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Below N, Morrison D, McGowan R, Jones GC. Diagnostic pitfalls in a young adult with new diabetes. Endocrinol Diabetes Metab Case Rep 2023; 2023:23-0024. [PMID: 37855645 PMCID: PMC10620446 DOI: 10.1530/edm-23-0024] [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] [Received: 02/17/2023] [Accepted: 09/20/2023] [Indexed: 10/20/2023] Open
Abstract
Summary A 20-year-old South Asian male presented with polyuria, polydipsia, HbA1c 81 mmol/mol, BMI 28.8 and family history of both type 1 and type 2 diabetes mellitus. As autoantibody testing was negative and c-peptide level demonstrated significant endogenous insulin secretion, type 1 diabetes was excluded. Given his age and family history, the differential diagnosis included maturity-onset diabetes of the young (MODY), a rare form of diabetes caused by a single-gene variant. A high probability of MODY was calculated and he was subsequently referred for genetic testing. Although a useful tool, the pre-test probability calculator for MODY is only validated in White Europeans. A heterogenous variant of unknown clinical significance of the NEUROD1 gene was detected, leading to gliclazide use with poor response. The patient responded well to metformin. Type 2 diabetes was considered the most likely diagnosis. This case highlights the diagnostic challenges in young patients of Asian ethnicity and the importance of interpreting genetic results of unknown significance within the clinical context. Ethnicity-specific BMI thresholds should be used when classifying patients as overweight or obese. Learning points Variants of unknown significance detected by genetic sequencing should be interpreted within the context of the patient's other clinical parameters. It is important to use ethnicity-specific BMI thresholds for obesity. Diagnosis of type 2 diabetes mellitus at younger ages is becoming increasingly common. The pre-test probability calculator for MODY is only validated in White Europeans; although a useful guide, results should be interpreted with caution in patients of other ethnicities.
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Affiliation(s)
- Natalie Below
- Diabetes Centre, Gartnavel General Hospital, Glasgow, UK
- University of Glasgow, Glasgow, UK
| | | | - Ruth McGowan
- West of Scotland Centre for Genomic Medicine, Glasgow, UK
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2
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Barker HL, Morrison D, Llano A, Sainsbury CAR, Jones GC. Practical Guide to Glucocorticoid Induced Hyperglycaemia and Diabetes. Diabetes Ther 2023; 14:937-945. [PMID: 36961675 PMCID: PMC10037401 DOI: 10.1007/s13300-023-01393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Abstract
Glucocorticoids, also known as steroids, are a class of anti-inflammatory drugs utilised widely in clinical practice for a variety of conditions. They are associated with a range of side effects including abnormalities of glucose metabolism. Multiple guidelines have been published to illustrate best management of glucocorticoid-induced hyperglycaemia and diabetes in a variety of settings. This article discusses current best clinical practice including diagnosis, investigations and ongoing management of glucocorticoid-induced dysglycaemia in both in- and outpatient settings.
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Affiliation(s)
- Hannah L. Barker
- Diabetes Department, Gartnavel General Hospital, Glasgow University, 1053 Great Western Road, Glasgow, G12 0YN UK
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3
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Coma S, Musteanu M, Mira A, Caffarra C, Morrison D, Ambrogio C, Barbacid M, Pachter J. The RAF/MEK clamp VS-6766 shows strong anti-tumor activity across multiple MAPK pathway alterations, with a preferential effect on KRAS G12V. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00851-6] [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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4
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Morrison D, Bedinger M, Beevers L, McClymont K. Exploring the raison d'etre behind metric selection in network analysis: a systematic review. Appl Netw Sci 2022; 7:50. [PMID: 35854964 PMCID: PMC9281375 DOI: 10.1007/s41109-022-00476-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/27/2022] [Indexed: 05/28/2023]
Abstract
UNLABELLED Network analysis is a useful tool to analyse the interactions and structure of graphs that represent the relationships among entities, such as sectors within an urban system. Connecting entities in this way is vital in understanding the complexity of the modern world, and how to navigate these complexities during an event. However, the field of network analysis has grown rapidly since the 1970s to produce a vast array of available metrics that describe different graph properties. This diversity allows network analysis to be applied across myriad research domains and contexts, however widespread applications have produced polysemic metrics. Challenges arise in identifying which method of network analysis to adopt, which metrics to choose, and how many are suitable. This paper undertakes a structured review of literature to provide clarity on raison d'etre behind metric selection and suggests a way forward for applied network analysis. It is essential that future studies explicitly report the rationale behind metric choice and describe how the mathematics relates to target concepts and themes. An exploratory metric analysis is an important step in identifying the most important metrics and understanding redundant ones. Finally, where applicable, one should select an optimal number of metrics that describe the network both locally and globally, so as to understand the interactions and structure as holistically as possible. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s41109-022-00476-w.
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Affiliation(s)
- D. Morrison
- School of Energy, Geosciences, Infrastructure and Society, Heriot-Watt University, William Arrol Building, Room W.A. 3.36/3.37, 2 Third Gait, Currie, Edinburgh, EH14 4AS UK
| | - M. Bedinger
- School of Energy, Geosciences, Infrastructure and Society, Heriot-Watt University, William Arrol Building, Room W.A. 3.36/3.37, 2 Third Gait, Currie, Edinburgh, EH14 4AS UK
| | - L. Beevers
- School of Energy, Geosciences, Infrastructure and Society, Heriot-Watt University, William Arrol Building, Room W.A. 3.36/3.37, 2 Third Gait, Currie, Edinburgh, EH14 4AS UK
| | - K. McClymont
- School of Energy, Geosciences, Infrastructure and Society, Heriot-Watt University, William Arrol Building, Room W.A. 3.36/3.37, 2 Third Gait, Currie, Edinburgh, EH14 4AS UK
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Morrison D, Schwartz KA, Wolcutt L. COVID-19 Reflections: We Are Not OK: Safety Net Primary Care Access in a Non-Expansion State Amid COVID-19. N C Med J 2022; 83:194-196. [PMID: 35504703 DOI: 10.18043/ncm.83.3.194] [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: 11/11/2022]
Abstract
In North Carolina, rural health care-especially the primary care safety net-is a remarkable but under-resourced vital support system. COVID-19 stressed that already precarious system. While the acute COVID-19 crisis may be receding, we are concerned about the long-term effects of the pandemic on both individuals and the rural primary care safety net.
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Affiliation(s)
- Deborah Morrison
- Board chair, Roanoke Chowan Community Health Center, Ahoskie, North Carolina
| | - Kim A Schwartz
- CEO, Roanoke Chowan Community Health Center, Ahoskie, North Carolina.
| | - Leslie Wolcutt
- Director of communications, Roanoke Chowan Community Health Center, Ahoskie, North Carolina
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Korah T, Morrison D, Mason D, Diehl ER, Bussing R. Therapeutic Horticulture as a Therapeutic Intervention in Patients Receiving Electroconvulsive Therapy (ECT) Treatment for Major Depressive Disorder. Cureus 2021; 13:e17363. [PMID: 34434684 PMCID: PMC8380433 DOI: 10.7759/cureus.17363] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 11/17/2022] Open
Abstract
This study explored the effect of a structured therapeutic horticulture (TH) program on depression symptoms and quality of life indicators for individuals receiving inpatient electroconvulsive therapy (ECT) for major depressive disorders (MDD). Self-reported measures of depressive symptomatology (PHQ9, BDI-II) and quality of life (SF-36) were employed to compare intervention (n = 25) and control groups (n = 27), with the intervention group attending TH sessions for one-hour periods, twice per week, in addition to standard inpatient care associated with ECT received by both groups. All patients were assessed at admission, and after two weeks’ time or prior to discharge, during which the intervention group participated in a minimum of four TH sessions. Sessions were led by a horticultural therapist in an accessible on-campus greenhouse. Both groups improved significantly between assessment times one and two on both measures of depression, with a statistically significant difference in change scores for the BDI-II only, favoring the control over the intervention group (16.5, s.d. 12.78 versus 9.6, s.d. 10.15; p = 0.36). Both groups improved significantly on four of eight SF-36 subscales during the same period. A statistically significant difference in change scores was found for the Role Limitations-Physical Health (RLPH) subscale, where the intervention group improved between assessment periods, whereas the control group worsened (16.0, s.d.48.8 versus -9.3, s.d. 33.4; p = .033). Although quantifying group changes or improvement for individuals receiving intensive treatment for major depressive disorders (ECT) by the addition of an adjunct therapy is difficult, this study provides a basic premise for the consideration of various therapeutic horticulture settings to achieve therapeutic benefits through TH.
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Affiliation(s)
- Tessy Korah
- Psychiatry, University of Florida, Gainesville, USA
| | | | - Dana Mason
- Psychiatry, University of Florida, Gainesville, USA
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Johnson CW, Terrell EM, Burd CE, Morrison D, Haigis KM. Abstract 84: Characterization of oncogenic KRAS A59 alleles and their cooperation with the MAPK signaling pathway. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-84] [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: 11/16/2022]
Abstract
Abstract
The Kirsten rat sarcoma (KRAS) proto-oncogene regulates signaling pathways that control proliferation (e.g. MAPK pathway), metabolism and survival (e.g. AKT pathway), and apoptosis (e.g. Hippo pathway). Mutations in KRAS are found in 40% of colorectal cancers (CRC). However, there are no FDA-approved drugs for CRC that target this oncogene. One reason why developing drugs against KRAS is difficult is because a number of different oncogenic alleles have been identified. Thus, an allele-specific approach to target KRAS is necessary. In turn, this approach requires a detailed understanding of their structure and function to drive cell transformation and tissue dysregulation. Our goal is to characterize the function of KRAS A59T in CRC. These alleles are interesting for a number of reasons. First, A59T discriminates retroviral homologues of mammalian RAS from their cellular counterparts. Second, unlike other oncogenic alleles, the KRAS A59T protein undergoes autophosphorylation, the biological function of which is unknown. Third, patient data show that A59 alleles of KRAS frequently co-occur with other genetic alterations in the MAPK signaling pathway, which is uncommon for other KRAS alleles. We hypothesize that KRAS autophosphorylation promotes CRC in a manner that is independent, but cooperative, with the MAPK signaling pathway. To test this hypothesis, we first characterized the function of KRAS A59T and its phosphomimetic A59E using in silico and biochemical techniques, along with classic assays of cell transformation. Next, we generated a new genetically engineered mouse model, K-Ras+/LSL-A59E, in order to test how KRAS autophosphorylation cooperates with other oncogenic mechanisms of MAPK pathway activation to alter colon homeostasis and model colon tumorigenesis. Consistent with our hypothesis, KRAS autophosphorylation and A59E inhibit KRAS-effector interactions that activate the MAPK, AKT, and Hippo signaling pathways. How this change in function alters the ability of K-RasA59E, versus K-RasG12D, to promote hyperproliferation and tumor development in combination with N-RasQ61K and Apc loss in the mouse colon, is currently underway. Ultimately, these studies bring us closer to discovering allele-specific vulnerabilities of KRAS and provide a means to test less understood aspects of oncogenic KRAS signaling.
Citation Format: Christian W. Johnson, Elizabeth M. Terrell, Christin E. Burd, Deborah Morrison, Kevin M. Haigis. Characterization of oncogenic KRAS A59 alleles and their cooperation with the MAPK signaling pathway [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 84.
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Siah A, Breyta RB, Warheit KI, Gagne N, Purcell MK, Morrison D, Powell JFF, Johnson SC. Erratum: Genomes reveal genetic diversity of Piscine orthoreovirus in farmed and free-ranging salmonids from Canada and USA. Virus Evol 2021; 7:veab008. [PMID: 34168895 PMCID: PMC8220306 DOI: 10.1093/ve/veab008] [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: 11/13/2022] Open
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Torres‐Ayuso P, An E, Nyswaner K, Bensen R, Ritt D, Specht S, Das S, Andresson T, Turk B, Morrison D, Brognard J. TNIK, a novel activator of FAK and YAP signaling, is a therapeutic target in Lung Squamous Cell Carcinoma. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.02752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Elvira An
- National Cancer InstituteFrederickMD
| | | | | | | | | | - Sudipto Das
- Leidos Biomedical Research, Frederick National Laboratory for Cancer ResearchFrederickMD
| | - Thorkell Andresson
- Leidos Biomedical Research, Frederick National Laboratory for Cancer ResearchFrederickMD
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10
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Johnson C, Seo H, Terrell E, Geffken E, Lakhani J, Song K, Hagel K, Popow O, Mattos C, Morrison D, Dhe‐Paganon S, Haigis K. Regulation of RAS function by active site autophosphorylation. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.01476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Hyuk‐Soo Seo
- Structural and Chemical Biology CenterDana‐Farber Cancer InstituteBostonMA
| | - Elizabeth Terrell
- Laboratory of Cell and Developmental SignalingNational Cancer InstituteFrederickMD
| | - Ezekiel Geffken
- Structural and Chemical Biology CenterDana‐Farber Cancer InstituteBostonMA
| | - Jimit Lakhani
- Structural and Chemical Biology CenterDana‐Farber Cancer InstituteBostonMA
| | - Kijun Song
- Structural and Chemical Biology CenterDana‐Farber Cancer InstituteBostonMA
| | | | - Olesja Popow
- Cancer BiologyDana‐Farber Cancer InstituteBostonMA
| | - Carla Mattos
- Chemistry and Chemical BiologyNortheastern UniversityBostonMA
| | - Deborah Morrison
- Laboratory of Cell and Developmental SignalingNational Cancer InstituteFrederickMD
| | - Sirano Dhe‐Paganon
- Structural and Chemical Biology CenterDana‐Farber Cancer InstituteBostonMA
| | - Kevin Haigis
- Cancer BiologyDana‐Farber Cancer InstituteBostonMA
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11
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Affiliation(s)
| | - James G. Boyle
- University of GlasgowGlasgowUK
- NHS Greater Glasgow and ClydeGlasgowUK
| | | | | | | | - Partha Kar
- Portsmouth Hospitals NHS TrustGlasgowUK
- NHS EnglandGlasgowUK
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12
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Tweed E, Leyland A, Morrison D, Katikireddi SV. Using cross-sectoral data linkage to understand the health of people experiencing multiple exclusion. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.052] [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: 11/12/2022] Open
Abstract
Abstract
Background
People affected by the intersection of homelessness, drug use, and/or serious mental illness have high rates of mortality and morbidity. However, they are often missed from routine information sources on population health, such as surveys and censuses. In many countries, administrative data are available which could help address this knowledge gap. We created a novel virtual cohort using cross-sectoral data linkage in order to inform policy and practice responses to these co-occurring issues.
Methods
Individual-level data from local authority homelessness services (HL), opioid substitution therapy dispensing (OST), and a psychosis case register (PSY) in Glasgow, Scotland between 2011-15 were confidentially linked to National Health Service records, using a mix of probabilistic and deterministic linkage. A de-identified dataset was made available to researchers through a secure analysis platform. Demographic characteristics associated with different exposure combinations were analysed using descriptive statistics.
Results
Linkage created a cohort of 24,767 unique individuals with any one of the experiences of interest between 2011-15. Preliminary results suggest that 89.2% of the cohort had one experience; 10.6% two; and 0.2% all three. The most common combination was HL & OST (n = 2,150; 8.7%), with other combinations much less frequent (HL & PSY, n = 279, 1.1%; OST & PSY, n = 188, 0.8%; HL & OST & PSY, n = 51, 0.2%). The odds of male gender increased with number of exposures (2 exposures, OR 2.1, 95% CI 1.9-2.2; 3 exposures, OR 4.1, 95% CI 2.3-7.2), but there was little difference in age. Work is ongoing to incorporate into the cohort additional datasets on criminal justice involvement.
Lessons
Administrative data linkage is a feasible approach to understanding the health of people affected by multiple exclusionary processes, but requires robust and timely governance. Our initiative can support service planning and evaluation of future policy or service changes.
Key messages
We describe the creation and characteristics of a novel virtual cohort of people affected by multiple exclusionary processes, using record linkage of administrative datasets. Cross-sectoral linkage has international potential for enhancing public health intelligence, especially for population groups who may be missed from surveys and censuses.
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Affiliation(s)
- E Tweed
- MRC-CSO Social and Public Health Sciences, University of Glasgow, Glasgow, UK
| | - A Leyland
- MRC-CSO Social and Public Health Sciences, University of Glasgow, Glasgow, UK
| | - D Morrison
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - S V Katikireddi
- MRC-CSO Social and Public Health Sciences, University of Glasgow, Glasgow, UK
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13
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Siah A, Breyta RB, Warheit KI, Gagne N, Purcell MK, Morrison D, Powell JFF, Johnson SC. Genomes reveal genetic diversity of Piscine orthoreovirus in farmed and free-ranging salmonids from Canada and USA. Virus Evol 2020; 6:veaa054. [PMID: 33381304 PMCID: PMC7751156 DOI: 10.1093/ve/veaa054] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Piscine orthoreovirus (PRV-1) is a segmented RNA virus, which is commonly found in salmonids in the Atlantic and Pacific Oceans. PRV-1 causes the heart and skeletal muscle inflammation disease in Atlantic salmon and is associated with several other disease conditions. Previous phylogenetic studies of genome segment 1 (S1) identified four main genogroups of PRV-1 (S1 genogroups I–IV). The goal of the present study was to use Bayesian phylogenetic inference to expand our understanding of the spatial, temporal, and host patterns of PRV-1 from the waters of the northeast Pacific. To that end, we determined the coding genome sequences of fourteen PRV-1 samples that were selected to improve our knowledge of genetic diversity across a broader temporal, geographic, and host range, including the first reported genome sequences from the northwest Atlantic (Eastern Canada). Nucleotide and amino acid sequences of the concatenated genomes and their individual segments revealed that established sequences from the northeast Pacific were monophyletic in all analyses. Bayesian inference phylogenetic trees of S1 sequences using BEAST and MrBayes also found that sequences from the northeast Pacific grouped separately from sequences from other areas. One PRV-1 sample (WCAN_BC17_AS_2017) from an escaped Atlantic salmon, collected in British Columbia but derived from Icelandic broodstock, grouped with other S1 sequences from Iceland. Our concatenated genome and S1 analysis demonstrated that PRV-1 from the northeast Pacific is genetically distinct but descended from PRV-1 from the North Atlantic. However, the analyses were inconclusive as to the timing and exact source of introduction into the northeast Pacific, either from eastern North America or from European waters of the North Atlantic. There was no evidence that PRV-1 was evolving differently between free-ranging Pacific Salmon and farmed Atlantic Salmon. The northeast Pacific PRV-1 sequences fall within genogroup II based on the classification of Garseth, Ekrem, and Biering (Garseth, A. H., Ekrem, T., and Biering, E. (2013) ‘Phylogenetic Evidence of Long Distance Dispersal and Transmission of Piscine Reovirus (PRV) between Farmed and Wild Atlantic Salmon’, PLoS One, 8: e82202.), which also includes North Atlantic sequences from Eastern Canada, Iceland, and Norway. The additional full-genome sequences herein strengthen our understanding of phylogeographical patterns related to the northeast Pacific, but a more balanced representation of full PRV-1 genomes from across its range, as well additional sequencing of archived samples, is still needed to better understand global relationships including potential transmission links among regions.
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Affiliation(s)
- A Siah
- British Columbia Centre for Aquatic Health Sciences, 871A Island Highway, V9W 2C2, Campbell River, BC, Canada
| | - R B Breyta
- School of Aquatic Fisheries Sciences, University of Washington, Western Fisheries Research Center, USGS, 6505 NE 65th Street Seattle, WA 98115-5016, USA
| | - K I Warheit
- Washington Department of Fish and Wildlife PO Box 43200, Olympia, WA 98504-3200, USA
| | - N Gagne
- Gulf Fisheries Center, Fisheries & Oceans, 343 Université Ave, Moncton, NB E1C 5K4, Canada
| | - M K Purcell
- Western Fisheries Research Center, U.S. Geological Survey, 56505 NE 65th Street Seattle, WA 98115-5016, USA
| | - D Morrison
- Mowi Canada West, Campbell River, BC, Canada
| | - J F F Powell
- British Columbia Centre for Aquatic Health Sciences, 871A Island Highway, V9W 2C2, Campbell River, BC, Canada
| | - S C Johnson
- Fisheries & Oceans Canada, Nanaimo, British Columbia, Canada
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Morrison D. Abstract IA17: Molecular mechanisms that regulate Raf kinase signaling. Mol Cancer Res 2020. [DOI: 10.1158/1557-3125.ras18-ia17] [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: 11/16/2022]
Abstract
Abstract
Raf kinases are essential for normal Ras pathway signaling, and activating mutations in components of this pathway are associated with a variety of human cancers as well as a group of related developmental disorders known collectively as the RASopathies. Of the core pathway components, the mechanisms that modulate the Raf family kinases are by far the most complex, involving changes in subcellular localization, protein interactions, and phosphorylation/dephosphorylation events. In addition, like numerous other protein kinases, the Raf kinases can form dimers. Functional studies investigating the importance of Raf dimerization have revealed that Raf dimer formation is required for normal Ras-dependent Raf activation and for the biologic activity of many disease-associated Raf mutants. At the meeting, I will present recent work examining the regulatory differences among Raf family members and will discuss how these differences contribute to Raf-mediated disease signaling. I will also present studies investigating the effect that various therapeutic agents have on Raf regulatory interactions and will describe new approaches to disrupt Ras-Raf-MEK-ERK pathway signaling.
Citation Format: Deborah Morrison. Molecular mechanisms that regulate Raf kinase signaling [abstract]. In: Proceedings of the AACR Special Conference on Targeting RAS-Driven Cancers; 2018 Dec 9-12; San Diego, CA. Philadelphia (PA): AACR; Mol Cancer Res 2020;18(5_Suppl):Abstract nr IA17.
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Moseley J, Vamvakas S, Berntgen M, Cave A, Kurz X, Arlett P, Acha V, Bennett S, Cohet C, Corriol-Rohou S, Du Four E, Lamoril C, Langeneckert A, Koban M, Pasté M, Sandler S, Van Baelen K, Cangini A, García S, Obach M, Gimenez Garcia E, Varela Lema L, Jauhonen HM, Rannanheimo P, Morrison D, Van De Casteele M, Strömgren A, Viberg A, Makady A, Guilhaume C. Regulatory and health technology assessment advice on postlicensing and postlaunch evidence generation is a foundation for lifecycle data collection for medicines. Br J Clin Pharmacol 2020; 86:1034-1051. [PMID: 32162368 PMCID: PMC7256124 DOI: 10.1111/bcp.14279] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/30/2020] [Accepted: 02/13/2020] [Indexed: 12/13/2022] Open
Abstract
The understanding of the benefit risk profile, and relative effectiveness of a new medicinal product, are initially established in a circumscribed patient population through clinical trials. There may be uncertainties associated with the new medicinal product that cannot be, or do not need to be resolved before launch. Postlicensing or postlaunch evidence generation (PLEG) is a term for evidence generated after the licensure or launch of a medicinal product to address these remaining uncertainties. PLEG is thus part of the continuum of evidence development for a medicinal product, complementing earlier evidence, facilitating further elucidation of a product's benefit/risk profile, value proposition, and/or exploring broader aspects of disease management and provision of healthcare. PLEG plays a role in regulatory decision making, not only in the European Union but also in other jurisdictions including the USA and Japan. PLEG is also relevant for downstream decision‐making by health technology assessment bodies and payers. PLEG comprises studies of different designs, based on data collected in observational or experimental settings. Experience to date in the European Union has indicated a need for improvements in PLEG. Improvements in design and research efficiency of PLEG could be addressed through more systematic pursuance of Scientific Advice on PLEG with single or multiple decision makers. To date, limited information has been available on the rationale, process or timing for seeking PLEG advice from regulators or health technology assessment bodies. This article sets out to address these issues and to encourage further uptake of PLEG advice.
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Affiliation(s)
- Jane Moseley
- European Medicines Agency (EMA), The Netherlands
| | | | | | - Alison Cave
- European Medicines Agency (EMA), The Netherlands
| | - Xavier Kurz
- European Medicines Agency (EMA), The Netherlands
| | - Peter Arlett
- European Medicines Agency (EMA), The Netherlands
| | - Virginia Acha
- MSD, UK.,European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg
| | - Simon Bennett
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,Biogen, UK
| | - Catherine Cohet
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,GSK, Belgium
| | - Solange Corriol-Rohou
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,AstraZeneca, France
| | - Emma Du Four
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,Abbvie, UK
| | - Christelle Lamoril
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,Sanofi, France
| | - Anja Langeneckert
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,F-Hoffmann La Roche, Switzerland
| | - Maren Koban
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,Merck KGaA Darmstadt, Germany
| | - Muriel Pasté
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,GSK, Belgium
| | - Susan Sandler
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,Janssen Pharmaceutical Companies of Johnson & Johnson, Belgium
| | - Karin Van Baelen
- European Federation of Pharmaceutical Industries and Associations (EFPIA), Luxembourg.,Janssen Pharmaceutical Companies of Johnson & Johnson, Belgium
| | - Agnese Cangini
- Agenzia Italiana del Farmaco (AIFA, Italian Medicines Agency), Italy.,European Union Network for Health technology assessment (EUnetHTA), The Netherlands
| | - Sonia García
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Agencia Española de Medicamentos y Productos Sanitarios (AEMPS, Spanish Medicines agency), Spain
| | - Mercè Obach
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS, Agency for Health Quality and Assessment of Catalonia), Spain.,Catalan Healthcare Service (Catsalut), Spain
| | - Emmanuel Gimenez Garcia
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS, Agency for Health Quality and Assessment of Catalonia), Spain
| | - Leonor Varela Lema
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Galician Agency for Health Knowledge Management (avalia-t; ACIS), Spain
| | - Hanna-Mari Jauhonen
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Finnish Medicines Agency (FIMEA), Finland
| | - Piia Rannanheimo
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Finnish Medicines Agency (FIMEA), Finland
| | - Deborah Morrison
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,National Institute for Health and Care Excellence (NICE), UK
| | - Marc Van De Casteele
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Rijksinstituut voor Ziekte- en Invaliditeitsverzekering/Institut national d'assurance maladie-invalidité (RIZIV-INAMI, National Institute for Health and Disability Insurance), Belgium
| | - Anna Strömgren
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Tandvårds-Läkemedelförmånsverket (TLV, Dental and Pharmaceutical Benefits Agency), Sweden
| | - Anders Viberg
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Tandvårds-Läkemedelförmånsverket (TLV, Dental and Pharmaceutical Benefits Agency), Sweden
| | - Amr Makady
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Zorginstituut Nederland (ZIN, National Health Care Institute), The Netherlands
| | - Chantal Guilhaume
- European Union Network for Health technology assessment (EUnetHTA), The Netherlands.,Haute Autorité de Santé, (HAS, French National Authority for Health), France
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Ayuso PT, An E, Ritt D, Nyswaner K, Specht S, Liang R, Das S, Andresson T, Turk B, Morrison D, Brognard J. The protein kinase TNIK: a novel druggable target in Lung Squamous Cell Carcinoma with 3q amplification. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.03326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Trasande L, Aldana SI, Trachtman H, Kannan K, Morrison D, Christakis DA, Whitlock K, Messito MJ, Gross RS, Karthikraj R, Sathyanarayana S. Glyphosate exposures and kidney injury biomarkers in infants and young children. Environ Pollut 2020; 256:113334. [PMID: 31677874 PMCID: PMC7307380 DOI: 10.1016/j.envpol.2019.113334] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/14/2019] [Accepted: 09/30/2019] [Indexed: 05/20/2023]
Abstract
The goal of this study was to assess biomarkers of exposure to glyphosate and assess potential associations with renal function in children. Glyphosate is used ubiquitously in agriculture worldwide. While previous studies have indicated that glyphosate may have nephrotoxic effects, few have examined potential effects on kidney function in children. We leveraged three cohorts across different phases of child development and measured urinary levels of glyphosate. We evaluated associations of glyphosate with three biomarkers of kidney injury: albuminuria (ACR), neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury marker 1 (KIM-1). Multivariable regression analyses examined associations of glyphosate with kidney injury biomarkers controlling for covariates. We identified glyphosate in 11.1% of the total participants. The herbicide was detected more frequently in the neonate population (30%). Multivariable regression models failed to identify significant associations of log-transformed glyphosate with any of the kidney injury biomarkers, controlling for covariates age, sex, and maternal education. While we confirm detectability of glyphosate in children's urine at various ages and stages of life, there is no evidence in this study for renal injury in children exposed to low levels of glyphosate. Further studies of larger sample size are indicated to better understand putative deleterious effects of the herbicide after different levels of exposure.
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Affiliation(s)
- Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA; NYU Wagner School of Public Service, New York, NY, USA; NYU College of Global Public Health, New York, NY, USA
| | - Sandra India Aldana
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Howard Trachtman
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA.
| | | | - Deborah Morrison
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | | | | | - Mary Jo Messito
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Rachel S Gross
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | | | - Sheela Sathyanarayana
- Seattle Children's Research Institute, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA; Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
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18
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Mccann B, Muhr R, O'Rourke N, Blum T, Milroy R, Morrison D, Kollmeier J, Misch D, Van Der Horst J, Sens B, Massalski O, Bauer T. P2.16-11 ADVANCE-1: Development and Feasibility Testing of a Benchmarking Approach for Quality Improvement in Lung Cancer Care. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Mohammed Abdul Wajid L, Barton P, Morrison D, Burrows E, Southern K. P048 An audit of the timeliness of processing newborn bloodspot screening results in a regional UK cystic fibrosis centre. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30343-1] [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: 11/25/2022]
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20
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Ho LTS, Lenihan M, McVey MJ, Karkouti K, Wijeysundera DN, Rao V, Crowther M, Grocott HP, Pinto R, Scales DC, Achen B, Brar S, Morrison D, Wong D, Bussières JS, Waal T, Harle C, Médicis É, McAdams C, Syed S, Tran D, Waters T. The association between platelet dysfunction and adverse outcomes in cardiac surgical patients. Anaesthesia 2019; 74:1130-1137. [PMID: 30932171 DOI: 10.1111/anae.14631] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2019] [Indexed: 11/30/2022]
Abstract
Haemostatic activation during cardiopulmonary bypass is associated with prothrombotic complications. Although it is not possible to detect and quantify haemostatic activation directly, platelet dysfunction, as measured with point-of-care-assays, may be a useful surrogate. In this study, we assessed the association between cardiopulmonary bypass-associated platelet dysfunction and adverse outcomes in 3010 cardiac surgical patients. Platelet dysfunction, as measured near the end of the rewarming phase of cardiopulmonary bypass, was calculated as the proportion of non-functional platelets after activation with collagen. Logistic regression and multivariable analyses were applied to assess the relationship between platelet dysfunction and a composite of in-hospital death; myocardial infarction; stroke; deep vein thrombosis or pulmonary embolism; and acute kidney injury (greater than a two-fold increase in creatinine). The outcome occurred in 251 (8%) of 3010 patients. The median (IQR [range]) percentage platelet dysfunction was less for those without the outcome as compared with those with the outcome; 14% (8-28% [1-99%]) vs. 19% (11-45% [2-98%]), p < 0.001. After risk adjustment, platelet dysfunction was independently associated with the composite outcome (p < 0.001), such that for each 1% increase in platelet dysfunction there was an approximately 1% increase in the composite outcome (OR 1.012; 95%CI 1.006-1.018). This exploratory study suggests that cardiopulmonary bypass-associated platelet dysfunction has prognostic value and may be a useful clinical measure of haemostatic activation in cardiac surgery.
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Affiliation(s)
- L T S Ho
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, ON, Canada
| | - M Lenihan
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, ON, Canada
| | - M J McVey
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, ON, Canada
| | - K Karkouti
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, ON, Canada.,Toronto General Research Institute and the Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, ON, Canada
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21
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Anderson M, Naci H, Morrison D, Osipenko L, Mossialos E. A review of NICE appraisals of pharmaceuticals 2000–2016 found variation in establishing comparative clinical effectiveness. J Clin Epidemiol 2019; 105:50-59. [DOI: 10.1016/j.jclinepi.2018.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/14/2018] [Accepted: 09/10/2018] [Indexed: 12/11/2022]
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22
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Abugideiri M, Press R, Zhang C, Thomas M, Tian S, Jhaveri J, Cassidy R, Zaenger D, Morgan T, Madden N, Parks J, Buchwald Z, Morrison D, Chen Z, Robertson Y, Phillips R, Landry J, Godette K. Improving Reproducibility and Inter-Rater Reliability for Lumpectomy Cavity Boost Contouring in Breast Cancer Patients Using a 3-D Bio-Absorbable Tissue Marker. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1602] [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: 10/28/2022]
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23
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Morrison D, Mair FS, Yardley L, Kirby S, Thomas M. Living with asthma and chronic obstructive airways disease: Using technology to support self-management - An overview. Chron Respir Dis 2017; 14:407-419. [PMID: 27512084 PMCID: PMC5729728 DOI: 10.1177/1479972316660977] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Long-term respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD) are common, and cause high levels of morbidity and mortality. Supporting self-management is advocated for both asthma and increasingly so for COPD, and there is growing interest in the potential role of a range of new technologies, such as smartphone apps, the web or telehealth to facilitate and promote self-management in these conditions. Treatment goals for both asthma and COPD include aiming to control symptoms, maintain activities, achieve the best possible quality of life and minimize risks of exacerbation. To do this, health professionals should be (a) helping patients to recognize deteriorating symptoms and act appropriately; (b) promoting adherence to maintenance therapy; (c) promoting a regular review where triggers can be established, and strategies for managing such triggers discussed; and (d) promoting healthy lifestyles and positive self-management of symptoms. In particular, low uptake of asthma action plans is a modifiable contributor to morbidity and possibly also to mortality in those with asthma and should be addressed as a priority. Using technology to support self-management is an evolving strategy that shows promise. This review provides an overview of self-management support and discusses how newer technologies may help patients and health professionals to meet key treatment goals.
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Affiliation(s)
- Deborah Morrison
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Highfield, Southampton, UK
| | - Sarah Kirby
- Department of Psychology, University of Southampton, Highfield, Southampton, UK
| | - Mike Thomas
- Primary Care Research, Aldermoor Health Centre, University of Southampton, Aldermoor Close, Southampton, UK
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Dale CD, McLoone P, Sloan B, Kinsella J, Morrison D, Puxty K, Quasim T. Critical care provision after colorectal cancer surgery. BMC Anesthesiol 2016; 16:94. [PMID: 27733119 PMCID: PMC5059906 DOI: 10.1186/s12871-016-0243-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 03/09/2016] [Accepted: 08/04/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the 2nd largest cause of cancer related mortality in the UK with 40 000 new patients being diagnosed each year. Complications of CRC surgery can occur in the perioperative period that leads to the requirement of organ support. The aim of this study was to identify pre-operative risk factors that increased the likelihood of this occurring. METHODS This is a retrospective observational study of all 6441 patients who underwent colorectal cancer surgery within the West of Scotland Region between 2005 and 2011. Logistic regression was employed to determine factors associated with receiving postoperative organ support. RESULTS A total of 610 (9 %) patients received organ support. Multivariate analysis identified age ≥65, male gender, emergency surgery, social deprivation, heart failure and type II diabetes as being independently associated with organ support postoperatively. After adjusting for demographic and clinical factors, patients with metastatic disease appeared less likely to receive organ support (p = 0.012). CONCLUSIONS Nearly one in ten patients undergoing CRC surgery receive organ support in the post operative period. We identified several risk factors which increase the likelihood of receiving organ support post operatively. This is relevant when consenting patients about the risks of CRC surgery.
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Affiliation(s)
- C D Dale
- Undergraduate Medical School, School of Medicine, University of Glasgow, Glasgow, UK
| | - P McLoone
- West of Scotland Cancer Surveillance Unit, Public Health Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - B Sloan
- West of Scotland Cancer Surveillance Unit, Public Health Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - J Kinsella
- Anaesthesia, Critical Care and Pain Medicine, School of Medicine, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - D Morrison
- West of Scotland Cancer Surveillance Unit, Public Health Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - K Puxty
- Anaesthesia, Critical Care and Pain Medicine, School of Medicine, Glasgow Royal Infirmary, Glasgow, Scotland, UK.
| | - T Quasim
- Anaesthesia, Critical Care and Pain Medicine, School of Medicine, Glasgow Royal Infirmary, Glasgow, Scotland, UK
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Morrison D, Agur K, Mercer S, Eiras A, González-Montalvo JI, Gruffydd-Jones K. Managing multimorbidity in primary care in patients with chronic respiratory conditions. NPJ Prim Care Respir Med 2016; 26:16043. [PMID: 27629064 PMCID: PMC5024357 DOI: 10.1038/npjpcrm.2016.43] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/20/2016] [Indexed: 01/15/2023] Open
Abstract
The term multimorbidity is usually defined as the coexistence of two or more chronic conditions within an individual, whereas the term comorbidity traditionally describes patients with an index condition and one or more additional conditions. Multimorbidity of chronic conditions markedly worsens outcomes in patients, increases treatment burden and increases health service costs. Although patients with chronic respiratory disease often have physical comorbidities, they also commonly experience psychological problems such as depression and anxiety. Multimorbidity is associated with increased health-care utilisation and specifically with an increased number of prescription drugs in individuals with multiple chronic conditions such as chronic obstructive pulmonary disease. This npj Primary Care Respiratory Medicine Education Section case study involves a patient in a primary care consultation presenting several common diseases prevalent in people of this age. The patient takes nine different drugs at this moment, one or more pills for each condition, which amounts to polypharmacy. The problems related with polypharmacy recommend that a routine medication review by primary care physicians be performed to reduce the risk of adverse effects of polypharmacy among those with multiple chronic conditions. The primary care physician has the challenging role of integrating all of the clinical problems affecting the patient and reviewing all medicaments (including over-the-counter medications) taken by the patient at any point in time, and has the has the key to prevent the unwanted consequences of polypharmacy. Multimorbid chronic disease management can be achieved with the use of care planning, unified disease templates, use of information technology with appointment reminders and with the help of the wider primary care and community teams.
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Affiliation(s)
- Deborah Morrison
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Karolina Agur
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stewart Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Andreia Eiras
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Rainha D. Amélia Family Health Unit, Porto, Portugal
| | - Juan I González-Montalvo
- Geriatrics Department, IdiPaz Research Institute Hospital Universitario La Paz, Universidad Autónoma de Madrid, School of Medicine, Madrid, Spain
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26
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Soliman R, Morrison D, Husselbee K, Phillips G. Scalded Skin Syndrome Caused by a Methicillin Sensitive Staphylococcus aureus of a type not commonly associated with exfoliative toxins in Scotland. Scott Med J 2016. [DOI: 10.1258/rsmsmj.52.4.53a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A three-year-old boy was admitted to the hospital with a three-day history of chickenpox and a one-day history of fever and enlarging skin lesions on his chest, trunk, and around his neck. The lesions were enlarged and skin peeling over the chest wall was noted. Despite starting him on Flucloxacillin/Aciclovir, new lesions were noted with blisters over chest, legs, arms and buttocks. A clinical diagnosis of Staphylococcal Scalded Skin Syndrome (SSSS) was made and laboratory results confirmed Methicillin sensitive Staphylococcus aureus (MRSA) isolation. The isolates were sent to Scottish MRSA reference lab (SMRSARL) for typing and toxin detection. The isolate from this child was positive for the exfoliative toxin A (eta) gene and negative for exfoliative toxin B, toxic shock syndrome toxin, panton-valentine leukocidin and entertoxins A, B, C, D, E. By Pulse Field Gel Electrophoresis (PFGE) this isolate was identified as MLST Type 88 clone which has been associated with skin lesions in other countries.
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Affiliation(s)
| | - D. Morrison
- MRSA Reference Laboratory, Stobhill Hospital, Glasgow, UK
| | - K. Husselbee
- Department of Paediatrics, Ninewells Hospital, Dundee
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27
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Traboulsi EI, Vanderveen D, Morrison D, Drews-Botsch CD, Lambert SR. Associated systemic and ocular disorders in patients with congenital unilateral cataracts: the Infant Aphakia Treatment Study experience. Eye (Lond) 2016; 30:1170-4. [PMID: 27315350 DOI: 10.1038/eye.2016.124] [Citation(s) in RCA: 11] [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] [Received: 02/28/2016] [Accepted: 04/06/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeFive-year prospective data on children enrolled in the Infant Aphakia Treatment Study (IATS) provided an opportunity to explore ocular and systemic associations in patients with a unilateral congenital cataract.MethodsInfants <7 months of age with a unilateral cataract were eligible for IATS screening. We reviewed data pertaining to the exclusion of patients as well as data collected on standardized study forms used at any time for documentation of ocular or systemic disorders.ResultsOverall, 227 infants were referred for possible enrollment. Of these, 10 had insignificant cataracts and 32 refused to participate. Of those excluded, 3 were premature, 27 had significant ocular disease (usually persistent fetal vasculature (PFV) or corneal diameter <9 mm), and 4 had systemic disorders. An additional 26 were excluded at the time of the first EUA, most often because of PFV or variants thereof. On follow-up, in the 114 enrolled patients, the following disorders were diagnosed: Stickler syndrome (1), mitochondrial disease (1), autism (1), and presumed congenital rubella syndrome (1). No patient developed a cataract in the fellow eye.DiscussionSome conditions that can feature unilateral cataracts are diagnosed at birth or very early in life, but others may be diagnosed at varying periods thereafter. PFV and its variants are the most common associated ocular findings in about a quarter of cases of unilateral congenital cataracts.ConclusionAlthough patients with a unilateral cataract may have significant associated abnormalities in the affected eye, most commonly PFV and its variants, the prevalence of associated significant systemic disease is quite low.
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Affiliation(s)
- E I Traboulsi
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - D Vanderveen
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - D Morrison
- Vanderbilt Eye Center, Vanderbilt University, Nashville, TN, USA
| | | | - S R Lambert
- Emory Eye Center, Emory University, Atlanta, GA, USA
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28
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Morrison D, Wyke S, Saunderson K, McConnachie A, Agur K, Chaudhuri R, Thomas M, Thomson NC, Yardley L, Mair FS. Findings from a pilot Randomised trial of an Asthma Internet Self-management Intervention (RAISIN). BMJ Open 2016; 6:e009254. [PMID: 27173807 PMCID: PMC4874112 DOI: 10.1136/bmjopen-2015-009254] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of a phase 3 randomised controlled trial (RCT) of a website (Living Well with Asthma) to support self-management. DESIGN AND SETTING Phase 2, parallel group, RCT, participants recruited from 20 general practices across Glasgow, UK. Randomisation through automated voice response, after baseline data collection, to website access for minimum 12 weeks or usual care. PARTICIPANTS Adults (age≥16 years) with physician diagnosed, symptomatic asthma (Asthma Control Questionnaire (ACQ) score ≥1). People with unstable asthma or other lung disease were excluded. INTERVENTION 'Living Well with Asthma' is a desktop/laptop compatible interactive website designed with input from asthma/ behaviour change specialists, and adults with asthma. It aims to support optimal medication management, promote use of action plans, encourage attendance at asthma reviews and increase physical activity. OUTCOME MEASURES Primary outcomes were recruitment/retention, website use, ACQ and mini-Asthma Quality of Life Questionnaire (AQLQ). Secondary outcomes included patient activation, prescribing, adherence, spirometry, lung inflammation and health service contacts after 12 weeks. Blinding postrandomisation was not possible. RESULTS Recruitment target met. 51 participants randomised (25 intervention group). Age range 16-78 years; 75% female; 28% from most deprived quintile. 45/51 (88%; 20 intervention group) followed up. 19 (76% of the intervention group) used the website, for a mean of 18 min (range 0-49). 17 went beyond the 2 'core' modules. Median number of logins was 1 (IQR 1-2, range 0-7). No significant difference in the prespecified primary efficacy measures of ACQ scores (-0.36; 95% CI -0.96 to 0.23; p=0.225), and mini-AQLQ scores (0.38; -0.13 to 0.89; p=0.136). No adverse events. CONCLUSIONS Recruitment and retention confirmed feasibility; trends to improved outcomes suggest use of Living Well with Asthma may improve self-management in adults with asthma and merits further development followed by investigation in a phase 3 trial. TRIAL REGISTRATION NUMBER ISRCTN78556552; Results.
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Affiliation(s)
- D Morrison
- General Practice & Primary Care, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - S Wyke
- Institute of Health and Wellbeing/Interdisciplinary Research Professor, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - K Saunderson
- General Practice & Primary Care, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - A McConnachie
- Institute of Health and Wellbeing/Interdisciplinary Research Professor, College of Social Sciences, University of Glasgow, Glasgow, UK Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - K Agur
- General Practice & Primary Care, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - R Chaudhuri
- Institute of Infection, Immunity and Inflammation, Gartnavel General Hospital, University of Glasgow, Glasgow, UK
| | - M Thomas
- Primary Care Research, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - N C Thomson
- Institute of Infection, Immunity and Inflammation, Gartnavel General Hospital, University of Glasgow, Glasgow, UK
| | - L Yardley
- Department of Psychology, University of Southampton, Southampton, UK
| | - F S Mair
- General Practice & Primary Care, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
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Wedgeworth E, Glover M, Irvine A, Neri I, Baselga E, Clayton T, Beattie P, Bjerre J, Burrows N, Foelster-Holst R, Hedelund L, Hernandez-Martin A, Audrain H, Bhate K, Brown S, Baryschpolec S, Darne S, Durack A, Dvorakova V, Gach J, Goldstraw N, Goodyear H, Grabczynska S, Greenblatt D, Halpern J, Hearn R, Hoey S, Hughes B, Jayaraj R, Johansson E, Lam M, Leech S, O'Regan G, Morrison D, Porter W, Ramesh R, Schill T, Shaw L, Taylor A, Taylor R, Thomson J, Tiffin P, Tsakok M, Janmohamed S, Laguda B, McPherson T, Oranje A, Patrizi A, Ravenscroft J, Shahidullah H, Solman L, Svensson A, Wahlgren C, Hoeger P, Flohr C. Propranolol in the treatment of infantile haemangiomas: lessons from the European Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce survey. Br J Dermatol 2015; 174:594-601. [DOI: 10.1111/bjd.14233] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 12/25/2022]
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Morrison D, Mair FS, Chaudhuri R, McGee-Lennon M, Thomas M, Thomson NC, Yardley L, Wyke S. Details of development of the resource for adults with asthma in the RAISIN (randomized trial of an asthma internet self-management intervention) study. BMC Med Inform Decis Mak 2015. [PMID: 26215651 PMCID: PMC4517557 DOI: 10.1186/s12911-015-0177-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Around 300 million people worldwide have asthma and prevalence is increasing. Self-management can be effective in improving a range of outcomes and is cost effective, but is underutilised as a treatment strategy. Supporting optimum self-management using digital technology shows promise, but how best to do this is not clear. We aimed to develop an evidence based, theory informed, online resource to support self-management in adults with asthma, called ‘Living well with Asthma’, as part of the RAISIN (Randomized Trial of an Asthma Internet Self-Management Intervention) study. Methods We developed Living well with Asthma in two phases. Phase 1: A low fidelity prototype (paper-based) version of the website was developed iteratively through input from a multidisciplinary expert panel, empirical evidence from the literature, and potential end users via focus groups (adults with asthma and practice nurses). Implementation and behaviour change theories informed this process. Phase 2: The paper-based designs were converted to a website through an iterative user centred process. Adults with asthma (n = 10) took part in think aloud studies, discussing the paper based version, then the web-based version. Participants considered contents, layout, and navigation. Development was agile using feedback from the think aloud sessions immediately to inform design and subsequent think aloud sessions. Think aloud transcripts were also thematically analysed, further informing resource development. Results The website asked users to aim to be symptom free. Key behaviours targeted to achieve this include: optimising medication use (including inhaler technique); attending primary care asthma reviews; using asthma action plans; increasing physical activity levels; and stopping smoking. The website had 11 sections, plus email reminders, which promoted these behaviours. Feedback on the contents of the resource was mainly positive with most changes focussing on clarification of language, order of pages and usability issues mainly relating to navigation difficulties. Conclusions Our multifaceted approach to online intervention development underpinned by theory, using evidence from the literature, co-designed with end users and a multidisciplinary panel has resulted in a resource which end users find relevant to their needs and easy to use. Living well with Asthma is undergoing evaluation within a randomized controlled trial. Electronic supplementary material The online version of this article (doi:10.1186/s12911-015-0177-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Deborah Morrison
- General Practice & Primary Care, Institute of Health & Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, UK
| | - Frances S Mair
- General Practice & Primary Care, Institute of Health & Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, UK.
| | - Rekha Chaudhuri
- Institute of Infection, Immunity and Inflammation, Gartnavel General Hospital, University of Glasgow, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Marilyn McGee-Lennon
- Computer and Information Science, University of Strathclyde, Glasgow, G1 1XH, UK
| | - Mike Thomas
- Primary Care Research, Aldermoor Health Centre, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Neil C Thomson
- Institute of Infection, Immunity and Inflammation, Gartnavel General Hospital, University of Glasgow, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Shackleton Building, Highfield, Southampton, SO17 1BJ, UK
| | - Sally Wyke
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Rm 204, 25-28 Bute Gardens, Glasgow, G12 8RS, UK
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Hulse K, Quasim T, Morrison D, MacLoone P, Sloane B, Kinsella J, Puxty K. Characteristics and outcomes of lung cancer patients after intensive care admission. J Intensive Care Soc 2015; 16:239. [PMID: 28979417 DOI: 10.1177/1751143715583857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- K Hulse
- Department of Anaesthesia, University of Glasgow, Glasgow, UK
| | - T Quasim
- Department of Anaesthesia, University of Glasgow, Glasgow, UK
| | - D Morrison
- West of Scotland Cancer Surveillance Unit, University of Glasgow, Glasgow, UK
| | - P MacLoone
- West of Scotland Cancer Surveillance Unit, University of Glasgow, Glasgow, UK
| | - B Sloane
- West of Scotland Cancer Surveillance Unit, University of Glasgow, Glasgow, UK
| | - J Kinsella
- Department of Anaesthesia, University of Glasgow, Glasgow, UK
| | - K Puxty
- Department of Anaesthesia, University of Glasgow, Glasgow, UK
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Mudan S, Giakoustidis A, Morrison D, Iosifidou S, Raobaikady R, Neofytou K, Stebbing J. 1000 Port-A-Cath ® placements by subclavian vein approach: single surgeon experience. World J Surg 2015; 39:328-34. [PMID: 25245435 DOI: 10.1007/s00268-014-2802-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 11/26/2022]
Abstract
INTRODUCTION Totally implantable venous access ports are widely used for the administration of chemotherapy in patients with cancer. Although there are several approaches to implantation, here we describe Port-A-Cath(®) (PAC) placement by percutaneous puncture of the subclavian vein with ultrasonographic guidance. PATIENTS AND METHODS Data on our vascular access service were collected prospectively from June 2004. This service included port-a-caths and Hickman lines. Once 1000 consecutive port-a-caths(®) had been reached the study was closed and data analysed for the port-a-caths(®) alone. The left subclavian vein was the preferred site for venous access, with the right subclavian and jugular veins being the alternative choices if the initial approach failed. Patients were followed up in the short-term, and all the procedures were carried out by a single surgeon at each one of two institutions. RESULTS Venous access by PAC was established in 100 % of the 1,000 cases. Of the 952 patients where the left subclavian vein was chosen for the first attempt of puncture, the success rate of PAC placement was 95 % (n = 904). Pneumothorax occurred in 12 patients (1.2 %), and a wound haematoma occurred in 4 (0.4 %) out of the total 1,000 patients. No infections were recorded during the immediate post-operative period but only in the long-term post-operative use with 8 patients requiring removal of the PAC due to infection following administration of chemotherapy. CONCLUSION This is a very large series of PAC placement with an ultrasound-guided approach for left subclavian vein and X-ray confirmation, performed by a single surgeon, demonstrating both the safety and effectiveness of the procedure.
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Affiliation(s)
- S Mudan
- Department of Academic Surgery, The Royal Marsden NHS Trust, Fulham Road, London, SW3 6JJ, UK
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Giakoustidis A, Morrison D, Gaya A, Mudan S. 341. ypT0, ypN0, ypM0 resection in locally advanced pancreas ductal adenocarcinoma with synchronous liver metastases, following neoadjuvant chemoradioimmunotherapy and surgery. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.331] [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] Open
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Morrison D, Wyke S, Thomson NC, McConnachie A, Agur K, Saunderson K, Chaudhuri R, Mair FS. A Randomized trial of an Asthma Internet Self-management Intervention (RAISIN): study protocol for a randomized controlled trial. Trials 2014; 15:185. [PMID: 24884722 PMCID: PMC4055289 DOI: 10.1186/1745-6215-15-185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/02/2014] [Indexed: 11/10/2022] Open
Abstract
Background The financial costs associated with asthma care continue to increase while care remains suboptimal. Promoting optimal self-management, including the use of asthma action plans, along with regular health professional review has been shown to be an effective strategy and is recommended in asthma guidelines internationally. Despite evidence of benefit, guided self-management remains underused, however the potential for online resources to promote self-management behaviors is gaining increasing recognition. The aim of this paper is to describe the protocol for a pilot evaluation of a website ‘Living well with asthma’ which has been developed with the aim of promoting self-management behaviors shown to improve outcomes. Methods/Design The study is a parallel randomized controlled trial, where adults with asthma are randomly assigned to either access to the website for 12 weeks, or usual asthma care for 12 weeks (followed by access to the website if desired). Individuals are included if they are over 16-years-old, have a diagnosis of asthma with an Asthma Control Questionnaire (ACQ) score of greater than, or equal to 1, and have access to the internet. Primary outcomes for this evaluation include recruitment and retention rates, changes at 12 weeks from baseline for both ACQ and Asthma Quality of Life Questionnaire (AQLQ) scores, and quantitative data describing website usage (number of times logged on, length of time logged on, number of times individual pages looked at, and for how long). Secondary outcomes include clinical outcomes (medication use, health services use, lung function) and patient reported outcomes (including adherence, patient activation measures, and health status). Discussion Piloting of complex interventions is considered best practice and will maximise the potential of any future large-scale randomized controlled trial to successfully recruit and be able to report on necessary outcomes. Here we will provide results across a range of outcomes which will provide estimates of efficacy to inform the design of a future full-scale randomized controlled trial of the ‘Living well with asthma’ website. Trial registration This trial is registered with Current Controlled Trials ISRCTN78556552 on 18/06/13.
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Affiliation(s)
| | | | | | | | | | | | | | - Frances S Mair
- General Practice & Primary Care, 1 Horselethill Road, Institute of Health & Wellbeing, University of Glasgow, Glasgow G12 9LX, UK.
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Moll S, Lindley C, Pescatore S, Morrison D, Tsuruta K, Mohri M, Serada M, Sata M, Shimizu H, Yamada K, White GC. Phase I study of a novel recombinant human soluble thrombomodulin, ART-123. J Thromb Haemost 2014. [DOI: 10.1111/j.1538-7836.2003.tb05793.x] [Citation(s) in RCA: 2] [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: 11/28/2022]
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Lowrie R, Mair FS, Greenlaw N, Forsyth P, McConnachie A, Richardson J, Khan N, Morrison D, Messow CM, Rae B, McMurray JJ. The Heart failure and Optimal Outcomes from Pharmacy Study (HOOPS): rationale, design, and baseline characteristics. Eur J Heart Fail 2014; 13:917-24. [DOI: 10.1093/eurjhf/hfr083] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Frances S. Mair
- Section of General Practice and Primary Care; University of Glasgow; Glasgow Scotland UK
| | - Nicola Greenlaw
- The Robertson Centre for Biostatistics; University of Glasgow; Glasgow Scotland UK
| | - Paul Forsyth
- NHS Greater Glasgow and Clyde; Glasgow Scotland UK
| | - Alex McConnachie
- The Robertson Centre for Biostatistics; University of Glasgow; Glasgow Scotland UK
| | | | - Nina Khan
- NHS Greater Glasgow and Clyde; Glasgow Scotland UK
| | - Deborah Morrison
- Section of General Practice and Primary Care; University of Glasgow; Glasgow Scotland UK
| | | | - Brian Rae
- NHS Greater Glasgow and Clyde; Glasgow Scotland UK
| | - John J.V. McMurray
- BHF Cardiovascular Research Centre; University of Glasgow; Glasgow Scotland UK
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Morrison D, Wyke S, Agur K, Cameron EJ, Docking RI, Mackenzie AM, McConnachie A, Raghuvir V, Thomson NC, Mair FS. Digital asthma self-management interventions: a systematic review. J Med Internet Res 2014; 16:e51. [PMID: 24550161 PMCID: PMC3958674 DOI: 10.2196/jmir.2814] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 11/18/2013] [Accepted: 12/12/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Many people with asthma tolerate symptoms and lifestyle limitations unnecessarily by not utilizing proven therapies. Better support for self-management is known to improve asthma control, and increasingly the Internet and other digital media are being used to deliver that support. OBJECTIVE Our goal was to summarize current knowledge, evidenced through existing systematic reviews, of the effectiveness and implementation of digital self-management support for adults and children with asthma and to examine what features help or hinder the use of these programs. METHODS A comprehensive search strategy combined 3 facets of search terms: (1) online technology, (2) asthma, and (3) self-management/behavior change/patient experience. We undertook searches of 14 databases, and reference and citation searching. We included qualitative and quantitative systematic reviews about online or computerized interventions facilitating self-management. Title, abstract, full paper screening, and quality appraisal were performed by two researchers independently. Data extraction was undertaken using standardized forms. RESULTS A total of 3810 unique papers were identified. Twenty-nine systematic reviews met inclusion criteria: the majority were from the United States (n=12), the rest from United Kingdom (n=6), Canada (n=3), Portugal (n=2), and Australia, France, Spain, Norway, Taiwan, and Greece (1 each). Only 10 systematic reviews fulfilled pre-determined quality standards, describing 19 clinical trials. Interventions were heterogeneous: duration of interventions ranging from single use, to 24-hour access for 12 months, and incorporating varying degrees of health professional involvement. Dropout rates ranged from 5-23%. Four RCTs were aimed at adults (overall range 3-65 years). Participants were inadequately described: socioeconomic status 0/19, ethnicity 6/19, and gender 15/19. No qualitative systematic reviews were included. Meta-analysis was not attempted due to heterogeneity and inadequate information provision within reviews. There was no evidence of harm from digital interventions. All RCTs that examined knowledge (n=2) and activity limitation (n=2) showed improvement in the intervention group. Digital interventions improved markers of self care (5/6), quality of life (4/7), and medication use (2/3). Effects on symptoms (6/12) and school absences (2/4) were equivocal, with no evidence of overall benefits on lung function (2/6), or health service use (2/15). No specific data on economic analyses were provided. Intervention descriptions were generally brief making it impossible to identify which specific "ingredients" of interventions contribute most to improving outcomes. CONCLUSIONS Digital self-management interventions show promise, with evidence of beneficial effects on some outcomes. There is no evidence about utility in those over 65 years and no information about socioeconomic status of participants, making understanding the "reach" of such interventions difficult. Digital interventions are poorly described within reviews, with insufficient information about barriers and facilitators to their uptake and utilization. To address these gaps, a detailed quantitative systematic review of digital asthma interventions and an examination of the primary qualitative literature are warranted, as well as greater emphasis on economic analysis within trials.
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Affiliation(s)
- Deborah Morrison
- General Practice & Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Gallacher K, Jani B, Morrison D, Macdonald S, Blane D, Erwin P, May CR, Montori VM, Eton DT, Smith F, Batty GD, Mair FS. Erratum to: Qualitative systematic reviews of treatment burden in stroke, heart failure and diabetes - Methodological challenges and solutions. BMC Med Res Methodol 2014. [PMCID: PMC3890487 DOI: 10.1186/1471-2288-13-160] [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: 11/29/2022] Open
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Merkley H, Morrison D, Pammit M. Rates of Vaginal Cuff Dehiscence after Total Robotic Hysterectomy. J Minim Invasive Gynecol 2013. [DOI: 10.1016/j.jmig.2013.08.108] [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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Cameron EJ, Chaudhuri R, Mair F, McSharry C, Greenlaw N, Weir CJ, Jolly L, Donnelly I, Gallacher K, Morrison D, Spears M, Evans TJ, Anderson K, Thomson NC. Randomised controlled trial of azithromycin in smokers with asthma. Eur Respir J 2013; 42:1412-5. [PMID: 24036246 PMCID: PMC3814414 DOI: 10.1183/09031936.00093913] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Euan J Cameron
- Immunity and Inflammation, University of Glasgow, Glasgow
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Burrows E, Harrison G, Mayell S, Barton P, Bennett S, Morrison D, Watling R, Southern K. 29 A review of the management of infants with an equivocal diagnosis of cystic fibrosis (CF) following newborn screening in a UK CF regional network. J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60172-1] [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: 10/26/2022]
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Abstract
BACKGROUND Personal, interpersonal and organisational factors have been suggested as possible causes of stress, anxiety and depression for veterinarians. We used established psychological scales to measure (1) levels of distress and work-related stress (anxiety and depression) and (2) the demographic and work characteristics of female veterinarians in relation to anxiety, depression and mental health. METHODS A national cross-sectional survey of a cohort population was conducted and self-administered questionnaires were received from 1017 female veterinarians who completed the mental health section of the survey. Using linear and logistic regression analyses, we examined demographic and work-related factors associated with overall stress measured by the General Health Questionnaire scale and the Affective Well-Being scale (Anxiety-Contentment Axis and Depression-Enthusiasm Axis). RESULTS More than one-third (37%) of the sample was suffering 'minor psychological distress', suggesting the stressful nature of veterinary practice. Women with two or more children had less anxiety and depression compared with those who had never been pregnant or were childless. Longer working hours were associated with increased anxiety and depression in female veterinarians overall and in stratified samples of women with and without children. CONCLUSION Among the work characteristics of veterinary practice, long working hours may have a direct effect on a veterinarian's health in terms of anxiety, depression and mental health. The finding also indicates that women with two or more children have less anxiety and depression than women who have never been pregnant or childless women.
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Affiliation(s)
- A Shirangi
- School of Population Health, Faculty of Medicine and Dentistry, The University of Western Australia, Crawley, Western Australia, 6009, Australia.
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Saksida SM, Morrison D, McKenzie P, Milligan B, Downey E, Boyce B, Eaves A. Use of Atlantic salmon, Salmo salar L., farm treatment data and bioassays to assess for resistance of sea lice, Lepeophtheirus salmonis, to emamectin benzoate (SLICE(®) ) in British Columbia, Canada. J Fish Dis 2013; 36:515-520. [PMID: 23106395 DOI: 10.1111/jfd.12018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 08/31/2012] [Accepted: 09/11/2012] [Indexed: 06/01/2023]
Affiliation(s)
- S M Saksida
- BC Centre for Aquatic Health Sciences, Campbell River, BC, Canada.
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Morrison D, Lin Q, Wiehe S, Liu G, Rosenman M, Fuller T, Wang J, Filippelli G. Spatial relationships between lead sources and children's blood lead levels in the urban center of Indianapolis (USA). Environ Geochem Health 2013; 35:171-83. [PMID: 22782519 DOI: 10.1007/s10653-012-9474-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 06/20/2012] [Indexed: 05/05/2023]
Abstract
Urban children remain disproportionately at risk of having higher blood lead levels than their suburban counterparts. The Westside Cooperative Organization (WESCO), located in Marion County, Indianapolis, Indiana, has a history of children with high blood lead levels as well as high soil lead (Pb) values. This study aims at determining the spatial relationship between soil Pb sources and children's blood lead levels. Soils have been identified as a source of chronic Pb exposure to children, but the spatial scale of the source-recipient relationship is not well characterized. Neighborhood-wide analysis of soil Pb distribution along with a furnace filter technique for sampling interior Pb accumulation for selected homes (n = 7) in the WESCO community was performed. Blood lead levels for children aged 0-5 years during the period 1999-2008 were collected. The study population's mean blood lead levels were higher than national averages across all ages, race, and gender. Non-Hispanic blacks and those individuals in the Wishard advantage program had the highest proportion of elevated blood lead levels. The results show that while there is not a direct relationship between soil Pb and children's blood lead levels at a spatial scale of ~100 m, resuspension of locally sourced soil is occurring based on the interior Pb accumulation. County-wide, the largest predictor of elevated blood lead levels is the location within the urban core. Variation in soil Pb and blood lead levels on the community level is high and not predicted by housing stock age or income. Race is a strong predictor for blood lead levels in the WESCO community.
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Affiliation(s)
- Deborah Morrison
- Department of Earth Sciences, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN 46202, USA
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Gallacher K, Jani B, Morrison D, Macdonald S, Blane D, Erwin P, May CR, Montori VM, Eton DT, Smith F, Batty DG, Mair FS. Qualitative systematic reviews of treatment burden in stroke, heart failure and diabetes - methodological challenges and solutions. BMC Med Res Methodol 2013; 13:10. [PMID: 23356353 PMCID: PMC3568050 DOI: 10.1186/1471-2288-13-10] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 10/15/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment burden can be defined as the self-care practices that patients with chronic illness must perform to respond to the requirements of their healthcare providers, as well as the impact that these practices have on patient functioning and well being. Increasing levels of treatment burden may lead to suboptimal adherence and negative outcomes. Systematic review of the qualitative literature is a useful method for exploring the patient experience of care, in this case the experience of treatment burden. There is no consensus on methods for qualitative systematic review. This paper describes the methodology used for qualitative systematic reviews of the treatment burdens identified in three different common chronic conditions, using stroke as our exemplar. METHODS Qualitative studies in peer reviewed journals seeking to understand the patient experience of stroke management were sought. Limitations of English language and year of publication 2000 onwards were set. An exhaustive search strategy was employed, consisting of a scoping search, database searches (Scopus, CINAHL, Embase, Medline & PsycINFO) and reference, footnote and citation searching. Papers were screened, data extracted, quality appraised and analysed by two individuals, with a third party for disagreements. Data analysis was carried out using a coding framework underpinned by Normalization Process Theory (NPT). RESULTS A total of 4364 papers were identified, 54 were included in the review. Of these, 51 (94%) were retrieved from our database search. Methodological issues included: creating an appropriate search strategy; investigating a topic not previously conceptualised; sorting through irrelevant data within papers; the quality appraisal of qualitative research; and the use of NPT as a novel method of data analysis, shown to be a useful method for the purposes of this review. CONCLUSION The creation of our search strategy may be of particular interest to other researchers carrying out synthesis of qualitative studies. Importantly, the successful use of NPT to inform a coding frame for data analysis involving qualitative data that describes processes relating to self management highlights the potential of a new method for analyses of qualitative data within systematic reviews.
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Gallacher K, Morrison D, Jani B, Macdonald S, May CR, Montori VM, Erwin PJ, Batty GD, Eton DT, Langhorne P, Mair FS. Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research. PLoS Med 2013; 10:e1001473. [PMID: 23824703 PMCID: PMC3692487 DOI: 10.1371/journal.pmed.1001473] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 05/09/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed 'treatment burden' and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective. METHODS AND FINDINGS The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce. CONCLUSIONS Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems.
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Affiliation(s)
- Katie Gallacher
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Deborah Morrison
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Bhautesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Sara Macdonald
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Carl R. May
- Faculty of Health Sciences, University of Southampton, United Kingdom
| | - Victor M. Montori
- Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, United States of America
| | - Patricia J. Erwin
- Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, United States of America
| | - G. David Batty
- Department of Epidemiology and Public Health, University College London, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom
| | - David T. Eton
- Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, United States of America
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Frances S. Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
- * E-mail:
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Lee YY, Whiting JGH, Robertson EV, Derakhshan MH, Wirz AA, Smith D, Morrison D, Kelman A, Connolly P, McColl KEL. Kinetics of transient hiatus hernia during transient lower esophageal sphincter relaxations and swallows in healthy subjects. Neurogastroenterol Motil 2012; 24:990-e539. [PMID: 22680279 DOI: 10.1111/j.1365-2982.2012.01948.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Proximal displacement of the gastro-esophageal junction (GEJ) is present in hiatus hernia but also occurs transiently during transient lower esophageal sphincter relaxations (TLESRs) and swallows. Using a novel magnetic-based technique we have performed detailed examination of the GEJ movement during TLESRs and swallows in healthy subjects. METHODS In 12 subjects, a magnet was endoscopically clipped to the GEJ and combined assembly of Hall-Effect locator probe and 36 channel high-resolution manometer passed nasally. After a test meal the subjects were studied for 90 min. KEY RESULTS The median amplitude of proximal movement of GEJ during TLESRs was 4.3 cm (1.6-8.8 cm) and this was substantially greater than during swallowing at 1.2 cm (0.4-2.7 cm), P = 0.002. With both TLESRs and swallows proximal GEJ movement coincided with lower esophageal sphincter (LES) relaxation and return to its original position occurred 4 s after return of LES tone. Kinetic modeling of the movement of the GEJ during TLESRs indicated two return phases with the initial return phase having the greater velocity (0.9 cm s(-1) ) and being strongly correlated with amplitude of proximal movement (r = 0.8, P < 0.001). CONCLUSIONS & INFERENCES The marked proximal GEJ migration during TLESRs represents very severe herniation of the GEJ. The rapid initial return of the GEJ following TLESRs when the crural diaphragm is relaxed and its correlation with amplitude suggest it is due to elastic recoil of the phreno-esophageal ligament. The marked stretching of the phreno-esophageal ligament during TLESRs may contribute to its weakening and development of established hiatus hernia.
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Affiliation(s)
- Y Y Lee
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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