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Meaney P, Hokororo A, Ndosi H, Dahlen A, Jacob T, Mwanga JR, Kalabamu FS, Joyce C, Mediratta R, Rozenfeld B, Berg M, Smith Z, Chami N, Mkopi NP, Mwanga C, Diocles E, Agweyu A. Feasibility of an Adaptive E-Learning Environment to Improve Provider Proficiency in Essential and Sick Newborn Care in Mwanza, Tanzania. medRxiv 2023:2023.07.11.23292406. [PMID: 37502852 PMCID: PMC10370233 DOI: 10.1101/2023.07.11.23292406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Introduction To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment (AEE). The objectives of this study were to 1) assess implementation success with use of in-person support and nudging strategy and 2) describe baseline provider knowledge and metacognition. Methods 6-month observational study at 1 zonal hospital and 3 health centers in Mwanza, Tanzania. To assess implementation success, we used the RE-AIM framework and to describe baseline provider knowledge and metacognition we used Howell's conscious-competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity. Results aESNC reached 85% (195/231) of providers: 75 medical, 53 nursing, and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centers. Median clinical experience was 4 years [IQR 1,9] and 45 (23%) had previous in-service training for both newborn essential and sick newborn care. Efficacy was 42% (SD±17%). Providers averaged 78% (SD±31%) completion of initial learning and 7%(SD±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious-competence was 53% [IQR:38-63%], unconscious-incompetence 32% [IQR:23-42%], conscious-incompetence 7% [IQR:2-15%], and unconscious-competence 2% [IQR:0-3%]. Higher baseline conscious-competence (OR 31.6 [95%CI:5.8, 183.5) and being a nursing officer (aOR: 5.6 [95%CI:1.8, 18.1]), compared to medical officer) were associated with initial learning completion or persistent activity. Conclusion aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in-person support and nudging increased reach, initial learning, and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e-learning normalization is needed.
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Affiliation(s)
- Peter Meaney
- Stanford University School of Medicine, Palo Alto, CA
| | - Adolfine Hokororo
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
| | - Hanston Ndosi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Alex Dahlen
- Stanford University School of Medicine, Palo Alto, CA
| | | | - Joseph R Mwanga
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Florence S Kalabamu
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
- Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
| | - Christine Joyce
- Cornell University School of Medicine, New York, New York USA
| | | | | | - Marc Berg
- Stanford University School of Medicine, Palo Alto, CA
- Area9 Lyceum, Boston, Massachusetts, USA
| | - Zack Smith
- Stanford University School of Medicine, Palo Alto, CA
| | - Neema Chami
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
| | - Namala P Mkopi
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Castory Mwanga
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
| | - Enock Diocles
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Ambrose Agweyu
- KEMRI-Wellcome Trust Research Programme, Kenya
- London School of Hygiene and Tropical Medicine, London, UK
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St. Thomas N, Joyce C, Lauro C. Palliative radiation therapy for metaplastic breast cancer: Case report 2141217. Current Problems in Cancer: Case Reports 2022. [DOI: 10.1016/j.cpccr.2022.100182] [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: 11/25/2022] Open
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3
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Dadrass F, Joyce C, Lake E. LB958 A retrospective study of skin biopsy diagnostic accuracy among dermatologists throughout the day: Do physicians experience diagnostic or procedure fatigue? J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.978] [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: 11/25/2022]
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4
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Bashir M, Joyce C, Bolduan A, Sehgal V, Smith M, Charous S. Revisiting CT Signs of Unilateral Vocal Fold Paralysis: A Single, Blinded Study. AJNR Am J Neuroradiol 2022; 43:592-596. [PMID: 35332018 PMCID: PMC8993190 DOI: 10.3174/ajnr.a7451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Several CT findings are thought to be indicative of vocal cord paralysis; however, these signs have never been validated in a blinded fashion. This study attempts to compare and validate these signs and determine their accuracy in predicting vocal cord paralysis. MATERIALS AND METHODS A retrospective chart review was performed, and CT scans from patients with known unilateral vocal cord paralysis and known normal vocal cord movement were reviewed by 3 radiologists who were blinded to the status of the patients' laryngeal function. The scans were reviewed and scored for 8 accepted signs of vocal cord paralysis as well as for predicting a final diagnostic conclusion. Statistical analysis using odds ratios for signs and the Fleiss κ for criterion agreement among the radiologists was performed for diagnostic accuracy. RESULTS The presence of medial displacement of the posterior ipsilateral vocal fold margin and ipsilateral laryngeal ventricular dilation yielded the greatest positive predictive value. Other signs demonstrated high specificity, but interrater discrepancy was greater than expected and diminished the reliability of these signs in predicting vocal cord paralysis. Overall, sensitivity and negative predictive values were low. CONCLUSIONS Predicting vocal cord paralysis on the basis of CT findings is not as accurate or straightforward in prospectively predicting vocal cord paralysis as implied in prior studies.
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Affiliation(s)
- M.H. Bashir
- From the Department of Radiology (M.H.B., V.S.)
| | - C. Joyce
- Loyola University Medical Center (C.J.), Maywood, Illinois
| | - A. Bolduan
- Vanderbilt University Medical Center (A.B.), Nashville, Tennessee
| | - V. Sehgal
- From the Department of Radiology (M.H.B., V.S.)
| | - M. Smith
- Diagnostic Imaging Alliance of Louisville (M.S.), Louisville, Kentucky
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5
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Joyce C, Roman FL, Miller B, Jeffries J, Miller RC. Emerging Cybersecurity Threats in Radiation Oncology. Adv Radiat Oncol 2021; 6:100796. [PMID: 34746516 PMCID: PMC8555435 DOI: 10.1016/j.adro.2021.100796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/18/2021] [Accepted: 08/22/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose Modern image guided radiation therapy is dependent on information technology and data storage applications that, like any other digital technology, are at risk from cyberattacks. Owing to a recent escalation in cyberattacks affecting radiation therapy treatments, the American Society for Radiation Oncology's Advances in Radiation Oncology is inaugurating a new special manuscript category devoted to cybersecurity issues. Methods and Materials We conducted a review of emerging cybersecurity threats and a literature review of cyberattacks that affected radiation oncology practices. Results In the last 10 years, numerous attacks have led to an interruption of radiation therapy for thousands of patients, and some of these catastrophic incidents have been described as being worse than the coronavirus disease of 2019 impact on centers in New Zealand. Conclusions Cybersecurity threats continue to evolve, making combatting these attacks more difficult for health care organizations and requiring a change in strategies, tactics, and culture around cyber security in health and radiation oncology. We recommend an assume breach mentality (threat-informed defense posture) and adopting a cloud-first and zero-trust security strategy. A reliance on computer-driven technology makes radiation oncology practices more vulnerable to cyberattacks. Health care providers should increase their resilience and cyber security maturity. The increase in the diversity of these attacks demands improved preparedness and collaboration between oncologic treatment centers both nationwide and internationally to protect patients.
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Affiliation(s)
- Christine Joyce
- University of Tennessee Health Science Center College of Medicine, Memphis, Tennesse
| | | | - Brett Miller
- Division of Radiation Oncology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - John Jeffries
- Information Security, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Robert C Miller
- Division of Radiation Oncology, University of Tennessee Medical Center, Knoxville, Tennessee
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Edwards T, Banyard H, Pigott B, Haff G, Joyce C. Sprint acceleration profiles of junior Australian football players: Intra-individual determinants of performance. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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7
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Wang X, Joyce C, Kuipers J. Making a convenient, low-cost phantom with a previously unreported material for practicing ultrasound-guided procedures. J Clin Ultrasound 2021; 49:987-991. [PMID: 34505641 DOI: 10.1002/jcu.23065] [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: 05/10/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
Ultrasound-guided procedures require excellent hand-eye coordination and practice. Trainees should gain this important skill with a phantom prior to performing procedures on patients. Currently available phantoms each have their own unique limitations. We propose an easily made, inexpensive, tissue-like phantom using a previously unreported material. The sonographic appearance of the phantom, with and without a 14-gauge needle, is compared with breast tissue, gelatin phantoms, and commercial phantoms. Target lesions can be produced using readily available materials. The proposed phantom is cheaper than commercial phantoms; performs better than gelatin phantoms, and is ultimately a superior practice tool for residents.
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Affiliation(s)
- Xiaoqin Wang
- Department of Radiology, University of Kentucky Health Care, Lexington, Kentucky, USA
- Markey Cancer Center, Lexington, Kentucky, USA
| | - Christine Joyce
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - John Kuipers
- Department of Radiology, University of Kentucky Health Care, Lexington, Kentucky, USA
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8
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Clements C, Barsamian J, Burnham N, Cruz C, Darcy AMG, Duphiney L, FitzGerald J, Holland S, Joyce C, DeSanto-Madeya S. Supporting Frontline Staff During the COVID-19 Pandemic. Am J Nurs 2021; 121:46-55. [PMID: 34438429 DOI: 10.1097/01.naj.0000790632.18077.c1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The coronavirus disease 2019 (COVID-19) pandemic that emerged in early 2020 put unprecedented physical, mental, and emotional strain on the staff of health care organizations, who have been caring for a critically ill patient population for more than a year and a half. Amid the ongoing pandemic, health care workers have struggled to keep up with new information about the disease, while also coping with the anxiety associated with caring for affected patients. It has also been a continual challenge for nurse leaders to provide adequate support for staff members and keep them informed about frequently changing practices and protocols. In this article, nursing leaders at an academic medical center in Boston reflect on the initial COVID-19 patient surge, which occurred from March to June 2020, and identify key actions taken to provide clinical and emotional support to frontline staff who cared for these patients. Lessons learned in this period provide insight into the management of redeployed staff, use of emotional support and debriefing, and relationship between access to information and staff morale. The knowledge gained through these initial experiences has been a vital resource as health care workers continue to face challenges associated with the ongoing pandemic.
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Affiliation(s)
- Charlotte Clements
- Charlotte Clements is a nurse educator at Beth Israel Deaconess Medical Center in Boston, where Jennifer Barsamian and Ann Marie Grillo Darcy are nurse specialists, Nicolette Burnham , Claire Cruz , and Jacqueline FitzGerald are nursing directors, Lindsay Duphiney is a nurse educator, Susan Holland is a patient safety coordinator and risk manager, Christine Joyce is a resource nurse, and Susan DeSanto-Madeya is a nurse scientist. Contact author: Charlotte Clements, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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9
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Kwak R, Joyce C, Werchniak AE, Lin JY, Tsibris HC. Clinical and histologic features associated with lentigo maligna clearance after imiquimod treatment. J DERMATOL TREAT 2021; 33:1995-1999. [PMID: 34315342 DOI: 10.1080/09546634.2021.1962001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Imiquimod cream may be used as a non-surgical treatment for lentigo maligna or as adjuvant therapy following excision to decrease the risk of recurrence. OBJECTIVES To evaluate histologic and clinical factors associated with clinical clearance of lentigo maligna treated with imiquimod. METHODS We performed a retrospective review of all patients diagnosed with lentigo maligna and treated with imiquimod between 1997 and 2019 at our academic institution. RESULTS We observed clinical clearance in 93% (66/71) of participants who received adjuvant imiquimod following surgery and 79% (19/24) in the primary non-surgical treatment group over a median of 38 months of follow-up. In the adjuvant therapy group, positive surgical margins were associated with a decreased rate of clinical clearance when compared to cases with close (<1 mm) margins or background melanocytic dysplasia (83.3 vs. 100%, p = .01). The presence of an inflammatory response during treatment was associated with increased clearance (94.1 vs. 66.7%, p = .02). CONCLUSIONS Adjuvant imiquimod treatment may decrease LM recurrence rates in cases with background melanocytic dysplasia or close margins. LM cases with positive surgical margins need close clinical follow-up given higher recurrence rates.
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Affiliation(s)
- R Kwak
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - C Joyce
- Department of Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
| | | | - J Y Lin
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - H C Tsibris
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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10
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Wasserman E, Toal M, Nellis ME, Traube C, Joyce C, Finkelstein R, Killinger JS, Joashi U, Harrington JS, Torres LK, Greenwald BM, Howell J. Rapid Transition of a PICU Space and Staff to Adult Coronavirus Disease 2019 ICU Care. Pediatr Crit Care Med 2021; 22:50-55. [PMID: 33031350 DOI: 10.1097/pcc.0000000000002597] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We describe the process by which a PICU and a PICU care team were incorporated into a hospital-wide ICU care model during the coronavirus disease 2019 pandemic. DESIGN A descriptive, retrospective report from a single-center PICU. SETTING Twenty-three bed, quaternary PICU, within an 862-bed hospital. PATIENTS Critically ill adults, with coronavirus disease 2019-related disease. INTERVENTIONS ICU care provided by pediatric intensivists with training and support from medical intensivists. MEASUREMENTS AND MAIN RESULTS Within the context of the institution's comprehensive effort to centralize and systematize care for adults with severe coronavirus disease 2019 disease, the PICU was transitioned to an adult coronavirus disease 2019 critical care unit. Nurses and physicians underwent just-in-time training over 3 days and 2 weeks, respectively. Medical ICU physicians and nurses provided oversight for care and designated hospital-based teams were available for procedures and common adult emergencies. Over a 7-week period, the PICU cared for 60 adults with coronavirus disease 2019-related critical illness. Fifty-three required intubation and mechanical ventilation for a median of 18 days. Eighteen required renal replacement therapy and 17 died. CONCLUSIONS During the current and potentially in future pandemics, where critical care resources are limited, pediatric intensivists and staff can be readily utilized to meaningfully contribute to the care of critically ill adults.
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Affiliation(s)
- Emily Wasserman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Megan Toal
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Marianne E Nellis
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Chani Traube
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Christine Joyce
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Robert Finkelstein
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Weill Cornell Medicine, New York, NY
| | - James S Killinger
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Umesh Joashi
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - John S Harrington
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell, New York, NY
| | - Lisa K Torres
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell, New York, NY
| | - Bruce M Greenwald
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Joy Howell
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
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Gomez-Perez S, Barrett R, Bojko M, Buzzi G, Smith A, O'Connor P, Sclamberg J, Rao R, Cobleigh M, Joyce C, Lomasney L, Vasilopoulos V, Sheean P. Prevalence of Sarcopenia in Women with Metastatic Breast Cancer. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.241] [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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12
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Bojko M, Barrett R, Morales-Perez M, Buzzi G, Smith A, Klein E, Usha L, Swoboda A, O'Connor P, Joyce C, Lomasney L, Sheean P, Gomez-Perez S. Adherence to American Cancer Society (ACS) Guidelines in Women with Metastatic Breast Cancer. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Kwak R, Joyce C, Werchniak A, Lin J, Tsibris H. LB958 Imiquimod treatment of lentigo maligna with positive margins, close margins, or field of dysplasia. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.05.053] [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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14
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Kwak P, Wesolowoski M, Baker K, Joyce C, Lowery E. Use of Cyclosporine Leads to Poorer Outcomes in Patients with Cystic Fibrosis Following Lung Transplant. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.725] [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] Open
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15
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Hartman R, Xue Y, Singer S, Markossian T, Joyce C, Mostaghimi A. Modelling the value of risk‐stratified skin cancer screening of asymptomatic patients by dermatologists. Br J Dermatol 2020; 183:509-515. [DOI: 10.1111/bjd.18816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 12/11/2022]
Affiliation(s)
- R.I. Hartman
- Department of Dermatology Brigham and Women's Hospital and Harvard Medical School Boston MA USA
| | - Y. Xue
- Harvard Combined Dermatology Residency Training Program Boston MA USA
| | - S. Singer
- Department of Dermatology Brigham and Women's Hospital and Harvard Medical School Boston MA USA
| | - T.W. Markossian
- Department of Public Health Sciences Loyola University Stritch School of Medicine Chicago IL USA
| | - C. Joyce
- Department of Public Health Sciences Loyola University Stritch School of Medicine Chicago IL USA
| | - A. Mostaghimi
- Department of Dermatology Brigham and Women's Hospital and Harvard Medical School Boston MA USA
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Zameer M, Iqbal S, Macanovic B, Clarke DB, Joyce C, O’Reilly S, Bambury R, Power D, Collins D. Feasibility and impact of prospective DPYD screening in the Irish population. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Elman SA, Joyce C, Costenbader KH, Merola JF. Time to progression from discoid lupus erythematosus to systemic lupus erythematosus: a retrospective cohort study. Clin Exp Dermatol 2019; 45:89-91. [PMID: 31120600 DOI: 10.1111/ced.14014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2019] [Indexed: 11/29/2022]
Abstract
Determining the risk of progression to systemic lupus erythematosus (SLE) among patients diagnosed with discoid lupus erythematosus (DLE), and the time frame of this risk, are important clinical questions. Past reports have demonstrated a wide time frame of progression from DLE to SLE, with mean time to progression of approximately 8 years. Using data obtained from an academic lupus centre, we identified 32 patients who progressed from DLE to SLE. In our cohort, we found that the median time to progression from DLE to SLE was 453 days, much sooner than previously reported. We believe this information can help inform clinicians on monitoring visit intervals and how best to counsel patients on SLE progression.
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Affiliation(s)
- S A Elman
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - C Joyce
- Loyola University, Chicago, IL, USA
| | - K H Costenbader
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - J F Merola
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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Hartman R, Xue Y, Karmouta R, Joyce C, Mostaghimi A. 270 Development and validation of a simple model to predict the risk of keratinocyte carcinoma on screening total body skin examination. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.346] [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: 10/27/2022]
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Boots RJ, Joyce C, Mullany DV, Anstey C, Blackwell N, Garrett PM, Gillis S, Alexander N. Near-Hanging as Presenting to Hospitals in Queensland: Recommendations for Practice. Anaesth Intensive Care 2019; 34:736-45. [PMID: 17183891 DOI: 10.1177/0310057x0603400610] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Near-hanging is an increasing presentation to hospitals in Australasia. We reviewed the clinical management and outcome of these patients as they presented to public hospitals in Queensland. A retrospective clinical record audit was made at five public hospitals between 1991 and 2000. Of 161 patients enrolled, 82% were male, 8% were indigenous and 10% had made a previous hanging attempt. Chronic medical illnesses were documented in 11% and previous psychiatric disorders in 42%. Of the 38 patients with a Glasgow Coma Scale score (GCS) of 3 on arrival at hospital, 32% returned to independent living and 63% died. Fifty-two patients received CPR, of whom 46% had an independent functional outcome. Independent predictors of mortality were a GCS on hospital arrival of 3 (AOR 150, CI 95% 12.4–1818, P<0.001), taking plain X-rays of the cervical spine (AOR 0.06, CI 95% 0.004–0.97, P=0.047) and contact with the ground (AOR 0.03, CI 95% 0.002–0.62, P=0.02). Only 66% had imaging of the cervical spine performed with other imaging performed infrequently. There were three laryngeal, two hyoid bone and three cervical spine injuries and one carotid dissection. The number of cervical spine X-rays required to find a significant cervical spine fracture was 54. Near-hanging presenting to hospital with a poor conscious state or even cardiac arrest can have a favourable clinical outcome. Radiological investigations are infrequently performed despite a low GCS precluding early accurate assessment. Given the general favourable outcome, an aggressive approach to searching for correctable injuries is recommended.
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Affiliation(s)
- R J Boots
- Department of Intensive Care, Royal Brisbane and Women's Hospital, Brisbane
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Lockwood S, Li D, Butler D, Tsiaras W, Joyce C, Mostaghimi A. The validity of the diagnostic code for pyoderma gangrenosum in an electronic database. Br J Dermatol 2018; 179:216-217. [DOI: 10.1111/bjd.16446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S.J. Lockwood
- Clinical Unit for Research Trials in Skin; Department of Dermatology; Massachusetts General Hospital; Harvard Medical School; Boston MA U.S.A
| | - D.G. Li
- Department of Dermatology; Brigham and Women's Hospital; Boston MA U.S.A
| | - D. Butler
- Department of Dermatology; Brigham and Women's Hospital; Boston MA U.S.A
| | - W. Tsiaras
- Department of Dermatology; Brigham and Women's Hospital; Boston MA U.S.A
| | - C. Joyce
- Loyola University Chicago Department of Public Health Sciences; Chicago IL U.S.A
| | - A. Mostaghimi
- Department of Dermatology; Brigham and Women's Hospital; Boston MA U.S.A
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Hartman R, Xue Y, Markossian T, Joyce C, Mostaghimi A. 253 Modeling the value of risk stratified skin cancer screening by dermatologists in the U.S. population. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.259] [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: 12/01/2022]
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White K, Scott IA, Bernard A, McCulloch K, Vaux A, Joyce C, Sullivan CM. Patient characteristics, interventions and outcomes of 1151 rapid response team activations in a tertiary hospital: a prospective study. Intern Med J 2017; 46:1398-1406. [PMID: 27600063 DOI: 10.1111/imj.13248] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 06/30/2016] [Revised: 08/23/2016] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The characteristics of mature contemporary rapid response systems are unclear. AIM To determine the patient characteristics, processes and outcomes, both in-hospital and post-discharge, of a well-established rapid response system in a tertiary adult hospital. METHODS This is a prospective study of consecutive rapid response team (RRT) activations between 1 July and 25 November 2015. Variables included patient characteristics, timing, location and triggers of RRT activations, interventions undertaken, mortality and readmission status at 28 days post-discharge. RESULTS A total of 1151 RRT activations was analysed (69.1 per 1000 admissions), involving 800 patients, of whom 81.5% were emergency admissions. A total of 351 (30.5%) activations comprised repeat activations for the same patient. Most activations (723; 62.8%) occurred out of hours, and 495 (43%) occurred within 48 h of admission. Hypotension, decreased level of consciousness and oxygen desaturation were the most common triggers. Advanced life support was undertaken in less than 7%; 198 (17.2%) responses led to transfer to higher-level care units. Acute resuscitation plans were noted for only 29.1% of RRT activations, with 80.3% stipulating supportive care only. A total of 103 (12.6%) patients died in hospital, equalling 14 deaths per 100 RRT activations. At 28 days, 150 (18.8%) patients had died, significantly more among those with multiple versus single RRT activations (24.9 vs 16.6%; odds ratio 1.66, 95% confidence interval 1.31-2.44; P = 0.013). CONCLUSION Relatively few RRT activations are associated with acute resuscitation plans, and most interventions during RRT responses are low level. The high rate of post-RRT deaths and transfers to higher-level care units calls for the prospective identification of such patients in targeting appropriate care.
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Affiliation(s)
- K White
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - I A Scott
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - A Bernard
- Queensland Facility for Advanced Bioinformatics, Brisbane, Queensland, Australia
| | - K McCulloch
- Division of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - A Vaux
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - C Joyce
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - C M Sullivan
- Division of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Hutten R, Surucu M, Joyce C, Alite F, Stang K, Small C, Sethi A, Emami B, Harkenrider M. Association of Lung Stereotactic Body Radiation Therapy Conformality Index and Posttreatment Radiation Pneumonitis in Early Stage Non–small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Earley C, Joyce C, McElvaney J, Richards D, Timulak L. Preventing depression: Qualitatively examining the benefits of depression-focused iCBT for participants who do not meet clinical thresholds. Internet Interv 2017; 9:82-87. [PMID: 30135841 PMCID: PMC6096201 DOI: 10.1016/j.invent.2017.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/01/2017] [Indexed: 01/19/2023] Open
Abstract
•First qualitative study on the benefits of iCBT for those who do not meet clinical thresholds•Successful application of cognitive and behavioural strategies reported•Increased insight/awareness and improved self-efficacy reported•The format of online delivery was reported as helpful.•Findings align with previous face-to-face and iCBT treatments.
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Affiliation(s)
- C. Earley
- SilverCloud Health, The Priory, John's Street West, Dublin, Ireland
- School of Psychology, Trinity College Dublin, Ireland
| | - C. Joyce
- SilverCloud Health, The Priory, John's Street West, Dublin, Ireland
| | - J. McElvaney
- School of Psychology, Trinity College Dublin, Ireland
| | - D. Richards
- SilverCloud Health, The Priory, John's Street West, Dublin, Ireland
- School of Psychology, Trinity College Dublin, Ireland
| | - L. Timulak
- School of Psychology, Trinity College Dublin, Ireland
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Charrow A, Xia F, Lu J, Waul M, Joyce C, Mostaghimi A. 384 iPledge disproportionately affects women, minorities, and low-income patients: a retrospective-cohort study. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.401] [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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26
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Traube C, Silver G, Gerber LM, Kaur S, Mauer EA, Kerson A, Joyce C, Greenwald BM. Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium. Crit Care Med 2017; 45:891-898. [PMID: 28288026 PMCID: PMC5392157 DOI: 10.1097/ccm.0000000000002324] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Delirium occurs frequently in adults and is an independent predictor of mortality. However, the epidemiology and outcomes of pediatric delirium are not well-characterized. The primary objectives of this study were to describe the frequency of delirium in critically ill children, its duration, associated risk factors, and effect on in-hospital outcomes, including mortality. Secondary objectives included determination of delirium subtype, and effect of delirium on duration of mechanical ventilation, and length of hospital stay. DESIGN Prospective, longitudinal cohort study. SETTING Urban academic tertiary care PICU. PATIENTS All consecutive admissions from September 2014 through August 2015. INTERVENTIONS Children were screened for delirium twice daily throughout their ICU stay. MEASUREMENTS AND MAIN RESULTS Of 1,547 consecutive patients, delirium was diagnosed in 267 (17%) and lasted a median of 2 days (interquartile range, 1-5). Seventy-eight percent of children with delirium developed it within the first 3 PICU days. Most cases of delirium were of the hypoactive (46%) and mixed (45%) subtypes; only 8% of delirium episodes were characterized as hyperactive delirium. In multivariable analysis, independent predictors of delirium included age less than or equal to 2 years old, developmental delay, severity of illness, prior coma, mechanical ventilation, and receipt of benzodiazepines and anticholinergics. PICU length of stay was increased in children with delirium (adjusted relative length of stay, 2.3; CI = 2.1-2.5; p < 0.001), as was duration of mechanical ventilation (median, 4 vs 1 d; p < 0.001). Delirium was a strong and independent predictor of mortality (adjusted odds ratio, 4.39; CI = 1.96-9.99; p < 0.001). CONCLUSIONS Delirium occurs frequently in critically ill children and is independently associated with mortality. Some in-hospital risk factors for delirium development are modifiable. Interventional studies are needed to determine best practices to limit delirium exposure in at-risk children.
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Affiliation(s)
- Chani Traube
- Department of Pediatrics, Weill Cornell Medical College, New York, NY
| | - Gabrielle Silver
- Department of Psychiatry, Weill Cornell Medical College, New York, NY
| | - Linda M. Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY
| | - Savneet Kaur
- Department of Pediatrics, Weill Cornell Medical College, New York, NY
| | - Elizabeth A. Mauer
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY
| | - Abigail Kerson
- (no department – medical student), Weill Cornell Medical College, New York, NY
| | - Christine Joyce
- Department of Pediatrics, New York Presbyterian Hospital, New York, NY
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Abstract
Fixed and dilated pupils are disturbing when encountered during a physical examination in the pediatric intensive care unit, particularly when sedation or neuromuscular blockade confounds the neurologic examination. Rocuronium, a nondepolarizing neuromuscular drug, does not cross the blood-brain barrier and is not considered a causative agent for fixed mydriasis. We report a case of bilateral fixed and dilated pupils in a 1-week-old low-birth-weight neonate, which we contend was secondary to centrally mediated neuromuscular blockade.
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Affiliation(s)
- Christine Joyce
- From the Division of Pediatric Critical Care Medicine, Weill Cornell Medical College, New York, New York
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Kerson AG, DeMaria R, Mauer E, Joyce C, Gerber LM, Greenwald BM, Silver G, Traube C. Validity of the Richmond Agitation-Sedation Scale (RASS) in critically ill children. J Intensive Care 2016; 4:65. [PMID: 27800163 PMCID: PMC5080705 DOI: 10.1186/s40560-016-0189-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 10/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Richmond Agitation-Sedation Scale (RASS) is a single tool that is intuitive, is easy to use, and includes both agitation and sedation. The RASS has never been formally validated for pediatric populations. The objective of this study was to assess inter-rater agreement and criterion validity of the RASS in critically ill children. METHODS To evaluate validity, the RASS score was compared to both a visual analog scale (VAS) scored by the patient's nurse, and the University of Michigan Sedation Scale (UMSS), performed by a researcher. The nurse completed the VAS by drawing a single line on a 10-cm scale anchored by "unresponsive" and "combative." The UMSS was used to validate the sedation portion of the RASS only, as it does not include grades of agitation. For inter-rater agreement, one researcher and the patient's nurse simultaneously but independently scored the RASS. RESULTS One hundred patient encounters were obtained from 50 unique patients, ages 2 months to 21 years. Of these, 27 assessments were on children who were mechanically ventilated and 73 were on children who were spontaneously breathing. In validity testing, the RASS was highly correlated with the nurse's VAS (Spearman correlation coefficient 0.810, p < .0001) and with the UMSS (weighted kappa 0.902, p < .0001). Inter-rater agreement between nurse- and researcher-assessed RASS was excellent, with weighted kappa of 0.825 (p < .0001). CONCLUSIONS The RASS is a valid responsiveness tool for use in critically ill children. It allows for accurate assessment of awareness in mechanically ventilated and spontaneously breathing patients, and may improve our ability to titrate sedatives and assess for delirium in pediatrics.
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Affiliation(s)
| | | | - Elizabeth Mauer
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY USA
| | - Christine Joyce
- Pediatric Critical Care Medicine, Weill Cornell Medical College, New York, NY USA
| | - Linda M Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY USA
| | - Bruce M Greenwald
- Pediatric Critical Care Medicine, Weill Cornell Medical College, New York, NY USA
| | - Gabrielle Silver
- Department of Child Psychiatry, Weill Cornell Medical College, New York, NY USA
| | - Chani Traube
- Pediatric Critical Care Medicine, Weill Cornell Medical College, New York, NY USA
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Brenner SK, Kaushal R, Grinspan Z, Joyce C, Kim I, Allard RJ, Delgado D, Abramson EL. Effects of health information technology on patient outcomes: a systematic review. J Am Med Inform Assoc 2016; 23:1016-36. [PMID: 26568607 PMCID: PMC6375119 DOI: 10.1093/jamia/ocv138] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To systematically review studies assessing the effects of health information technology (health IT) on patient safety outcomes. MATERIALS AND METHODS The authors employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement methods. MEDLINE, Cumulative Index to Nursing Allied Health (CINAHL), EMBASE, and Cochrane Library databases, from 2001 to June 2012, were searched. Descriptive and comparative studies were included that involved use of health IT in a clinical setting and measured effects on patient safety outcomes. RESULTS Data on setting, subjects, information technology implemented, and type of patient safety outcomes were all abstracted. The quality of the studies was evaluated by 2 independent reviewers (scored from 0 to 10). A total of 69 studies met inclusion criteria. Quality scores ranged from 1 to 9. There were 25 (36%) studies that found benefit of health IT on direct patient safety outcomes for the primary outcome measured, 43 (62%) studies that either had non-significant or mixed findings, and 1 (1%) study for which health IT had a detrimental effect. Neither the quality of the studies nor the rate of randomized control trials performed changed over time. Most studies that demonstrated a positive benefit of health IT on direct patient safety outcomes were inpatient, single-center, and either cohort or observational trials studying clinical decision support or computerized provider order entry. DISCUSSION AND CONCLUSION Many areas of health IT application remain understudied and the majority of studies have non-significant or mixed findings. Our study suggests that larger, higher quality studies need to be conducted, particularly in the long-term care and ambulatory care settings.
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Affiliation(s)
- Samantha K Brenner
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA Center for Healthcare Informatics and Policy, New York, NY, USA Department of Medicine, Stanford School of Medicine, Palo Alto, CA, USA Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Rainu Kaushal
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA Center for Healthcare Informatics and Policy, New York, NY, USA Department of Medicine, Weill Cornell Medical College, New York, NY, USA Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA New York-Presbyterian Hospital, New York, NY, USA
| | - Zachary Grinspan
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA Center for Healthcare Informatics and Policy, New York, NY, USA Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA New York-Presbyterian Hospital, New York, NY, USA
| | - Christine Joyce
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA New York-Presbyterian Hospital, New York, NY, USA
| | - Inho Kim
- New York-Presbyterian Hospital, New York, NY, USA Department of Emergency Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Rhonda J Allard
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Diana Delgado
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, NY, USA
| | - Erika L Abramson
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA Center for Healthcare Informatics and Policy, New York, NY, USA Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA New York-Presbyterian Hospital, New York, NY, USA
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Dommasch E, Joyce C, Mostaghimi A. 158 Trends in emergency department visits for herpes zoster from 2006-2012. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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31
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Mahon N, Joyce C, Joyce K, Dockery P, Kelly J. A novel barbed suture tie-over dressing for skin grafts: a comparison with traditional techniques. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.126] [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: 11/15/2022]
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32
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Mahon N, Joyce C. The 50 most cited papers in cleft lip and palate. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.050] [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: 11/16/2022]
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Joyce C, Witcher R, Herrup E, Kaur S, Mendez-Rico E, Silver G, Greenwald BM, Traube C. Evaluation of the Safety of Quetiapine in Treating Delirium in Critically Ill Children: A Retrospective Review. J Child Adolesc Psychopharmacol 2015; 25:666-70. [PMID: 26469214 PMCID: PMC4808274 DOI: 10.1089/cap.2015.0093] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Quetiapine is an atypical antipsychotic that has been used off-label for the treatment of intensive care unit (ICU) delirium in the adult population, with studies demonstrating both efficacy and a favorable safety profile. Although there is a potential role for quetiapine in the treatment of pediatric ICU delirium, there has been no systematic reporting to date of safety in this patient population. METHODS Pharmacy records were used to identify 55 consecutive pediatric ICU patients who were diagnosed with delirium and received quetiapine. A comprehensive retrospective medical chart review was performed to collect data on demographics, dosing, and side effects. RESULTS Fifty patients treated between January 2013 and November 2014 were included, and five patients were excluded from the study. Subjects ranged in age from 2 months to 20 years. Median daily dose was 1.3 mg/kg/day, and median duration of treatment was 12 days. There were three episodes of QTc prolongation that were clinically nonsignificant with no associated dysrhythmia: Two resolved over time without intervention, and one resolved with decrease in quetiapine dosage. There were no episodes of extrapyramidal symptoms or neuroleptic malignant syndrome. CONCLUSIONS In this population of critically ill youth, short-term use of quetiapine as treatment for delirium appears to be safe, without serious adverse events. Further research is required to assess efficacy and evaluate for long-term effects. A prospective, randomized, placebo-controlled study of quetiapine in managing pediatric delirium is necessary.
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Affiliation(s)
- Christine Joyce
- Department of Pediatrics, NewYork-Presbyterian Hospital, New York, New York
| | - Robert Witcher
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York
| | - Elizabeth Herrup
- Department of Pediatrics, NewYork-Presbyterian Hospital, New York, New York
| | - Savneet Kaur
- Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Elena Mendez-Rico
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York
| | - Gabrielle Silver
- Department of Psychiatry, Weill Cornell Medical College, New York, New York
| | - Bruce M. Greenwald
- Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Chani Traube
- Department of Pediatrics, Weill Cornell Medical College, New York, New York
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Ponsford M, Carne E, Kingdon C, Joyce C, Price C, Williams C, El-Shanawany T, Williams P, Jolles S. Facilitated subcutaneous immunoglobulin (fSCIg) therapy--practical considerations. Clin Exp Immunol 2015; 182:302-13. [PMID: 26288095 DOI: 10.1111/cei.12694] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/03/2015] [Accepted: 08/05/2015] [Indexed: 12/30/2022] Open
Abstract
There is an increasing range of therapeutic options for primary antibody-deficient patients who require replacement immunoglobulin. These include intravenous immunoglobulin (IVIg), subcutaneous immunoglobulin (SCIg), rapid push SCIg and most recently recombinant human hyaluronidase-facilitated SCIg (fSCIg). Advantages of fSCIg include fewer needle punctures, longer infusion intervals and an improved adverse effect profile relative to IVIg. Limited real-life experience exists concerning the practical aspects of switching or starting patients on fSCIg. We describe the first 14 patients who have been treated with fSCIg at the Immunodeficiency Centre for Wales (ICW), representing more than 6 patient-years of experience. The regimen was well tolerated, with high levels of satisfaction and no increase in training requirement, including for a treatment-naive patient. Two patients discontinued fSCIg due to pain and swelling at the infusion site, and one paused therapy following post-infusion migraines. Ultrasound imaging of paired conventional and facilitated SCIg demonstrated clear differences in subcutaneous space distribution associated with a 10-fold increase in rate and volume delivery with fSCIg. Patient profiles for those choosing fSCIg fell into two main categories: those experiencing clinical problems with their current treatment and those seeking greater convenience and flexibility. When introducing fSCIg, consideration of the type and programming of infusion pump, needle gauge and length, infusion site, up-dosing schedule, home training and patient information are important, as these may differ from conventional SCIg. This paper provides guidance on practical aspects of the administration, training and outcomes to help inform decision-making for this new treatment modality.
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Affiliation(s)
- M Ponsford
- Immunodeficiency Centre for Wales, Department of Immunology
| | - E Carne
- Immunodeficiency Centre for Wales, Department of Immunology
| | - C Kingdon
- Immunodeficiency Centre for Wales, Department of Immunology
| | - C Joyce
- Immunodeficiency Centre for Wales, Department of Immunology
| | - C Price
- Immunodeficiency Centre for Wales, Department of Immunology
| | - C Williams
- Department of Radiology, University Hospital of Wales, Cardiff, UK
| | - T El-Shanawany
- Immunodeficiency Centre for Wales, Department of Immunology
| | - P Williams
- Immunodeficiency Centre for Wales, Department of Immunology
| | - S Jolles
- Immunodeficiency Centre for Wales, Department of Immunology
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Bartels Ä, Egan N, Broadhurst DI, Khashan AS, Joyce C, Stapleton M, O'Mullane J, O'Donoghue K. Maternal serum cholesterol levels are elevated from the 1st trimester of pregnancy: a cross-sectional study. J OBSTET GYNAECOL 2013; 32:747-52. [PMID: 23075347 DOI: 10.3109/01443615.2012.714017] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cholesterol is monitored in the non-pregnant adult population, where normal values are established. Although reported to be elevated in pregnancy, cholesterol is neither routinely measured nor treated. We aimed to investigate cholesterol levels throughout pregnancy and to establish reference values for cholesterol in healthy pregnant women. This was a cross-sectional analysis of serum cholesterol in healthy women with an uncomplicated singleton pregnancy. Pregnant women attending for antenatal care were recruited and cholesterol levels assayed at 12, 20, 28 and 36 weeks' gestation and on day 1-3 postpartum. A total of 222 women were recruited. The majority (95%) were white Irish, with a median age of 31 years (range 16-46). Median BMI was 25.9 kg/m2 (range 18-40) and 16% were smokers. Cholesterol levels were elevated in all trimesters of pregnancy, with median values from 1st trimester raised outside the non-pregnant adult range. High-density lipoprotein (HDL) levels ranged from 0.9 to 3.7 mmol/l and low-density lipoprotein (LDL) levels ranged from 1.3 to 6.1 mmol/l. Fasting, smoking and obesity did not have any significant effects on results. Total and LDL-cholesterol levels were raised throughout pregnancy. Levels were above non-pregnant adult ranges as early as the 1st trimester. The implications of this on fetus and mother are undetermined and deserve further investigation.
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Affiliation(s)
- Ä Bartels
- Anu Research Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland
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Casey R, Prendeville S, Joyce C, O'Halloran D. First reported case in Ireland of MEN2A due to a rare mutation in exon 8 of the RET oncogene. Endocrinol Diabetes Metab Case Rep 2013; 2013:130044. [PMID: 24616773 PMCID: PMC3922143 DOI: 10.1530/edm-13-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/11/2013] [Accepted: 08/23/2013] [Indexed: 11/24/2022] Open
Abstract
We present the case of a 30-year-old female who was diagnosed with hereditary phaeochromocytoma secondary to a rare gene mutation in exon 8 of the RET oncogene. This genetic mutation was picked up as part of an extended genetic screen using a method known as next generation sequencing. Detection of this genetic mutation prompted further screening for the manifestation of multiple endocrine neoplasia type 2A (MEN2A). The patient subsequently underwent a thyroidectomy with histology confirming C-cell hyperplasia.
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Affiliation(s)
- R Casey
- Department of Endocrinology Cork University Hospital Cork Ireland
| | - S Prendeville
- Department of Pathology Cork University Hospital Cork Ireland
| | - C Joyce
- Department of Biochemistry Cork University Hospital Cork Ireland
| | - D O'Halloran
- Department of Endocrinology Cork University Hospital Cork Ireland
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Khalid AS, Joyce C, O'Donoghue K. Prevalence of subclinical and undiagnosed overt hypothyroidism in a pregnancy loss clinic. Ir Med J 2013; 106:107-110. [PMID: 23691843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Recent studies have associated pregnancy loss with subclinical hypothyroidism, defined as elevated thyroid-stimulating-hormone level, with normal free thyroxine. In overt hypothyroidism, the free thyroxine is low. Subclinical and overt hypothyroidism occurs in 0.25-2.5% and 0.2-0.3% of pregnancies respectively. We examined the prevalence of subclinical and undiagnosed overt hypothyroidism in women with recurrent miscarriage, late miscarriage and stillbirth attending the Pregnancy Loss Clinic. Data was collected from the Pregnancy Loss Clinic records. Women with sporadic miscarriages, autoimmune disorders, thrombophilias and known hypothyroidism were excluded. Two-hundred-and-sixty-two women were included. Median maternal age was 35 years (range 18-47). Subclinical and undiagnosed overt hypothyroidism was found in 11.45% of women. Twenty-two women (8.39%) had subclinical hypothyroidism, eight (3.05%) had undiagnosed overt hypothyroidism. Results were compared to women with ongoing pregnancies. A proportion of women attending the clinic had subclinical or undiagnosed overt hypothyroidism, raising the suspicion of causation in unexplained pregnancy loss.
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Affiliation(s)
- A S Khalid
- Anu Research Centre, Department of Obstetrics and Gynaecology, UCC, Cork University Maternity Hospital, Wilton, Cork
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Aitken L, Macfarlane B, Chaboyer W, Schuetz M, Joyce C, Barnett AG. Predicting physical function and mental health in trauma intensive care patients 2 years after hospitalisation. Crit Care 2013. [PMCID: PMC3642935 DOI: 10.1186/cc12420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Holt EW, Muntner P, Joyce C, Morisky DE, Webber LS, Krousel-Wood M. Life events, coping, and antihypertensive medication adherence among older adults: the cohort study of medication adherence among older adults. Am J Epidemiol 2012; 176 Suppl 7:S64-71. [PMID: 23035146 DOI: 10.1093/aje/kws233] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The authors examined the association between life events and antihypertensive medication adherence in older adults and the moderating role of coping. A cross-sectional analysis was conducted by using data (n = 1,817) from the Cohort Study of Medication Adherence among Older Adults (recruitment conducted from August 2006 through September 2007). Life events occurring in the 12 months preceding the study interview were assessed via the Holmes Rahe Social Readjustment Rating Scale (SRRS), and coping levels were assessed via an adapted version of the John Henry Active Coping Scale. Low adherence to antihypertensive medication was defined as scores less than 6 on the 8-item Morisky Medication Adherence Scale (known as "MMAS-8"). Of study participants, 13.2% had low adherence, and 27.2% and 5.0% had medium (150-299) and high (≥300) SRRS scores, respectively. After multivariable adjustment, the odds ratios for low adherence associated with medium and high, versus low, SRRS were 1.50 (95% confidence interval: 1.11, 2.02) and 2.11 (95% confidence interval: 1.24, 3.58), respectively. When multivariable models were stratified by coping level, the association between life events and adherence was evident only among participants with low coping levels.
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Affiliation(s)
- Elizabeth W Holt
- Center for Health Research, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA
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Bilotta GS, Burnside NG, Cheek L, Dunbar MJ, Grove MK, Harrison C, Joyce C, Peacock C, Davy-Bowker J. Developing environment-specific water quality guidelines for suspended particulate matter. Water Res 2012; 46:2324-32. [PMID: 22386884 DOI: 10.1016/j.watres.2012.01.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 01/23/2012] [Accepted: 01/30/2012] [Indexed: 05/26/2023]
Abstract
It is generally well recognised that suspended particulate matter (SPM), from nano-scale particles to sand-sized sediments, can cause serious degradation of aquatic ecosystems. However, at present there is a poor understanding of the SPM conditions that water quality managers should aim to achieve in contrasting environments in order to support good ecological status. In this article, we analyse long-term SPM data collected from a wide range of reference-condition temperate environments in the UK (638 stream/river sites comprising 42 different ecosystem-types). One-way analysis of variance reveals that there is a statistically significant difference (p < 0.001) between the background SPM concentrations observed in contrasting ecosystems that are in reference condition (minimal anthropogenic disturbance). One of the 42 ecosystems studied had mean background concentrations of SPM in excess of the current European Union (EU) water quality guideline, despite being in reference condition. The implications of this finding are that the EU's current blanket water quality guideline (25 mg L(-1) for all environments) is inappropriate for this specific ecosystem-type which will be non-compliant with the guideline regardless of the intensity of land-use. The other 41 ecosystems studied had mean concentrations below the current EU water quality guideline. However, this does not necessarily mean that the guideline is appropriate for these ecosystems, as previous research has demonstrated that detrimental impacts can be experienced by some freshwater organisms, of all trophic levels, when exposed to concentrations below 25 mg L(-1). Therefore, it is suggested here that it is likely that some ecosystems, particularly those with mean concentrations in the 0.00-5.99 mg L(-1) range, require much lower guideline values in order to be effectively protected. We propose a model for predicting environment-specific water quality guidelines for SPM. In order to develop this model, the 638 reference condition sites were first classified into one of five mean background SPM ranges (0.00-5.99, 6.00-11.99, 12.00-17.99, 18.00-23.99 and >24.00 mg L(-1)). Stepwise Multiple Discriminant Analysis (MDA) of these ranges showed that a site's SPM range can be predicted as a function of: mean annual air temperature, mean annual precipitation, mean altitude of upstream catchment, distance from source, slope to source, channel width and depth, the percentage of catchment area comprised of clay, chalk, and hard rock solid geology, and the percentage of the catchment area comprised of blown sand as the surface (drift) material. The MDA technique, with cross-validation (Wilks-Lambda 0.358, p 0.000), can predict the correct or the next closest SPM range of a site in 90% of cases. This technique can also predict SPM range membership in a probabilistic manner, allowing for an estimate of uncertainty to be made in the allocation of a site to an environment-specific SPM range.
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Affiliation(s)
- G S Bilotta
- School of Environment and Technology, University of Brighton, Cockcroft Building, Lewes Road, Brighton, East Sussex BN2 4GJ, UK.
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Schwadron NA, Baker T, Blake B, Case AW, Cooper JF, Golightly M, Jordan A, Joyce C, Kasper J, Kozarev K, Mislinski J, Mazur J, Posner A, Rother O, Smith S, Spence HE, Townsend LW, Wilson J, Zeitlin C. Lunar radiation environment and space weathering from the Cosmic Ray Telescope for the Effects of Radiation (CRaTER). ACTA ACUST UNITED AC 2012. [DOI: 10.1029/2011je003978] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
BACKGROUND Young people with complex healthcare needs (CHNs) face the challenge of transferring from child to adult health services. This study sought to identify successful models of transitional care for young people with CHNs. Three conditions were used as exemplars: cerebral palsy, autism spectrum disorders and diabetes. METHODS Scoping review: using search terms concerning transitional care, four databases were systematically searched for papers published in English between 1980 and April 2010. Additional informal search methods included recommendations from colleagues working with young people with each of the three conditions and making contact with clinical and research teams with expertise in transitional care. Inclusion and exclusion criteria were applied to define the papers selected for review. A separate review of policy documents, adolescent health and transition literature was also undertaken; 10 common summary categories for the components of high-quality services were identified. All papers were coded using a framework analysis which evaluated the data in two ways using the 10 transition categories and four elements of Normalization Process Theory that are important for successful implementation and integration of healthcare interventions. RESULTS Nineteen papers were selected for review. A very limited literature of models of service provision was identified for young people with cerebral palsy and diabetes. No models were identified for young people with autism spectrum disorders. Furthermore most publications were either descriptions of new service provision or time-limited pilot studies with little service evaluation or consideration of key elements of effective implementation. CONCLUSIONS Despite agreement about the importance of effective transitional care, there is a paucity of evidence to inform best practice about both the process of and what constitutes effective transitional care. There is therefore an urgent need for research to evaluate current transitional care practices for young people with CHNs.
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Affiliation(s)
- R Watson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Gremel G, Ryan D, Rafferty M, Lanigan F, Hegarty S, Lavelle M, Murphy I, Unwin L, Joyce C, Faller W, McDermott EW, Sheahan K, Ponten F, Gallagher WM. Functional and prognostic relevance of the homeobox protein MSX2 in malignant melanoma. Br J Cancer 2011; 105:565-74. [PMID: 21730974 PMCID: PMC3170959 DOI: 10.1038/bjc.2011.249] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: The homeobox containing transcription factor MSX2 is a key regulator of embryonic development and has been implicated to have a role in breast and pancreatic cancer. Methods: Using a selection of two- and three-dimensional in vitro assays and tissue microarrays (TMAs), the clinical and functional relevance of MSX2 in malignant melanoma was explored. A doxycyline-inducible over-expression system was applied to study the relevance of MSX2 in vitro. For TMA construction, tumour material from 218 melanoma patients was used. Results: Ectopic expression of MSX2 resulted in the induction of apoptosis and reduced the invasive capacity of melanoma cells in three-dimensional culture. MSX2 over-expression was shown to affect several signalling pathways associated with cell invasion and survival. Downregulation of N-Cadherin, induction of p21 and inhibition of both BCL2 and Survivin were observed. Cytoplasmic MSX2 expression was found to correlate significantly with increased recurrence-free survival (P=0.008). Nuclear expression of MSX2 did not result in significant survival correlations, suggesting that the beneficial effect of MSX2 may be independent of its DNA binding activity. Conclusions: MSX2 may be an important regulator of melanoma cell invasion and survival. Cytoplasmic expression of the protein was identified as biomarker for good prognosis in malignant melanoma patients.
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Affiliation(s)
- G Gremel
- UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland
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Dauber K, Joyce C, Peters P, Kaye G. Use of temporary cardiac resynchronization therapy to wean a patient successfully from ventilation. Intern Med J 2010; 39:e8-9. [PMID: 20233238 DOI: 10.1111/j.1445-5994.2009.02092.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sturgess D, Marwick T, Joyce C, Jenkins C, Jones M, Masci P, Stewart D, Venkatesh B. Diastolic dysfunction in septic shock is an independent predictor of elevated B-type natriuretic peptide and hospital mortality. Crit Care 2010. [PMCID: PMC2934146 DOI: 10.1186/cc8626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Hicks P, Cooper DJ, Webb S, Myburgh J, Seppelt I, Peake S, Joyce C, Stephens D, Turner A, French C, Hart G, Jenkins I, Burrell A. The Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. An assessment by the Australian and New Zealand intensive care society. Anaesth Intensive Care 2008; 36:149-51. [PMID: 18361003 DOI: 10.1177/0310057x0803600202] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Sturgess DJ, Joyce C, Marwick TH, Venkatesh B. A clinician's guide to predicting fluid responsiveness in critical illness: applied physiology and research methodology. Anaesth Intensive Care 2007; 35:669-78. [PMID: 17933152 DOI: 10.1177/0310057x0703500504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intravenous fluid administration is often used in critical care with the goal of improving haemodynamics and consequently tissue perfusion and oxygen delivery. While inotropic and vasoactive drugs are often necessary to correct haemodynamic instability, resuscitation usually begins with fluid therapy. As fluid challenge can result in clinical deterioration, the ability to predict haemodynamic response is desirable. In this way it might be possible to avoid unnecessary volume replacement in critically ill patients. Cardiac preload is a concept that accounts for the relationship between ventricular filling and stroke volume. It has been challenging to apply this concept to clinical practice. For this reason, the study of fluid responsiveness is of increasing research and clinical interest. The clinical application of predicting fluid responsiveness requires an understanding of relevant physiological principles. Furthermore, an improved understanding of these principles should assist the clinician in appraising published data, which has been characterised by significant methodological differences. This review aims to assist the clinician by detailing the physiological principles that underlie the prediction of fluid responsiveness in the critically ill. In addition, the potential importance of methodological differences in the cutrent literature will be considered.
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Affiliation(s)
- D J Sturgess
- School of Medicine, University of Queensland, Princess Alexandra Hospital, Wolloongabba, Queensland, Australia
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Joyce C. Of saving the elderly. J R Soc Med 2007. [DOI: 10.1258/jrsm.100.5.210] [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: 11/18/2022] Open
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