it is possible to modulate individuals' perceptions and responses to medical uncertainty, can provide insights into mechanisms for support for training and education. The objectives of this review were to further characterize moderators of healthcare UT and explore moderator influences on the perceptions and responses to uncertainty experienced by healthcare professionals. Framework analysis of qualitative primary literature was conducted on 17 articles, focusing on the impacts of UT on healthcare providers. Three domains of moderators were identified and characterized relating to the healthcare provider's personal attributes, patient-derived uncertainty and the healthcare system. These domains were further categorized into themes and subthemes. Results suggest these moderators influence perceptions and responses to healthcare uncertainty across a spectrum ranging from positive to negative to uncertain. In this way, UT could be a state-based construct within healthcare settings and is contextually determined. Our findings further characterize the integrative model of uncertainty tolerance (IMUT) (Hillen Social Science and Medicine 180, 62-75, 2017) and provide evidence for the relationship between moderators and their influences on cognitive, emotional and behavioral responses to uncertainty. These findings provide a foundation for understanding the complex nature of the UT construct, add to theory development, and provide groundwork for future research exploring appropriate support for training and education in healthcare fields.
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Affiliation(s)
- Ana Yap
- Department of Microbiology, Biomedical Discovery Institute, Monash University, Clayton, Victoria, 3800, Australia.
| | - Priscilla Johanesen
- Department of Microbiology, Biomedical Discovery Institute, Monash University, Clayton, Victoria, 3800, Australia
| | - Chris Walsh
- Victoria University, Victoria University (VU) Online, Melbourne, VIC, Australia
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Wilkins KA, Rosen A, Papalia N, Matelski J, Walsh C, Hobson SR, Kingdom JC, Murji A. Indications and Outcomes for Planned Cesarean Hysterectomy in Non-Placenta Accreta Spectrum Disorder Patients: A Systematic Review. J Obstet Gynaecol Can 2023; 45:102176. [PMID: 37380105 DOI: 10.1016/j.jogc.2023.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE Planned hysterectomy at the time of cesarean delivery may be reasonable in cases other than placenta accreta spectrum disorders. Our objective was to synthesize the published literature on the indications and outcomes for planned cesarean hysterectomy. DATA SOURCES We performed a systematic review of published literature from the following databases from inception (1946) to June 2021: MEDLINE, PubMed, EMBASE, Cochrane CENTRAL, DARE, and clinicaltrials.gov. STUDY SELECTION We included all study designs where subjects underwent planned cesarean delivery with simultaneous hysterectomy. Emergency procedures and those performed for placenta accreta spectrum disorders were excluded. DATA EXTRACTION AND SYNTHESIS The primary outcome was surgical indication, though other surgical outcomes were evaluated when data permitted. Quantitative analysis was limited to studies published in 1990 or later. Risk of bias was assessed using an adaptation of the ROBINS-I tool. CONCLUSION The most common indication for planned cesarean hysterectomy was malignancy, with cervical cancer being the most frequent. Other indications included permanent contraception, uterine fibroids, menstrual disorders, and chronic pelvic pain. Common complications included bleeding, infection, and ileus. The surgical skill for cesarean hysterectomy continues to be relevant in contemporary obstetrical practice for reproductive malignancy and several benign indications. Although the data indicate relatively safe outcomes, these studies show significant publication bias and, therefore, further systematic study of this procedure is justified. PROSPERO REGISTRATION NUMBER CRD42021260545, registered June 16, 2021.
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Affiliation(s)
- Katie A Wilkins
- Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, ON
| | - Adam Rosen
- Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, ON
| | - Nicholas Papalia
- Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, ON
| | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, ON
| | - Chris Walsh
- Sidney Liswood Library, Mount Sinai Hospital, Toronto, ON
| | - Sebastian R Hobson
- Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, ON
| | - John C Kingdom
- Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, ON
| | - Ally Murji
- Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, ON.
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Kang S, McLeod SL, Walsh C, Grewal K. Patient outcomes associated with cancer diagnosis through the emergency department: A systematic review. Acad Emerg Med 2023; 30:955-962. [PMID: 36692950 DOI: 10.1111/acem.14671] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Many patients are initially diagnosed with a new suspected cancer through the emergency department (ED). The objective of this systematic review was to compare stage of cancer and survival of patients diagnosed with cancer through the ED to patients diagnosed elsewhere. METHODS Electronic searches of Medline and EMBASE were conducted and reference lists were hand-searched. Studies comparing adult patients diagnosed with any type of cancer through the ED (ED diagnosis) to patients diagnosed elsewhere (non-ED diagnosis) were included. Two reviewers independently screened titles and abstracts, assessed quality of the studies, and extracted data. The risk of bias of included studies was assessed using the Newcastle-Ottawa Scale. Data pertaining to patient outcomes were summarized and pooled using random-effects models and reported as risk ratios (RRs) with 95% confidence intervals (CIs), where applicable. RESULTS Fourteen studies were included. There was an increased risk of more advanced/later stage cancer (Stage III/IV or late-stage vs. earlier stage) among patients with an ED diagnosis of cancer compared to a non-ED diagnosis of cancer (RR 1.30, 95% CI 1.39-1.58). Survival was lower for patients with an ED diagnosis of cancer compared to those diagnosed elsewhere (RR 0.61, 95% CI 0.49-0.75). CONCLUSIONS Patients with an ED diagnosis of cancer had more advanced/late stage of cancer at diagnosis and worse survival compared to patients diagnosed elsewhere. Future research examining patients diagnosed with cancer through the ED is required.
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Affiliation(s)
- Sally Kang
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, Ontario, Canada
- Division of Emergency Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shelley L McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, Ontario, Canada
- Division of Emergency Medicine, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Chris Walsh
- Library Services, Sinai Health, Toronto, Ontario, Canada
| | - Keerat Grewal
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, Ontario, Canada
- Division of Emergency Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Srivastava S, Bertone MP, Parmar D, Walsh C, De Allegri M. The genesis of the PM-JAY health insurance scheme in India: technical and political elements influencing a national reform towards universal health coverage. Health Policy Plan 2023:czad045. [PMID: 37436821 DOI: 10.1093/heapol/czad045] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/18/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023] Open
Abstract
Many countries are using health insurance to advance progress towards universal health coverage (UHC). India launched the Pradhan Mantri Jan Arogya Yojana (PM-JAY) health insurance scheme in 2018. We examine the political economy context around PM-JAY policy formulation, by examining the perspectives of policy stakeholders shaping decisions around the reform. More specifically, we focus on early policy design at the central (national) level. We use a framework on the politics of UHC reform proposed by Fox and Reich (The politics of universal health coverage in low- and middle-income countries: A framework for evaluation and action. J. Health Polit. Policy Law 2015;40:1023-1060), to categorize the reform into phases and examine the interactions between actors, institutions, interests, ideas and ideology which shaped reform decisions. We interviewed 15 respondents in Delhi between February and April 2019, who were either closely associated with the reform process or subject experts. The ruling centre-right government introduced PM-JAY shortly before national elections, drawing upon policy legacies from prior and state insurance schemes. Empowered policy entrepreneurs within the government focused discourse around ideas of UHC and strategic purchasing, and engaged in institution building leading to the creation of the National Health Authority and State Health Agencies through policy directives, thereby expanding state infrastructural and institutional power for insurance implementation. Indian state inputs were incorporated in scheme design features like mode of implementation, benefit package and provider network, while features like the coverage amount, portability of benefits and branding strategy were more centrally driven. These balanced negotiations opened up political space for a cohesive, central narrative of the reform and facilitated adoption. Our analysis shows that the PM-JAY reform focused on bureaucratic rather than ideological elements and that technical compromises and adjustments accommodating the interests of states enabled the political success of policy formulation. Appreciating these politics, power and structural issues shaping PM-JAY institutional design will be important to understand how PM-JAY is implemented and how it advances UHC in India.
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Affiliation(s)
- S Srivastava
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Baden-Württemberg 69120, Germany
| | - M P Bertone
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland EH21 6UU, UK
| | - D Parmar
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, King's College London, Strand, London WC2R 2LS, UK
| | - C Walsh
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Baden-Württemberg 69120, Germany
| | - M De Allegri
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Baden-Württemberg 69120, Germany
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Shmulewitz D, Stohl M, Greenstein E, Roncone S, Walsh C, Aharonovich E, Wall MM, Hasin DS. Validity of the DSM-5 craving criterion for alcohol, tobacco, cannabis, cocaine, heroin, and non-prescription use of prescription painkillers (opioids). Psychol Med 2023; 53:1955-1969. [PMID: 35506791 PMCID: PMC9096712 DOI: 10.1017/s0033291721003652] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although the DSM-5 was adopted in 2013, the validity of the new substance use disorder (SUD) diagnosis and craving criterion has not been investigated systematically across substances. METHODS Adults (N = 588) who engaged in binge drinking or illicit drug use and endorsed at least one DSM-5 SUD criterion were included. DSM-5 SUD criteria were assessed for alcohol, tobacco, cannabis, cocaine, heroin, and opioids. Craving was considered positive if "wanted to use so badly that could not think of anything else" (severe craving) or "felt a very strong desire or urge to use" (moderate craving) was endorsed. Baseline information on substance-related variables and psychopathology was collected, and electronic daily assessment queried substance use for the following 90 days. For each substance, logistic regression estimated the association between craving and validators, i.e. variables expected to be related to craving/SUD, and whether association with the validators differed for DSM-5 SUD diagnosed with craving as a criterion v. without. RESULTS Across substances, craving was associated with most baseline validators (p values<0.05); neither moderate nor severe craving consistently showed greater associations. Baseline craving predicted subsequent use [odds ratios (OR): 4.2 (alcohol) - 234.3 (heroin); p's ⩽ 0.0001], with stronger associations for moderate than severe craving (p's < 0.05). Baseline DSM-5 SUD showed stronger associations with subsequent use when diagnosed with craving than without (p's < 0.05). CONCLUSION The DSM-5 craving criterion as operationalized in this study is valid. Including craving improves the validity of DSM-5 SUD diagnoses, and clinical relevance, since craving may cause impaired control over use and development and maintenance of SUD.
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Affiliation(s)
- D Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - M Stohl
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - E Greenstein
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - S Roncone
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - C Walsh
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - E Aharonovich
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - MM Wall
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - DS Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
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Zhao AY, Gimpaya N, Lisondra J, Fujiyoshi R, Fujiyoshi Y, Khan R, Tham D, Scaffidi MA, Bansal R, Walsh C, Grover SC. A119 DEVELOPMENT AND EVALUATION OF LOW-COST GEL POLYPS FOR POLYPECTOMY SKILLS TRAINING IN NOVICE ENDOSCOPISTS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991154 DOI: 10.1093/jcag/gwac036.119] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Polypectomy is an essential skill for endoscopists to acquire. As polyps are encountered ad hoc during colonoscopies, exposure to polypectomy in clinical training may vary. There is a need to deliver a curriculum that standardizes exposure to polypectomy while remaining cost-effective for endoscopy programs worldwide. Purpose To develop low-cost simulated polyps that can be incorporated into endoscopic training programs, and to evaluate their perceived realism and useability for polypectomy training. Method We designed 3D molds based on the Paris classification, a validated rubric for polyp morphology. The polyps are depicted in Figure 1. Using low-cost materials, we created gel-based polyps compatible with physical colonic simulators. Current versions of the polyps were finalized based on visual realism and durability. Expert (performed >1000 procedures) and novice (<25 procedures) endoscopists were invited to perform simulated polypectomies and evaluate the realism of the polyps. Using a 7-point Likert scale (“strongly disagree” to “strongly agree”), we administered a survey adapted from the Direct Observed Polypectomy Skills (DOPyS) checklist to evaluate the polyps on practicality of design and useability for training. Additionally, the simulator’s resemblance to human polypectomy was assessed through a scale with 1 indicating “low resemblance” and 7 indicating “high resemblance”. The ease of identifying morphology was also evaluated, with 1 indicating “difficult” and 7 indicating “easy”. Result(s) The survey was completed by 11 expert endoscopists and 10 novices. The median score submitted by experts on the polyps’ useability in training the technique for mobilization of the polyp was 7 (IQR 6-7). Experts rated the simulator’s practicality in teaching cold snare or electrocautery techniques with a median score of 6 (IQR 6-7). Lastly, the ability of the simulator to develop skills in identifying and treating the residual polyp was assessed by expert endoscopists, giving it a median score of 6 (IQR 6-7). The simulators were tested on similarity to human polypectomy, with the median score of expert groups being 5 (IQR 5-6), and novice groups being 6 (IQR 6-6). Both groups were asked to rate if morphology could be identified using the simulator; the median score of expert groups being 6 (IQR 6-7), and 6.5 for novice endoscopists (IQR 5-7). Image ![]()
Conclusion(s) The development of simulated polyps with differing morphologies using low-cost and common materials with high realism is feasible. These polyps may potentially be integrated into different endoscopic training programs. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest A. Zhao: None Declared, N. Gimpaya: None Declared, J. Lisondra: None Declared, R. Fujiyoshi: None Declared, Y. Fujiyoshi: None Declared, R. Khan Grant / Research support from: Rishad Khan has received research grants from AbbVie (2018) and Ferring Pharmaceuticals (2019) and research funding from Pendopharm (2019). , D. Tham: None Declared, M. Scaffidi: None Declared, R. Bansal: None Declared, C. Walsh: None Declared, S. Grover Shareholder of: Samir C. Grover has equity in Volo Healthcare., Grant / Research support from: Samir C. Grover has received research grants and personal fees from AbbVie and Ferring Pharmaceuticals, personal fees from Takeda, education grants from Janssen.
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Affiliation(s)
- A Y Zhao
- Division of Gastroenterology, St. Michael's Hospital
| | - N Gimpaya
- Division of Gastroenterology, St. Michael's Hospital
| | - J Lisondra
- Division of Gastroenterology, St. Michael's Hospital
| | - R Fujiyoshi
- Division of Gastroenterology, St. Michael's Hospital
| | - Y Fujiyoshi
- Division of Gastroenterology, St. Michael's Hospital
| | - R Khan
- Division of Gastroenterology, St. Michael's Hospital,Department of Medicine, University of Toronto
| | - D Tham
- Division of Gastroenterology, St. Michael's Hospital
| | - M A Scaffidi
- Division of Gastroenterology, St. Michael's Hospital
| | - R Bansal
- Division of Gastroenterology, St. Michael's Hospital
| | - C Walsh
- Division of Gastroenterology, Hepatology, and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children,Department of Pediatrics, University of Toronto Faculty of medicine,The Wilson Centre, University of Toronto, Toronto, Canada
| | - S C Grover
- Division of Gastroenterology, St. Michael's Hospital,Department of Medicine, University of Toronto
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Khan R, Homsi H, Gimpaya N, Sabrie N, Gholami R, Bansal R, Scaffidi M, Lightfoot D, James P, Siau K, Forbes N, Wani S, Keswani R, Walsh C, Grover S. A117 VALIDITY EVIDENCE FOR ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY COMPETENCY ASSESSMENT TOOLS: A SYSTEMATIC REVIEW. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991253 DOI: 10.1093/jcag/gwac036.117] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Assessment of competence in endoscopic retrograde cholangiopancreatography (ERCP) is essential to ensure trainees possess the skills needed for independent practice. Traditionally, ERCP training has used the apprenticeship model, whereby novices learn skills under the supervision of an expert. A growing focus on procedural quality, however, has supported the implementation of competency-based medical education models which require documentation of a trainee’s competence for independent practice. Observational assessment tools with strong evidence of validity are critical to this process. Validity evidence supporting ERCP observational assessment tools has not been systematically evaluated. Purpose To conduct a systematic review of ERCP assessment tools and identify tools with strong evidence of validity using a unified validity evidence framework Method We conducted a systematic search using electronic databases and hand-searching from inception until August 2021 for studies evaluating observational assessment tools of ERCP performance. We used a unified validity framework to characterize validity evidence from five sources: content, response process, internal structure, relations to other variables, and consequences. Each domain was assigned a score of 0-3 (maximum score 15). We assessed educational utility and methodological quality using the Accreditation Council for Graduate Medical Education framework and the Medical Education Research Quality Instrument, respectively. Result(s) From 2769 records, we included 17 studies evaluating 7 assessment tools. Five tools were studied for clinical ERCP, one on simulated ERCP, and one on simulated and clinical ERCP. Validity evidence scores ranged from 2-12. The Bethesda ERCP Skills Assessment Tool (BESAT), ERCP Direct Observation of Procedural Skills Tool (ERCP DOPS), and The Endoscopic Ultrasound (EUS) and ERCP Skills Assessment Tool (TEESAT) had the strongest validity evidence with scores of 10, 12, and 11, respectively. Regarding educational utility, most tools were easy to use and interpret, and required minimal additional resources. Overall methodological quality was strong, with scores ranging from 10-12.5 (maximum 13.5). Conclusion(s) The BESAT, ERCP DOPS, and TEESAT have strong validity evidence compared to other assessments. Integrating tools into training may help drive learners’ development and support competency decision-making. Please acknowledge all funding agencies by checking the applicable boxes below CAG Disclosure of Interest None Declared
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Affiliation(s)
- R Khan
- Western University, London
| | | | | | | | | | | | | | | | - P James
- University Health Network, Toronto, Canada
| | - K Siau
- University of Birmingham College of Medical and Dental Sciences, Birmingham, United Kingdom
| | - N Forbes
- University of Calgary, Calgary, Canada
| | - S Wani
- University of Colorado Anschutz Medical Campus, Aurora
| | - R Keswani
- Northwestern University, Chicago, United States
| | - C Walsh
- The Hospital for Sick Children, Toronto, Canada
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10
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McCartney DM, O'Shea PM, Healy M, Walsh JB, Griffin TP, Walsh C, Byrne DG, Kenny RA, Faul JL. The Causal Role of Vitamin D Deficiency in Worse Covid-19 Outcomes: Implications for Policy and Practice Development. Ir Med J 2023; 116:733. [PMID: 37555788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
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11
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Curtis F, Li L, Kolanko M, Lai H, Daniels S, True J, Del Giovane M, Golemme M, Lyall R, Raza S, Hassim N, Patel A, Beal E, Walsh C, Purnell M, Whitethread N, Nilforooshan R, Norman C, Wingfield D, Barnaghi P, Sharp D, Dani M, Fertleman M, Parkinson M. 1362 ANTICHOLINERGIC PRESCRIBING HABITS AND ITS ASSOCIATIONS IN A COMMUNITY POPULATION OF PEOPLE LIVING WITH DEMENTIA. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.039] [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: 01/18/2023] Open
Abstract
Abstract
Introduction
Many commonly prescribed medications have inadvertent anticholinergic effects. People with Dementia (PwD) are more vulnerable to these effects and at risk of adverse outcomes, the risk being higher with a greater degree of anticholinergic exposure. We investigated prescribing patterns and Anticholinergic burden (ACB) in a cohort of community-dwelling older adults with dementia and aimed to explore the effect of ACB on cognition, mood, and quality of life(QoL).
Method
The medication and demographic information for 87 (39 female) community-dwelling PwD were obtained from Electronic Care Summaries. We used the German Anticholinergic Burden Scale (GABS) to measure ACB. Additionally, we investigated associations between ACB and cognitive (ADAS-Cog), functional (BADL) and QoL (DemQoL) assessments.
Results
28.7% of participants had a clinically significant score (ACB> 2). The most commonly prescribed medications with ACB were Lansoprazole(18.3%), Mirtazapine(12.6%) and Codeine(12.6%). ACB was higher in males and negatively correlated with age, r(87)=-.21,p=.03. There was no association between ACB and cognition, QoL, functional independence, and neuropsychiatric symptoms. Over six months, PLWD with no ACB had a greater negative change in neuropsychiatric symptoms[t(18)=2.27,p=.04] and functional independence[t(23)=-3.8,p=.001], indicating greater dependence and worsening neuropsychiatric symptoms.
Conclusion
A third of PLWD in the community had clinically significant ACB. No ACB was associated with worsening neuropsychiatric symptoms and functional dependence over a six-month period. Community prescribers should consider regular medication reviews with PLWD and carers to ensure medications are prescribed safely and appropriately.
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Affiliation(s)
- F Curtis
- Imperial College London , Department of Brain Sciences
| | - L Li
- Imperial College London , Department of Brain Sciences
| | - M Kolanko
- Imperial College London , Department of Brain Sciences
| | - H Lai
- Imperial College London , Department of Brain Sciences
| | - S Daniels
- Imperial College London , Department of Brain Sciences
| | - J True
- Imperial College London , Department of Brain Sciences
| | - M Del Giovane
- Imperial College London , Department of Brain Sciences
| | - M Golemme
- Imperial College London , Department of Brain Sciences
| | - R Lyall
- Imperial College London , Department of Brain Sciences
| | - S Raza
- Imperial College London , Department of Brain Sciences
| | - N Hassim
- Imperial College London , Department of Brain Sciences
| | - A Patel
- Imperial College London , Department of Brain Sciences
| | - E Beal
- Imperial College London , Department of Brain Sciences
| | - C Walsh
- Imperial College London , Department of Brain Sciences
| | - M Purnell
- Imperial College London , Department of Brain Sciences
| | - N Whitethread
- Imperial College London , Department of Brain Sciences
| | | | - C Norman
- Imperial College London , Department of Brain Sciences
| | - D Wingfield
- Imperial College London , Department of Brain Sciences
| | - P Barnaghi
- Imperial College London , Department of Brain Sciences
| | - D Sharp
- Imperial College London , Department of Brain Sciences
| | - M Dani
- Imperial College London , Department of Brain Sciences
| | - M Fertleman
- Imperial College London , Department of Brain Sciences
| | - M Parkinson
- UK DRI Centre for Care Research and Technology
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12
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Levendowski D, Walsh C, Boeve B, Lee-Iannotti J, Salat D, Hamilton J, Tsuang D, Shprecher D, Westbrook P, Berka C, Ruoff L, Timm P, Mazeika G, Neylan T, St. Louis E. Non-REM sleep Hypertonia in Parkinsonian-Spectrum Disorders. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.464] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Levendowski D, Boeve B, Walsh C, Tsuang D, Salat D, Hamilton J, Lee-Iannotti J, Shprecher D, Berka C, Westbrook P, Ruoff L, Timm P, Mazeika G, Neylan T, St. Louis E. Characterization of Neurodegenerative Disorder Subtypes Based on Non-REM Hypertonia and Sleep Spindle Duration. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.460] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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14
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Power JM, Hannigan C, Scharf T, Moynihan S, Walsh C, Johnson N, Lawlor B, Holton E, Kee F. 221 BEFRIENDING SERVICES ARE ASSOCIATED WITH LESS DECLINE IN HEALTH-RELATED QUALITY OF LIFE, BUT NOT COGNITIVE FUNCTION, OVER TIME. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.191] [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] Open
Abstract
Abstract
Background
Befriending services are commonly deployed in the support of older people living alone, but lack an established evidence base, particularly in relation to their association with health outcomes.
Methods
To explore the potentially therapeutic impact of befriending on Health-Related Quality-of-Life (HR-QoL) and cognitive function, we used a single case experimental design. Data were collected from 85 new users of ALONE’s befriending service between 2019 and 2021 in an AB multiple baseline design. Generalised additive modelling was then used to assess trajectories of HR-QoL and cognitive function (semantic fluency) over the course of six months, and its association with the onset of the befriending service intervention
Results
The befriending service was associated with less decline over time in HR-QoL, and with a mitigated impact of loneliness on HR-QoL too. No such effects were observed for cognitive function as an outcome, which did not change over time.
Conclusion
Befriending may exert a positive effect on health-related quality of life, and reduce the negative impact that loneliness has on this outcome.
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Affiliation(s)
- JM Power
- Maynooth University , Maynooth, Ireland
| | - C Hannigan
- National College of Ireland , Dublin, Ireland
| | - T Scharf
- Newcastle University , Newcastle, United Kingdom
| | | | - C Walsh
- University of Limerick , Limerick, Ireland
| | | | - B Lawlor
- Trinity College Dublin , Dublin, Ireland
| | - E Holton
- Maynooth University , Maynooth, Ireland
| | - F Kee
- Queen's University Belfast , Belfast, United Kingdom
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15
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O'Connor U, Walsh C, Gorman D, O'Reilly G, Martin Z, Madhavan P, Murphy RT, Szirt R, Almén A, Andersson M, Camp A, Garcia V, Duch MA, Ginjaume M, Abdelrahman M, Lombardo P, Vanhavere F. Feasibility study of computational occupational dosimetry: evaluating a proof-of-concept in an endovascular and interventional cardiology setting. J Radiol Prot 2022; 42:041501. [PMID: 36130583 DOI: 10.1088/1361-6498/ac9394] [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: 05/17/2022] [Accepted: 09/21/2022] [Indexed: 06/15/2023]
Abstract
Individual monitoring of radiation workers is essential to ensure compliance with legal dose limits and to ensure that doses are As Low As Reasonably Achievable. However, large uncertainties still exist in personal dosimetry and there are issues with compliance and incorrect wearing of dosimeters. The objective of the PODIUM (Personal Online Dosimetry Using Computational Methods) project was to improve personal dosimetry by an innovative approach: the development of an online dosimetry application based on computer simulations without the use of physical dosimeters. Occupational doses were calculated based on the use of camera tracking devices, flexible individualised phantoms and data from the radiation source. When combined with fast Monte Carlo simulation codes, the aim was to perform personal dosimetry in real-time. A key component of the PODIUM project was to assess and validate the methodology in interventional radiology workplaces where improvements in dosimetry are needed. This paper describes the feasibility of implementing the PODIUM approach in a clinical setting. Validation was carried out using dosimeters worn by Vascular Surgeons and Interventional Cardiologists during patient procedures at a hospital in Ireland. Our preliminary results from this feasibility study show acceptable differences of the order of 40% between calculated and measured staff doses, in terms of the personal dose equivalent quantity Hp(10), however there is a greater deviation for more complex cases and improvements are needed. The challenges of using the system in busy interventional rooms have informed the future needs and applicability of PODIUM. The availability of an online personal dosimetry application has the potential to overcome problems that arise from the use of current dosimeters. In addition, it should increase awareness of radiation protection among staff. Some limitations remain and a second phase of development would be required to bring the PODIUM method into operation in a hospital setting. However, an early prototype system has been tested in a clinical setting and the results from this two-year proof-of-concept PODIUM project are very promising for future development.
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Affiliation(s)
- U O'Connor
- Medical Physics and Bioengineering Department, St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College, Dublin, Ireland
| | - C Walsh
- Medical Physics and Bioengineering Department, St James's Hospital, Dublin, Ireland
| | - D Gorman
- Medical Physics and Bioengineering Department, St James's Hospital, Dublin, Ireland
| | - G O'Reilly
- Medical Physics and Bioengineering Department, St James's Hospital, Dublin, Ireland
| | - Z Martin
- Department of Vascular Surgery, St James's Hospital, Dublin, Ireland
| | - P Madhavan
- Department of Vascular Surgery, St James's Hospital, Dublin, Ireland
| | - R T Murphy
- Department of Cardiology, St James's Hospital, Dublin, Ireland
| | - R Szirt
- Department of Cardiology, St James's Hospital, Dublin, Ireland
| | - A Almén
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - M Andersson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - A Camp
- Institut de Tècniques Energètiques, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - V Garcia
- Institut de Tècniques Energètiques, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - M A Duch
- Institut de Tècniques Energètiques, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - M Ginjaume
- Institut de Tècniques Energètiques, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - M Abdelrahman
- Belgian Nuclear Research Center, Boeretang, Mol, Belgium
| | - P Lombardo
- Belgian Nuclear Research Center, Boeretang, Mol, Belgium
| | - F Vanhavere
- Belgian Nuclear Research Center, Boeretang, Mol, Belgium
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16
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Murji A, Sanders AP, Monteiro I, Haiderbhai S, Matelski J, Walsh C, Abbott JA, Munro MG, Maheux-Lacroix S. Cesarean scar defects and abnormal uterine bleeding: a systematic review and meta-analysis. Fertil Steril 2022; 118:758-766. [PMID: 35985862 DOI: 10.1016/j.fertnstert.2022.06.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To synthesize the published literature to better understand the association between cesarean scar defects (CSDs) and abnormal uterine bleeding (AUB). In particular, we aimed to evaluate the risk and pattern(s) of CSD-associated AUB in addition to exploring the relationship between defect morphology with bleeding symptoms. DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENTS Patients with CSD and reports of uterine bleeding as an outcome were identified in 60 studies from database searches. INTERVENTIONS Studies that investigated CSD (as defined by investigators) and reported uterine bleeding, menstrual bleeding, or AUB as an outcome were included. MAIN OUTCOME MEASURES The prevalence and risk of AUB (intermenstrual, postmenstrual, and unscheduled bleeding) in patients with confirmed CSD. RESULTS Nine studies reported on the prevalence of AUB in patients with a confirmed CSD. Patients with CSD were more likely to experience AUB, compared with those without CSD (relative risk, 3.47; 95% confidence interval [CI], 2.02-5.97; 6 studies, 1,385 patients; I2 = 67%). In a population of patients with at least 1 cesarean delivery, the prevalence of AUB in those with CSD was 25.5% (95% CI, 14.7-40.5; 6 studies, 667 patients, I2 = 93%). However, symptom prevalence was much higher in patients presenting for imaging for a gynecologic indication where the prevalence of AUB in the presence of a CSD was 76.4% (95% CI, 67.8-83.3; 5 studies, 505 patients; I2 = 71%). The mean menstrual duration in symptomatic patients with CSD was 13.4 days (95% CI, 12.6-14.2; 19 studies, 2,095 patients; I2 = 96%), and the mean duration of early-cycle intermenstrual bleeding was 6.8 days (95% CI, 5.7-7.8 days; 9 studies, 759 patients; I2 = 93%). The most common descriptor of CSD-associated AUB was "brown discharge". Patients with larger CSD experienced more bleeding symptoms. CONCLUSION There is a strong and consistent association between patients with CSD and AUB. These patients experience a unique bleeding pattern, namely prolonged menstruation and early-cycle intermenstrual bleeding. These data should provide impetus for including CSD as a distinct entity in AUB classification systems. High heterogeneity in our results calls for standardization of nomenclature and outcome reporting for this condition.
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Affiliation(s)
- Ally Murji
- Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.
| | - Ari P Sanders
- Department of Obstetrics and Gynecology, University of Calgary, Peter Lougheed Centre, Calgary, Alberta, Canada
| | - Ilza Monteiro
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences (UNICAMP), Campinas, SP, Brazil
| | - Shabbir Haiderbhai
- Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Chris Walsh
- Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Sidney Liswood Library, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jason A Abbott
- School of Women's and Children's Health University of New South Wales (UNSW), Sydney, Australia
| | - Malcolm G Munro
- Department of Obstetrics & Gynecology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
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17
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Eakins J, Hager L, O'Connor U, Cooke J, O'Reilly G, Walsh C, Willson T. Personal dosimetry for positron emitters, and occupational exposures from clinical use of gallium-68. J Radiol Prot 2022; 42:031511. [PMID: 35947972 DOI: 10.1088/1361-6498/ac8885] [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: 05/16/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
The current status and issues regarding positron dosimetry in nuclear medicine are summarized. The suitability of the United Kingdom Health Security Agency extremity and eye beta-gamma personal thermoluminescence dosemeters are then considered. Monte Carlo modelling is performed to determine their responses and derive sets of calibration factors, along withHp(0.07) andHp(3) conversion coefficients, for carbon-11, nitrogen-13, oxygen-15, fluorine-18 and gallium-68 sources, which are commonly used in positron emission tomography (PET) computed tomography; data for these isotopes is assumed extrapolatable to other positron sources. It is found that the dosemeters are adequate for assessing exposures to PET radionuclides, even if their routine calibrations to caesium-137 were maintained. An idealized set of measurements representing gallium-68 exposure scenarios is then described, including reproducible mock-ups of individuals manipulating vials and syringes. Finally, a short case-study is presented that explores occupational doses during routine clinical use of gallium-68. The extremity dosemeter results demonstrated significant variations dependent upon the exposure conditions, with some seen to be comparatively large; whole-body and eye dose rates per activity were found to be lower. The importance of routine dose monitoring of workers is emphasized, with the need for a longer-termed follow-up study demonstrated.
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Affiliation(s)
- J Eakins
- United Kingdom Health Security Agency (UKHSA) RCE, Didcot, Oxfordshire, United Kingdom
| | - L Hager
- United Kingdom Health Security Agency (UKHSA) RCE, Didcot, Oxfordshire, United Kingdom
| | - U O'Connor
- Medical Physics & Bioengineering Department, St James's Hospital, Dublin, Ireland
| | - J Cooke
- Medical Physics & Bioengineering Department, St James's Hospital, Dublin, Ireland
| | - G O'Reilly
- Medical Physics & Bioengineering Department, St James's Hospital, Dublin, Ireland
| | - C Walsh
- Medical Physics & Bioengineering Department, St James's Hospital, Dublin, Ireland
| | - T Willson
- Nuclear Medicine Department, Royal Free London NHS Foundation Trust, London, United Kingdom
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18
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Tierney A, Curran M, Collins L, Kennedy L, McDonnell C, Jurascheck A, Sheikhi A, Walsh C, Button B, Casserly B, Cahalan R. P231 Steps Ahead: optimising physical activity in adults with cystic fibrosis - a pilot randomised trial using wearable technology, goal setting and text message feedback. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00560-4] [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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19
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Sloot L, Bae J, Baker L, O'Donnell K, Menard N, Porciuncula F, Choe D, Ellis T, Awad L, Walsh C. O 089 - A soft robotic exosuit assisting the paretic ankle in patients post-stroke: Effect on muscle activation during overground walking. Gait Posture 2022; 95:217-218. [PMID: 29983296 DOI: 10.1016/j.gaitpost.2018.06.124] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study compared overground walking with and without exosuit assistance in post-stroke patients. Exosuit-assisted walking was found to improve paretic propulsion and ground clearance during swing, two common gait deviations in stroke patients. No changes in leg muscle activity was found, motivating further study of the exosuit as a tool for gait training during stroke rehabilitation.
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Affiliation(s)
- L Sloot
- Harvard University, School of Engineering and Applied Sciences, Cambridge, USA.
| | - J Bae
- Harvard University, School of Engineering and Applied Sciences, Cambridge, USA
| | - L Baker
- Harvard University, School of Engineering and Applied Sciences, Cambridge, USA
| | - K O'Donnell
- Harvard University, School of Engineering and Applied Sciences, Cambridge, USA
| | - N Menard
- Harvard University, School of Engineering and Applied Sciences, Cambridge, USA
| | - F Porciuncula
- Harvard University, School of Engineering and Applied Sciences, Cambridge, USA
| | - D Choe
- Harvard University, School of Engineering and Applied Sciences, Cambridge, USA
| | - T Ellis
- Boston University, Department of Physical Therapy & Athletic Training, Boston, USA
| | - L Awad
- Boston University, Department of Physical Therapy & Athletic Training, Boston, USA
| | - C Walsh
- Boston University, Department of Physical Therapy & Athletic Training, Boston, USA
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20
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Moody JD, Pollock BB, Sio H, Strozzi DJ, Ho DDM, Walsh C, Kemp GE, Kucheyev SO, Kozioziemski B, Carroll EG, Kroll J, Yanagisawa DK, Angus J, Bhandarkar SD, Bude JD, Divol L, Ferguson B, Fry J, Hagler L, Hartouni E, Herrmann MC, Hsing W, Holunga DM, Javedani J, Johnson A, Kalantar D, Kohut T, Logan BG, Masters N, Nikroo A, Orsi N, Piston K, Provencher C, Rowe A, Sater J, Skulina K, Stygar WA, Tang V, Winters SE, Chittenden JP, Appelbe B, Boxall A, Crilly A, O’Neill S, Davies J, Peebles J, Fujioka S. The Magnetized Indirect Drive Project on the National Ignition Facility. J Fusion Energ 2022. [DOI: 10.1007/s10894-022-00319-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Thiel P, Mathur S, Zakhari A, Matelski J, Walsh C, Murji A. Retrograde Bladder Filling After Outpatient Gynaecologic Surgery: A Systematic Review and Meta-Analysis. Journal of Obstetrics and Gynaecology Canada 2022. [DOI: 10.1016/j.jogc.2022.02.112] [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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22
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Cooke GJ, Marsh DR, Walsh C, Black B, Lamarque JF. A revised lower estimate of ozone columns during Earth's oxygenated history. R Soc Open Sci 2022; 9:211165. [PMID: 35070343 PMCID: PMC8728182 DOI: 10.1098/rsos.211165] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/25/2021] [Indexed: 05/17/2023]
Abstract
The history of molecular oxygen (O2) in Earth's atmosphere is still debated; however, geological evidence supports at least two major episodes where O2 increased by an order of magnitude or more: the Great Oxidation Event (GOE) and the Neoproterozoic Oxidation Event. O2 concentrations have likely fluctuated (between 10-3 and 1.5 times the present atmospheric level) since the GOE ∼2.4 Gyr ago, resulting in a time-varying ozone (O3) layer. Using a three-dimensional chemistry-climate model, we simulate changes in O3 in Earth's atmosphere since the GOE and consider the implications for surface habitability, and glaciation during the Mesoproterozoic. We find lower O3 columns (reduced by up to 4.68 times for a given O2 level) compared to previous work; hence, higher fluxes of biologically harmful UV radiation would have reached the surface. Reduced O3 leads to enhanced tropospheric production of the hydroxyl radical (OH) which then substantially reduces the lifetime of methane (CH4). We show that a CH4 supported greenhouse effect during the Mesoproterozoic is highly unlikely. The reduced O3 columns we simulate have important implications for astrobiological and terrestrial habitability, demonstrating the relevance of three-dimensional chemistry-climate simulations when assessing paleoclimates and the habitability of faraway worlds.
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Affiliation(s)
- G. J. Cooke
- School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT, UK
| | - D. R. Marsh
- School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT, UK
- National Center for Atmospheric Research, Boulder, CO 80301, USA
| | - C. Walsh
- School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT, UK
| | - B. Black
- Department of Earth and Planetary Sciences, Rutgers University, Piscataway, NJ, USA
- Department of Earth and Atmospheric Sciences, CUNY City College, New York, NY, USA
| | - J.-F. Lamarque
- National Center for Atmospheric Research, Boulder, CO 80301, USA
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Sithamparapillai A, Grewal K, Thompson C, Walsh C, McLeod S. Intra-articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta-analysis. CAN J EMERG MED 2022; 24:809-819. [PMID: 36181665 PMCID: PMC9525937 DOI: 10.1007/s43678-022-00368-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/28/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Anterior shoulder dislocations are commonly treated in the emergency department (ED). Analgesia for reduction is provided by intra-articular lidocaine (IAL) injection or intravenous sedation (IV sedation). The objective of this systematic review and meta-analysis was to compare IAL versus IV sedation for closed reduction of acute anterior shoulder dislocation in the ED. METHODS Electronic searches of MEDLINE and EMBASE (1946-September 2021) were completed and reference lists were hand-searched. Randomized controlled trials (RCTs) comparing IAL and IV sedation for reduction of acute anterior shoulder dislocations among patients ≥ 15 years old in the ED were included. Outcomes of interest included a successful reduction, adverse events, ED length of stay, pain scores, procedure time, ease of reduction, patient satisfaction, and cost. Two reviewers independently screened abstracts, assessed study quality and extracted data. Data were pooled using random-effects models and reported as mean differences and risk ratios (RR) with 95% confidence intervals (CIs). RESULTS 12 RCTs were included with a total of 630 patients (IAL = 327; IV sedation = 303). There was no difference in reduction success between IAL and IV sedation (RR 0.93; 95% CI 0.86-1.01, I2 = 69%), significantly lower adverse events with IAL (RR 0.16; 95% CI 0.07-0.33, I2 = 0%), shorter ED length of stay with IAL (mean difference - 1.48; 95% CI - 2.48 to - 0.47, I2 = 93%), no difference in pain scores post-analgesia and no difference in ease of reduction. CONCLUSIONS Intra-articular lidocaine may have similar effectiveness as IV sedation in the successful reduction of anterior shoulder dislocations in the ED with fewer adverse events, shorter ED length of stay, and no difference in pain scores or ease of reduction. Intra-articular lidocaine may be an effective alternative to IV sedation for reducing anterior shoulder dislocations, particularly when IV sedation is contraindicated or not feasible.
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Affiliation(s)
- Arjun Sithamparapillai
- grid.17063.330000 0001 2157 2938Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON Canada
| | - Keerat Grewal
- grid.17063.330000 0001 2157 2938Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON Canada ,grid.512298.5Schwartz/Reisman Emergency Medicine Institute, Toronto, ON Canada ,grid.492573.e0000 0004 6477 6457Sinai Health, Toronto, ON Canada
| | - Cameron Thompson
- grid.512298.5Schwartz/Reisman Emergency Medicine Institute, Toronto, ON Canada ,grid.492573.e0000 0004 6477 6457Sinai Health, Toronto, ON Canada
| | - Chris Walsh
- grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, University of Toronto, Toronto, ON Canada
| | - Shelley McLeod
- grid.512298.5Schwartz/Reisman Emergency Medicine Institute, Toronto, ON Canada ,grid.492573.e0000 0004 6477 6457Sinai Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, University of Toronto, Toronto, ON Canada
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Robb L, Joubert G, Jordaan M, van den Berg L, Osei Ngounda J, Walsh C. Diet quality and associations with choline intake in pregnant women in Bloemfontein, South Africa. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.230] [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: 10/19/2022]
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Ngounda J, Baumgartner J, Nel M, Walsh C. Iodine status of pregnant women residing in urban and rural areas of the free state province, south africa. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.214] [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: 10/19/2022]
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Shiel E, Costello M, McCarthy C, Murphy R, McDermott C, Geoghegan J, Mannion E, Conry M, Flanagan L, Moroney E, Bhaoill CU, Walsh C, Coffey K, Waters R, Robinson S, O'Donnell M, Canavan M. 112 INTEGRATED CARE PROGRAMME FOR OLDER PEOPLE (ICPOP) IN A RURAL SETTING—ROLE OF ADVANCED NURSE PRACTITIONER (ANP). Age Ageing 2021. [DOI: 10.1093/ageing/afab219.112] [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: 02/25/2023] Open
Abstract
Abstract
Background
Sláintecare advocates for right care, in the right place at the right time. ANPs for Older Persons in the community are uniquely placed to deliver care as close as possible to the older person’s home and to lead a holistic, flexible model of care minimising admission to acute care and maximising existing local resources. A pilot programme aimed at providing ANP led comprehensive geriatric assessment (CGA) (with Geriatrician support) to older people in a defined area commenced in June 2019. This pilot was part of a larger Hub and Spoke model funded by Sláintecare which gave additional MDT support.
Methods
A referral template was designed. Criteria for referral included; age > 75 years, Rockwood Frailty Scale 4–6 (focusing on Falls, Cognitive Impairment and Complex Frailty). Older people on the cusp of requiring long term care (LTC) were also prioritised. A prospective database of patients was maintained by the ANP to evaluate the service.
Results
From June 2019 to August 2021, 156 patients received an ANP led CGA, mostly conducted in the home. 247 reviews were conducted at the local spoke clinic and 46 joint ANP/Geriatrician home visits. Majority of referrals were from GP (n = 69), hospital (n = 30), LTC reviews (n = 22) and Community Nursing Units (CNUs) (n = 19). 449 outpatient appointments have been removed from the tertiary referral centre. Independent case load management from the ANP includes further appointments, telephone follow up/advice and she is a point of contact where crises arise before referral to acute services. 99% of patients surveyed reported satisfaction with the service especially the ease of local access and home visits.
Conclusion
Older Persons’ ANP can provide longitudinal care pathways for older adults in the community in conjunction with ICPOP and local CNUs, intervening before crises emerge and providing continuity of care and an alternative to acute care.
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Affiliation(s)
- E Shiel
- University Hospital Galway\St. Brendan's CNU , Galway, Ireland
| | - M Costello
- University Hospital Galway , Galway, Ireland
| | - C McCarthy
- University Hospital Galway , Galway, Ireland
| | - R Murphy
- University Hospital Galway , Galway, Ireland
| | - C McDermott
- University Hospital Galway , Galway, Ireland
| | - J Geoghegan
- University Hospital Galway , Galway, Ireland
| | - E Mannion
- University Hospital Galway , Galway, Ireland
| | - M Conry
- University Hospital Galway , Galway, Ireland
| | - L Flanagan
- Community Healthcare West , Galway, Ireland
| | - E Moroney
- Community Healthcare West , Galway, Ireland
| | | | - C Walsh
- Community Healthcare West , Galway, Ireland
| | - K Coffey
- Community Healthcare West , Galway, Ireland
| | - R Waters
- University Hospital Galway , Galway, Ireland
| | - S Robinson
- University Hospital Galway , Galway, Ireland
| | - M O'Donnell
- University Hospital Galway , Galway, Ireland
| | - M Canavan
- University Hospital Galway , Galway, Ireland
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Rosen A, Chan W, Matelski J, Walsh C, Murji A. Medical Treatment of Uterine Arteriovenous Malformation: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.050] [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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Walsh C, Duggan N, Selame L, Fischetti C, Eyre A, Goldsmith A. 217 Establishing an Ultrasound-Guided Regional Anesthesia Training Curriculum for Emergency Physicians. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ektesabi AM, Mori K, Tsoporis JN, Vaswani CM, Gupta S, Walsh C, Varkouhi AK, Mei SH, Stewart DJ, Liles WC, Marshall JC, Hu P, Parker TG, dos Santos CC. Mesenchymal Stem/Stromal Cells Increase Cardiac miR-187-3p Expression in a Polymicrobial Animal Model of Sepsis. Shock 2021; 56:133-141. [PMID: 33378320 PMCID: PMC8240645 DOI: 10.1097/shk.0000000000001701] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/14/2020] [Accepted: 11/19/2020] [Indexed: 12/27/2022]
Abstract
ABSTRACT Sepsis-induced myocardial dysfunction (MD) is an important pathophysiological feature of multiorgan failure caused by a dysregulated host response to infection. Patients with MD continue to be managed in intensive care units with limited understanding of the molecular mechanisms controlling disease pathogenesis. Emerging evidences support the use of mesenchymal stem/stromal cell (MSC) therapy for treating critically ill septic patients. Combining this with the known role that microRNAs (miRNAs) play in reversing sepsis-induced myocardial-dysfunction, this study sought to investigate how MSC administration alters miRNA expression in the heart. Mice were randomized to experimental polymicrobial sepsis induced by cecal ligation and puncture (CLP) or sham surgery, treated with either MSCs (2.5 × 105) or placebo (saline). Twenty-eight hours post-intervention, RNA was collected from whole hearts for transcriptomic and microRNA profiling. The top microRNAs differentially regulated in hearts by CLP and MSC administration were used to generate a putative mRNA-miRNA interaction network. Key genes, termed hub genes, within the network were then identified and further validated in vivo. Network analysis and RT-qPCR revealed that septic hearts treated with MSCs resulted in upregulation of five miRNAs, including miR-187, and decrease in three top hit putative hub genes (Itpkc, Lrrc59, and Tbl1xr1). Functionally, MSC administration decreased inflammatory and apoptotic pathways, while increasing cardiac-specific structural and functional, gene expression. Taken together, our data suggest that MSC administration regulates host-derived miRNAs production to protect cardiomyocytes from sepsis-induced MD.
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Affiliation(s)
- Amin M. Ektesabi
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Keisuke Mori
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - James N. Tsoporis
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Chirag M. Vaswani
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Sahil Gupta
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Chris Walsh
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Amir K. Varkouhi
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Shirley H.J. Mei
- Ottawa Hospital Research Institute and the University of Ottawa, Ottawa, ON, Canada
| | - Duncan J. Stewart
- Ottawa Hospital Research Institute and the University of Ottawa, Ottawa, ON, Canada
| | - W. Conrad Liles
- Department of Medicine and Sepsis Center of Research Excellence-UW (SCORE-UW), University of Washington, Seattle, Washington
| | - John C. Marshall
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Pingzhao Hu
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB, Canada
| | - Thomas G. Parker
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Claudia C. dos Santos
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Rosen A, Chan WV, Matelski J, Walsh C, Murji A. Medical treatment of uterine arteriovenous malformation: a systematic review and meta-analysis. Fertil Steril 2021; 116:1107-1116. [PMID: 34130801 DOI: 10.1016/j.fertnstert.2021.05.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/13/2021] [Revised: 04/15/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To quantify the efficacy of medical management of uterine arteriovenous malformation (AVM) and compare efficacy between different classes of medication. In addition, we evaluated for factors associated with treatment success and pregnancy outcomes after medical management. DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Thirty-two studies representing 121 premenopausal women with medically-treated uterine AVM were identified via database searches of MEDLINE, Embase, Web of Science, and cited references. INTERVENTION(S) Medical treatment with progestins, gonadotropin-releasing hormone agonists (GnRH-a), methotrexate, combined hormonal contraception , uterotonics, danazol, or combination of the above. MAIN OUTCOME MEASURE(S) Primary outcome of treatment success was defined as AVM resolution without subsequent procedural interventions. Secondary outcome was treatment complication (readmission or transfusion). RESULT(S) The overall success rate of medical management was 88% (106/121). After adjusting for clustering effects, success rates for progestin (82.5%; 95% confidence interval [CI], 70.1%-90.4%), GnRH-a (89.3%; 99% CI, 71.4%-96.5%) and methotrexate (90.0%; 99% CI, 55.8%-98.8%) were significantly different from the null hypothesis of 50% success. The agents with the lowest adjusted proportion of complications were progestins (10.0%; 99% CI, 3.3%-26.8%) and GnRH-a (10.7%; 99% CI, 3.5%-28.4%). No clinical factors were found to predict treatment success. Twenty-six subsequent pregnancies are described, with no reported recurrences of AVM. CONCLUSION(S) Medical management for uterine AVM is a reasonable approach in a well selected patient. These data should be interpreted in the context of significant publication bias.
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Affiliation(s)
- Adam Rosen
- Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Wilson Ventura Chan
- Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Chris Walsh
- Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ally Murji
- Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.
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Wellbelove Z, Walsh C, Barlow GD, Lillie PJ. Comparing scoring systems for prediction of mortality in patients with bloodstream infection. QJM 2021; 114:105-110. [PMID: 33151308 DOI: 10.1093/qjmed/hcaa300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/02/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Blood stream infections (BSIs) are associated with significant short-term mortality. There are many different scoring systems for assessing the severity of BSI. AIM We studied confusion, urea, respiratory rate, blood pressure, age 65(CURB65), Confusion Respiratory Rate, Blood pressure, age 65(CRB65), quick sequential organ failure assessment (qSOFA), systemic inflammatory response syndrome (SIRS) and National Early Warning Score (NEWS) and assessed how effective they were at predicting 30-day mortality across three separate BSI cohorts. DESIGN A retrospective analysis was performed on three established BSI cohorts: (i) All cause BSI, (ii) Escherichia coli and (iii) Streptococcus pneumoniae. METHODS The performance characteristics (sensitivity, specificity, positive predictive value, negative predictive value and area under receiver operating curve [AUROC]) for the prediction of 30-day mortality were calculated for the 5 scores using clinically relevant cut-offs. RESULTS 528 patients were included: All cause BSI-148, E. coli-191 and S. pneumoniae-189. Overall, 30-day mortality was 22%. In predicting mortality, the AUROC for CURB65 and CRB65 were superior compared with qSOFA, SIRS and NEWS in the all cause BSI (0.72, 0.70, 0.66, 0.51 and 0.53) and E. coli cohorts (0.81, 0.76, 0.73, 0.55 and 0.71). In the pneumococcal cohort, CURB65, CRB65, qSOFA and NEWS were broadly equal (0.63, 0.65, 0.66 and 0.62), but all were superior to SIRS (0.57). CURB65, CRB65 and qSOFA had considerably higher accuracy than SIRS or NEWS across all cohorts. CONCLUSION CURB65 was superior to other scores in predicting 30-day mortality in the E. coli and all cause BSI cohorts. Further research is required to assess the potential of broadening the application of CURB65 beyond pneumonia.
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Affiliation(s)
- Z Wellbelove
- From the Department of Infection, Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Cottingham, Hull, UK
| | - C Walsh
- From the Department of Infection, Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Cottingham, Hull, UK
| | - G D Barlow
- From the Department of Infection, Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Cottingham, Hull, UK
| | - P J Lillie
- From the Department of Infection, Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Cottingham, Hull, UK
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Balzer N, McLeod SL, Walsh C, Grewal K. Low-dose Ketamine For Acute Pain Control in the Emergency Department: A Systematic Review and Meta-analysis. Acad Emerg Med 2021; 28:444-454. [PMID: 33098707 DOI: 10.1111/acem.14159] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/06/2020] [Accepted: 10/16/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE There has been increased interest in the use of low-dose ketamine (LDK) as an alternative analgesic for the management of acute pain in the emergency department (ED). The objective of this systematic review was to compare the analgesic effectiveness and safety profile of LDK and morphine for acute pain management in the ED. METHODS Electronic searches of Medline and EMBASE were conducted and reference lists were hand-searched. Randomized controlled trials (RCTs) comparing LDK to morphine for acute pain control in the ED were included. Two reviewers independently screened abstracts, assessed quality of the studies, and extracted data. Data were pooled using random-effects models and reported as mean differences and risk ratios (RRs) with 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty of the evidence. RESULTS Eight RCTs were included with a total of 1,191 patients (LDK = 598, morphine = 593). There was no significant difference in reported mean pain scores between LDK and morphine within the first 60 minutes after analgesia administration and a slight difference in pain scores favoring morphine at 60 to 120 minutes. The need for rescue medication was also similar between groups (RR = 1.26, 95% CI = 0.50 to 3.16), as was the proportion of patients who experienced nausea (RR = 0.97, 95% CI = 0.63 to 1.49) and hypoxia (RR = 0.38, 95% CI = 0.10 to 1.41). All outcomes were judged to have low certainty in the evidence. CONCLUSION Low-dose ketamine and morphine had similar analgesic effectiveness within 60 minutes of administration with comparable safety profiles, suggesting that LDK is an effective alternative analgesic for acute pain control in the ED.
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Affiliation(s)
- Nathan Balzer
- From the Department of Medicine Division of Emergency MedicineUniversity of Toronto TorontoOntarioCanada
| | - Shelley L. McLeod
- the Department of Family and Community Medicine University of Toronto TorontoOntarioCanada
- the Schwartz/Reisman Emergency Medicine InstituteSinai Health TorontoOntarioCanada
| | | | - Keerat Grewal
- From the Department of Medicine Division of Emergency MedicineUniversity of Toronto TorontoOntarioCanada
- the Schwartz/Reisman Emergency Medicine InstituteSinai Health TorontoOntarioCanada
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Walsh C, Tafforeau P, Wagner WL, Jafree DJ, Bellier A, Werlein C, Kühnel MP, Boller E, Walker-Samuel S, Robertus JL, Long DA, Jacob J, Marussi S, Brown E, Holroyd N, Jonigk DD, Ackermann M, Lee PD. Multiscale three-dimensional imaging of intact human organs down to the cellular scale using hierarchical phase-contrast tomography. bioRxiv 2021:2021.02.03.429481. [PMID: 33564772 PMCID: PMC7872374 DOI: 10.1101/2021.02.03.429481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Human organs are complex, three-dimensional and multiscale systems. Spatially mapping the human body down through its hierarchy, from entire organs to their individual functional units and specialised cells, is a major obstacle to fully understanding health and disease. To meet this challenge, we developed hierarchical phase-contrast tomography (HiP-CT), an X-ray phase propagation technique utilising the European Synchrotron Radiation Facility's Extremely Brilliant Source: the world's first high-energy 4 th generation X-ray source. HiP-CT enabled three-dimensional and non-destructive imaging at near-micron resolution in soft tissues at one hundred thousand times the voxel size whilst maintaining the organ's structure. We applied HiP-CT to image five intact human parenchymal organs: brain, lung, heart, kidney and spleen. These were hierarchically assessed with HiP-CT, providing a structural overview of the whole organ alongside detail of the organ's individual functional units and cells. The potential applications of HiP-CT were demonstrated through quantification and morphometry of glomeruli in an intact human kidney, and identification of regional changes to the architecture of the air-tissue interface and alveolar morphology in the lung of a deceased COVID-19 patient. Overall, we show that HiP-CT is a powerful tool which can provide a comprehensive picture of structural information for whole intact human organs, encompassing precise details on functional units and their constituent cells to better understand human health and disease.
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Affiliation(s)
- C Walsh
- Centre for Advanced Biomedical Imaging, University College London, U.K
| | - P Tafforeau
- European Synchrotron Radiation Facility, Grenoble, France
| | - Willi L Wagner
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany Translational Lung Research Centre Heidelberg (TLRC), German Lung Research Centre (DZL), Heidelberg, Germany
| | - D J Jafree
- Developmental Biology and Cancer Programme, Great Ormond Street Institute of Child Health, University College London, UK
- UCL MB/PhD Programme, Faculty of Medical Sciences, University College London, UK
| | - A Bellier
- French Alps Laboratory of Anatomy (LADAF), Grenoble Alpes University, Grenoble, France
| | - C Werlein
- Institute of Pathology, Hannover Medical School, Hannover, Germany (Carl-Neuberg-Straße 1, 30625 Hannover)
| | - M P Kühnel
- Institute of Pathology, Hannover Medical School, Hannover, Germany (Carl-Neuberg-Straße 1, 30625 Hannover)
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)
| | - E Boller
- European Synchrotron Radiation Facility, Grenoble, France
| | - S Walker-Samuel
- Centre for Advanced Biomedical Imaging, University College London, U.K
| | - J L Robertus
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
| | - D A Long
- Developmental Biology and Cancer Programme, Great Ormond Street Institute of Child Health, University College London, UK
| | - J Jacob
- Centre for Medical Image Computing, University College London, London, UK
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Marussi
- Department of Mechanical Engineering University College London, U.K
| | - E Brown
- Centre for Advanced Biomedical Imaging, University College London, U.K
| | - N Holroyd
- Centre for Advanced Biomedical Imaging, University College London, U.K
| | - D D Jonigk
- Institute of Pathology, Hannover Medical School, Hannover, Germany (Carl-Neuberg-Straße 1, 30625 Hannover)
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)
| | - M Ackermann
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz
| | - P D Lee
- Department of Mechanical Engineering University College London, U.K
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Robb L, Joubert G, Jordaan M, Ngounda JO, Walsh C. Dietary intake and food sources of choline in pregnant women in bloemfontein, South Africa. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.659] [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: 10/23/2022]
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Walsh C, Lydon S, Hehir A, O'Connor P. Development and evaluation of a novel caregiver-report tool to assess barriers to physical healthcare for people on the autism spectrum. Res Autism Spectr Disord 2020; 79:101680. [PMID: 33072182 PMCID: PMC7554131 DOI: 10.1016/j.rasd.2020.101680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/15/2020] [Accepted: 10/04/2020] [Indexed: 05/25/2023]
Abstract
INTRODUCTION People on the autism spectrum often experience poorer health than the general population despite higher engagement with the health services. This suggests a disparity in the accessibility of appropriate healthcare for autistic individuals. To improve access, barriers the autism community experience in healthcare first need to be identified. This paper aimed to: 1) develop and evaluate a caregiver-report tool; 2) identify barriers to physical healthcare for autistic individuals; and 3) identify potential contributing factors. METHODS A previously established taxonomy of barriers to healthcare for autistic individuals informed the development of the tool; this was then distributed to caregivers of autistic adults and children. Exploratory factor analysis (EFA) assessed validity and reliability of the tool. Multiple Regressions were performed to identify predictors of barriers. RESULTS In total, caregivers of 194 autistic children or adults participated in the study. The EFA produced four factors: 1) patient-level barriers; 2) healthcare provider-level (HCP) barriers; 3) healthcare system-level barriers; and 4) barriers related to managing healthcare. The greatest barriers included difficulties with identifying/reporting symptoms (endorsed by 62.4% of participants); difficulties handling the waiting area (60.3% of participants); and a lack of HCP knowledge regarding autism (52.1% of participants). Autism severity, general adjustment problems, anxiety, age and having unmet needs predicted the frequency and/or severity of barriers. CONCLUSIONS A tool that allows assessment of patient-, HCP-, and system-level barriers to healthcare was developed and evaluated. Patient-level barriers appear to occur frequently and pose substantial challenges. This tool will help identify areas most in need of intervention and support intervention evaluation.
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Affiliation(s)
- C Walsh
- Department of General Practice, School of Medicine, National University of Ireland Galway, Ireland
| | - S Lydon
- School of Medicine, National University of Ireland Galway, Ireland
| | - A Hehir
- School of Medicine, National University of Ireland Galway, Ireland
| | - P O'Connor
- Department of General Practice, School of Medicine, National University of Ireland Galway, Ireland
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Simpson G, Hopley P, Wilson J, Day N, Haworth A, Montazeri A, Smith D, Titu L, Anderson J, Agbamu D, Walsh C. Long-term outcomes of real world 'watch and wait' data for rectal cancer after neoadjuvant chemoradiotherapy. Colorectal Dis 2020; 22:1568-1576. [PMID: 32686268 DOI: 10.1111/codi.15177] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/13/2020] [Indexed: 12/27/2022]
Abstract
AIM A 'watch and wait' (W&W) strategy after neoadjuvant long-course chemoradiotherapy (NACRT) remains controversial. Whilst encouraging short-term data exist, the strategy will be judged on long-term data. We present long-term, real-world UK data from a single National Health Service trust. METHODS An analysis was performed of a prospectively maintained W&W database over 9 years between 2010 and 2018. Outcome measures include incidence and time to regrowth and overall and disease-free survival. RESULTS We diagnosed 563 rectal cancers in 9 years. In all, 283 patients underwent rectal resection (50.3%). NACRT was used in 155 patients for margin-threatened tumours on staging MRI. Forty-nine patients (31.6%) experienced either a 'near complete' or a complete clinical response (cCR) at their 10 weeks post-NACRT assessment (MRI and endoscopy). The median age was 69 years (range 44-83), and the male to female ratio was 32:17. The median follow-up was 38 months (range 12-96). The median tumour distance from the anal verge was 7 cm (1-15 cm). Twenty-two patients had a cCR on initial assessment and 27 patients had a 'near' cCR. Of those 27 who experienced a 'near' cCR, 17 (63%) progressed to cCR on repeat assessment and 10 (37%) did not. Of these 10 patients, seven underwent standard surgical resection and three were unfit for surgery. R0 for the seven with delayed resection was 100%. Of 39 patients (22 cCR and 17 'near' cCR who progressed to cCR) (25.2% of those receiving NACRT), six patients experienced local regrowth (15.4%). The median time to local regrowth was 29 months (15-60 months). One of these six patients underwent salvage abdominoperineal resection, one was advised to have contact radiotherapy and four opted against surgery and also had contact radiotherapy. The overall survival was 100% at 2 years and 90% at 5 years. Disease-free survival was 90.47% at 2 years and 74.8% at 5 years. CONCLUSION A W&W treatment strategy was employed safely in this patient cohort with acceptable rates of local regrowth and survival.
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Affiliation(s)
- G Simpson
- Wirral University Teaching Hospital, Wirral, UK
| | - P Hopley
- Wirral University Teaching Hospital, Wirral, UK
| | - J Wilson
- Wirral University Teaching Hospital, Wirral, UK
| | - N Day
- Wirral University Teaching Hospital, Wirral, UK
| | - A Haworth
- Wirral University Teaching Hospital, Wirral, UK
| | | | - D Smith
- Wirral University Teaching Hospital, Wirral, UK
| | - L Titu
- Wirral University Teaching Hospital, Wirral, UK
| | - J Anderson
- Wirral University Teaching Hospital, Wirral, UK
| | - D Agbamu
- Wirral University Teaching Hospital, Wirral, UK
| | - C Walsh
- Wirral University Teaching Hospital, Wirral, UK
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Schwartz Z, Li A, Walsh C, Rimel B, Alvarado M, Lentz S, Cass I. Patterns of care for risk reducing surgery in non-BRCA and Lynch ovarian cancer susceptibility mutation carriers. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.461] [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: 11/26/2022]
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Simpson G, Marks T, Blacker S, Smith D, Walsh C. Reply to "Fluoroscopy during coccygectomy for rectal cancer". Tech Coloproctol 2020; 24:1101. [PMID: 32862340 DOI: 10.1007/s10151-020-02336-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/22/2020] [Indexed: 10/23/2022]
Affiliation(s)
- G Simpson
- Department of Colorectal Surgery, Wirral University Teaching Hospital, Wirral, UK.
| | - T Marks
- Department of Colorectal Surgery, Wirral University Teaching Hospital, Wirral, UK
| | - S Blacker
- Department of Colorectal Surgery, Wirral University Teaching Hospital, Wirral, UK
| | - D Smith
- Department of Colorectal Surgery, Wirral University Teaching Hospital, Wirral, UK
| | - C Walsh
- Department of Colorectal Surgery, Wirral University Teaching Hospital, Wirral, UK
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Benseler A, Anglim B, Zhao ZY, Walsh C, McDermott CD. Antibiotic prophylaxis for urodynamic testing in women: a systematic review. Int Urogynecol J 2020; 32:27-38. [PMID: 32845398 PMCID: PMC7447964 DOI: 10.1007/s00192-020-04501-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/13/2020] [Indexed: 11/27/2022]
Abstract
Introduction and hypothesis Urinary tract infection is the most common complication after urodynamic studies (UDS). Practice guidelines recommend against antibiotic prophylaxis based on an outdated review of the literature, which advised on the premise of “a lack of good quality studies” and based on an assumed low incidence not consistently supported by the literature. Objectives This systematic review aims to update the assessment of the efficacy of antibiotic prophylaxis compared with placebo or no treatment for prevention of urinary tract infection in females over the age of 18 years undergoing UDS. Methods MEDLINE, EMBASE, COCHRANE, DISSERTATIONS, conference proceedings and clinical trial registries were searched for relevant randomized controlled trials. Two authors independently screened and selected articles, assessed these for quality according to Cochrane guidelines and extracted their data. Results A total of 2633 records were screened, identifying three relevant randomized controlled trials. The one study that was critically appraised as being the least likely biased showed a statistically significant effect of antibiotic prophylaxis in reducing bacteriuria post UDS in female patients. The other two studies included in the review did not. None of the studies included were powered to show a significant change in the incidence of urinary tract infection following UDS in female patients receiving antibiotic prophylaxis versus no prophylaxis. Conclusions Similar to the 2012 Cochrane review on this subject, this systematic review demonstrated that antibiotic prophylaxis may decrease bacteriuria in women post UDS; however, further research is required to assess its effect on urinary tract infections in this context.
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Affiliation(s)
- Anouk Benseler
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Breffini Anglim
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, 8-815, 700 University Ave., Toronto, Ontario, Canada
| | - Zi Ying Zhao
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Chris Walsh
- Sidney Liswood Library, Sinai Health System, Toronto, Canada
| | - Colleen D McDermott
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, 8-815, 700 University Ave., Toronto, Ontario, Canada.
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Dietz HP, Walsh C, Subramaniam N, Friedman T. Levator avulsion and vaginal parity: do subsequent vaginal births matter? Int Urogynecol J 2020; 31:2311-2315. [DOI: 10.1007/s00192-020-04330-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/29/2020] [Indexed: 11/28/2022]
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Forner D, Lee DJ, Walsh C, Witterick IJ, Taylor SM, Freeman J. Outpatient versus Inpatient Parotidectomy: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 162:818-825. [PMID: 32286187 DOI: 10.1177/0194599820911725] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Parotidectomies are commonly performed procedures by head and neck surgeons. Although parotidectomies are historically inpatient procedures, recent observational evidence has highlighted the potential for parotidectomies to be performed on an outpatient basis. This systematic review and meta-analysis sought to compare complications and unplanned health care utilization between patients undergoing outpatient versus inpatient parotidectomy. DATA SOURCES A systematic review was performed using MEDLINE, EMBASE, and the Cochrane Library. REVIEW METHODS Studies comparing the outcomes of outpatient parotidectomy with those of inpatient parotidectomy were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. Postoperative complications (hematoma, facial nerve dysfunction, seroma, fistulisation, Frey syndrome, and wound infection) and rates of 30-day readmission, reintervention, and emergency department presentation were compared. RESULTS We screened 1018 nonduplicate articles to include 5 studies, all of which were retrospective cohort studies. There were fewer complications found in the outpatient group (relative risk = 0.61, 95% confidence interval: 0.40-0.93). Outpatient procedures were more commonly performed on patients who lived close to the hospital, had fewer comorbidities, and had less extensive planned surgery. CONCLUSION Outpatient parotidectomy appears safe in select patients with outcomes comparable with inpatient surgery. However, evidence overall is of low quality, and further work is needed to delineate a satisfactory set of criteria for appropriate patient identification.
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Affiliation(s)
- David Forner
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Ontario, Canada
| | - Daniel J Lee
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Chris Walsh
- Sidney Liswood Health Sciences Library, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - S Mark Taylor
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Ontario, Canada
| | - Jeremy Freeman
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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John C, Amersi F, Fong A, Gillen J, Moore K, Walsh C, Li A, Rimel B, Cass I. Rethinking Breast Cancer Surveillance in Women with BRCA-associated Ovarian Cancer in the Post-SOLO Trial Era. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2019.11.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Reyes N, Walsh C, Soke N, Hepburn S. Changes in temperament over time in young children with autism spectrum disorder and other developmental delays: a follow-up comparison study. J Intellect Disabil Res 2019; 63:1248-1261. [PMID: 31169961 DOI: 10.1111/jir.12648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Although in the last decade some research has emerged on temperament in autism spectrum disorder (ASD), this research has primarily focused on the differences between children with ASD and their typically developing peers rather than the stability or change in temperament in this population. Thus, the goal of this study was to examine temperament over time in children with ASD, developmental delays (DD) and typical development (TD). Temperament differences were also compared among the three groups. METHODS To accomplish this, parents rated children's temperament at Time 1 (T1) and Time 2 (T2) using the Carey Temperament Scales (CTS). RESULTS Results from the study showed that at T1, parents of children with ASD rated their children as more withdrawn (i.e. approach), and emotionally negative (i.e. mood), and less distractible and adaptable than parents of children with TD and DD. Also, children with ASD were rated as more intense and children with DD as less distractible than their TD peers. Similarly, at T2, children with ASD were rated more withdrawn, and emotionally negative, and less persistent, rhythmic, adaptable and distractible than children with TD and DD. Also, children with ASD were rated as more active than their DD peers. Regarding stability, parent ratings of temperament appeared stable over time in the TD group, but ratings varied substantially in the ASD or DD groups. That is, for the ASD group, activity and approach at T1 were significantly associated with their corresponding dimensions at T2. However, for the TD group, rhythmicity, approach, intensity and mood at T1 were significantly associated with those dimensions at T2. No associations were found in the DD group. Regarding change, parents reported change in rhythmicity, persistence and threshold between T1 and T2 in the ASD group. Similarly, parents reported change in rhythmicity, approach and threshold between T1 and T2 in the DD group. Lastly, parents of TD children reported change in adaptability, persistence and distractibility between T1 and T2. CONCLUSIONS These findings are novel in that children with ASD appear to have less stable temperament profile and different change patterns than children with TD or DD. Similar to previous research, children with ASD were described by their parents as experiencing more temperamental difficulties.
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Affiliation(s)
- N Reyes
- Department of Pediatrics, University of Colorado, Aurora, CO, USA
- Department of Psychiatry, University of Colorado, Aurora, CO, USA
| | - C Walsh
- Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - N Soke
- Department of Psychiatry, University of Colorado, Aurora, CO, USA
| | - S Hepburn
- Department of Psychiatry, University of Colorado, Aurora, CO, USA
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Ektesabi AM, Mori K, Tsoporis J, Walsh C, Mai S, Hu P, DosSantos C. REGULATION OF MIR-187B IN ENDOTOXEMIC PRIMARY CARDIOMYOCYTES AND SEPTIC MURINE HEARTS TREATED WITH MESENCHYMAL STROMAL/STEM CELLS. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.444] [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: 11/30/2022] Open
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Saunders S, Killackey T, Kurahashi A, Walsh C, Wentlandt K, Lovrics E, Scott M, Mahtani R, Bernstein M, Howard M, Tanuseputro P, Goldman R, Zimmermann C, Aslakson RA, Isenberg SR. Palliative Care Transitions From Acute Care to Community-Based Care-A Systematic Review. J Pain Symptom Manage 2019; 58:721-734.e1. [PMID: 31201875 DOI: 10.1016/j.jpainsymman.2019.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/31/2019] [Accepted: 06/05/2019] [Indexed: 12/25/2022]
Abstract
CONTEXT Although the literature on transitions from hospital to the community is extensive, little is known about this experience within the context of palliative care (PC). OBJECTIVE We conducted a systematic review to investigate the impact of receiving palliative care in hospital on the transition from hospital to the community. METHODS We systematically searched MEDLINE, Embase, ProQuest, and CINAHL from 1995 until April 10, 2018, and extracted relevant references. Eligible articles were published in English, included adult patients receiving PC as inpatients, and explored transitions from hospital to the community. RESULTS A total of 1514 studies were identified and eight met inclusion criteria. Studies were published recently (>2012; n = 7, 88%). Specialist PC interventions were delivered by multidisciplinary care teams as part of inpatient PC triggers, discharge planning programs, and transitional care programs. Common outcomes reported with significant findings consisted of length of stay (n = 5), discharge support (n = 5), and hospital readmissions (n = 6) for those who received inpatient PC. Most studies were at high risk of bias. CONCLUSION Heterogeneity of study designs, outcomes, findings, and poor methodological quality renders it challenging to draw conclusions regarding PC's impact on the transition from hospital to home. Further research should use standardized outcomes with randomized controlled trial and/or propensity matched cohort designs.
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Affiliation(s)
- Stephanie Saunders
- Temmy Latner Centre for Palliative Care and Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Tieghan Killackey
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Allison Kurahashi
- Temmy Latner Centre for Palliative Care and Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Chris Walsh
- Library Services, Sinai Health System, Toronto, Ontario, Canada; School of Communications and Nursing, George Brown College, Toronto, Ontario, Canada
| | - Kirsten Wentlandt
- Division of Palliative Care, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Emily Lovrics
- Temmy Latner Centre for Palliative Care and Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Mary Scott
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Ramona Mahtani
- Temmy Latner Centre for Palliative Care and Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Mark Bernstein
- Temmy Latner Centre for Palliative Care and Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Russell Goldman
- Temmy Latner Centre for Palliative Care and Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Division of Palliative Care, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca A Aslakson
- Department of Medicine and Anesthesiology, Stanford University, Stanford, California, USA
| | - Sarina R Isenberg
- Temmy Latner Centre for Palliative Care and Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada; Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
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Walsh C, Kamrava M, Rogatko A, Li A, Cass I, Karlan B, Rimel B. Phase II trial of pembrolizumab with cisplatin and gemcitabine in women with recurrent platinum-resistant ovarian cancer. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Curran M, Tierney A, Collins L, Kennedy L, McDonnell C, Sheikhi A, Walsh C, Casserly B, Cahalan R. ePS3.10 Reliability and validity of the ActivPAL and Fitbit Charge 2 as a measure of step count in cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30268-1] [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: 11/30/2022]
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Penn C, Lester J, Bohrer K, Moon C, Yearley J, Karlan B, Walsh C. PD-1/PD-L1 expression in mutated ovarian cancers. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.078] [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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Walsh C, Sémon P, Poulin D, Sordi G, Tremblay AMS. Local Entanglement Entropy and Mutual Information across the Mott Transition in the Two-Dimensional Hubbard Model. Phys Rev Lett 2019; 122:067203. [PMID: 30822052 DOI: 10.1103/physrevlett.122.067203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Indexed: 06/09/2023]
Abstract
Entanglement and information are powerful lenses to probe phases transitions in many-body systems. Motivated by recent cold atom experiments, which are now able to measure the corresponding information-theoretic quantities, we study the Mott transition in the half-filled two-dimensional Hubbard model using cellular dynamical mean-field theory, and focus on two key measures of quantum correlations: entanglement entropy and a measure of total mutual information. We show that they detect the first-order nature of the transition, the universality class of the end point, and the crossover emanating from the end point.
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Affiliation(s)
- C Walsh
- Department of Physics, Royal Holloway, University of London, Egham, Surrey, United Kingdom, TW20 0EX
| | - P Sémon
- Computational Science Initiative, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - D Poulin
- Département de physique & Institut quantique, Université de Sherbrooke, Sherbrooke, Québec, Canada J1K 2R1
- Canadian Institute for Advanced Research, Toronto, Ontario, Canada, M5G 1Z8
| | - G Sordi
- Department of Physics, Royal Holloway, University of London, Egham, Surrey, United Kingdom, TW20 0EX
| | - A-M S Tremblay
- Département de physique & Institut quantique, Université de Sherbrooke, Sherbrooke, Québec, Canada J1K 2R1
- Canadian Institute for Advanced Research, Toronto, Ontario, Canada, M5G 1Z8
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Lydon S, Greally C, Tujjar O, Reddy K, Lambe K, Madden C, Walsh C, Fox S, O'Connor P. Psychometric evaluation of a measure of factors influencing hand hygiene behaviour to inform intervention. J Hosp Infect 2019; 102:407-412. [PMID: 30769147 DOI: 10.1016/j.jhin.2019.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 11/26/2018] [Accepted: 02/06/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although the hand hygiene (HH) procedure is simple, the related behaviour is complex and is not readily understood, explained or changed. There is a need for practical tools to provide data that can guide healthcare managers and practitioners not only on the 'what' (the standards that must be met), but also the 'how' (guidance on how to achieve the standards). AIM To develop a valid questionnaire to evaluate attitudes to the factors that influence engagement in HH behaviour that can be readily completed, administered and analysed by healthcare professionals to identify appropriate intervention strategies. Construct validity was assessed using confirmatory factor analysis, predictive validity was assessed through comparison with self-reported HH behaviour, and convergent validity was assessed through direct unit-level observation of HH behaviour. METHODS The Capability, Opportunity, Motivation-Behaviour (COM-B) model was used to design a 25-item questionnaire that was distributed to intensive care unit (ICU) personnel in Ireland. Direct observation of HH behaviour was carried out at two ICUs. FINDINGS In total, 292 responses to the survey (response rate 41.0%) were included in the analysis. Confirmatory factor analysis resulted in a 17-item questionnaire. Multiple regression revealed that a model including capability, opportunity and motivation was a significant predictor of self-reported behavioural intention [F(3,209)=22.58, P<0.001]. However, the opportunity factor was not found to make a significant contribution to the regression model. CONCLUSION The COM-B HH questionnaire is reliable and valid, and provides data to support the development and evaluation of HH interventions that meet the needs of specific healthcare units.
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Affiliation(s)
- S Lydon
- Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Ireland
| | - C Greally
- Galway University Hospital, Galway, Ireland
| | - O Tujjar
- Sligo University Hospital, Sligo, Ireland
| | - K Reddy
- Health Services Executive, Ireland
| | - K Lambe
- Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Ireland; Discipline of General Practice, School of Medicine, National University of Ireland Galway, Ireland
| | - C Madden
- Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Ireland; Discipline of General Practice, School of Medicine, National University of Ireland Galway, Ireland
| | - C Walsh
- Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Ireland; Discipline of General Practice, School of Medicine, National University of Ireland Galway, Ireland
| | - S Fox
- Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Ireland
| | - P O'Connor
- Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Ireland; Discipline of General Practice, School of Medicine, National University of Ireland Galway, Ireland.
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