1
|
Moore EM, Gelberg L, Soh M, Alessi C, Ijadi-Maghsoodi R. Provider Perspectives on Sleep as a Determinant of Health and Housing Outcomes among Veterans Experiencing Homelessness: An Exploratory, Social-Ecological Study. Int J Environ Res Public Health 2023; 20:ijerph20095739. [PMID: 37174255 PMCID: PMC10177824 DOI: 10.3390/ijerph20095739] [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] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
Sleep problems are common among United States (U.S.) veterans and are associated with poor health, mental health, and functioning. Yet, little is known about insufficient sleep and factors contributing to sleep disparities among veterans experiencing homelessness. We conducted semi-structured interviews to better understand the clinical, environmental, and structural factors contributing to insufficient sleep among veterans and to improve care for this population. Interviews were conducted with 13 providers caring for veterans experiencing homelessness, including physicians, psychologists, nurses, social workers, and peer support specialists. Providers worked at a West Coast VA institution serving a large population of veterans experiencing homelessness. Interviews were analyzed for themes pertaining to sleep using the social-ecological model as a framework. On an individual level, factors influencing sleep included psychiatric disorders and use of substances. On an interpersonal level, factors included safety concerns while sleeping. On an environmental level, factors included noise and proximity to others as barriers to sleep. On the organizational level, logistical issues scheduling sleep clinic appointments and lack of transportation to attend sleep clinic appointments were identified as treatment barriers. These findings can inform future research studying the impact of sleep on health and housing outcomes and interventions addressing sleep among veterans experiencing homelessness.
Collapse
Affiliation(s)
- Elizabeth M Moore
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Lillian Gelberg
- Office of Healthcare Transformation and Innovation, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
| | - Michael Soh
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Cathy Alessi
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Roya Ijadi-Maghsoodi
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- VA Health Service Research & Development (HSR&D), VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- UCLA Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA 90024, USA
| |
Collapse
|
2
|
Tan JLC, Wellard C, Moore EM, Mollee P, Rajagopal R, Quach H, Harrison SJ, McDonald EJ, Ho PJ, Prince HM, Augustson BM, Campbell P, McQuilten ZK, Wood EM, Spencer A. The second revision of the International Staging System (R2-ISS) stratifies progression-free and overall survival in multiple myeloma: Real world data results in an Australian and New Zealand Population. Br J Haematol 2023; 200:e17-e21. [PMID: 36321478 DOI: 10.1111/bjh.18536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Joanne L C Tan
- The Alfred Hospital, Monash University and Australian Centre for Blood Diseases, Melbourne, Victoria, Australia
| | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth M Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Mollee
- Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Hang Quach
- St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Simon James Harrison
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - P Joy Ho
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - H Miles Prince
- Epworth Healthcare and Sir Peter MacCallum Department of Oncology University of Melbourne, Parkville, Victoria, Australia
| | | | | | - Zoe K McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew Spencer
- The Alfred Hospital, Monash University and Australian Centre for Blood Diseases, Melbourne, Victoria, Australia
| | | |
Collapse
|
3
|
Moore EM, Gabrielian S, Zito MF, Kozikowski SD, Lopez JR, Lesgart M, Green MF. Social Connectivity and Coping Among Vulnerable Veterans During the COVID-19 Pandemic. J Health Care Poor Underserved 2023; 34:1051-1059. [PMID: 38015136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic dramatically changed how people socialized. However, little is known about the extent to which the pandemic changed the social connections of people with tenuous interpersonal relationships at baseline, including homeless-experienced people and people with psychotic disorders. We sought to understand how these populations experienced changes in their social connectivity and to identify coping strategies employed. We conducted 43 semi-structured interviews with 27 vulnerable participants (11 homeless-experienced people and 16 people with psychotic disorders) and 16 comparison group participants, all of whom used services at the Department of Veterans Affairs (VA). Vulnerable participants in both groups had sparse prepandemic social connectedness; few perceived pandemic-related social network changes. While many homeless-experienced participants struggled with transitioning to technology to communicate, participants with psychotic disorders used technology to stay connected. Resilience derived from military service experiences was adaptive during the pandemic, complemented by VA services that provided supports.
Collapse
|
4
|
Moore EM, Brandl K, Dau LA. Intergovernmental organizations, institutional schisms, and business environments. J Int Bus Policy 2023; 6:141-158. [PMCID: PMC8521085 DOI: 10.1057/s42214-021-00121-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 07/15/2021] [Accepted: 08/06/2021] [Indexed: 06/15/2023]
Abstract
The last two decades have been marked by devastating global challenges that threaten the international problem-solving activities of intergovernmental organizations (IGOs), which have guided global interactions for decades. They offer collective actions by member countries, but come with pressures to create and sustain integrative IGO policies implemented by all members. If these globally focused IGO policies (supranational institutions) misalign with related country-focused national policies (national institutions), an institutional schism exists. We study different levels of institutional schisms and their impact on member countries and national/international business environments. Building on institutional theory/new institutional economics and insights from political science, we conceptualize the different levels of schisms based on the strength of a member country’s national institutions and the degree of compliance with IGO-specific national and supranational institutions. The developed concept allows identifying the impact of IGOs on countries and the global business environment, which is critical for policymakers and practitioners alike.
Collapse
Affiliation(s)
| | - Kristin Brandl
- University of Victoria, BEC 222, Victoria, BC BCV8P5C2 Canada
| | | |
Collapse
|
5
|
Moore EM, Blacklock H, Wellard C, Spearing R, Merriman L, Poplar S, George A, Baker B, Chan H, McQuilten ZK, Wood EM, Spencer A. Māori and Pacific Peoples With Multiple Myeloma in New Zealand are Younger and Have Inferior Survival Compared to Other Ethnicities: A Study From the Australian and New Zealand Myeloma and Related Diseases Registry (MRDR). Clin Lymphoma Myeloma Leuk 2022; 22:e762-e769. [PMID: 35501256 DOI: 10.1016/j.clml.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Māori and Pacific peoples (MPP) in New Zealand (NZ) have poorer health outcomes than other ethnicities. However, this has not been clinically investigated in multiple myeloma (MM). Using data from the Australian and NZ Myeloma and Related Diseases Registry for all participating centers in NZ, we compared MPP demographics, clinical characteristics, diagnostics, treatment, and outcomes to non-MPP. PATIENTS AND METHODS MPP were defined as having ≥1 grandparent of this heritage. We tested ethnicity as a predictor of overall survival (OS) with multivariable Cox regression. RESULTS Of 568 NZ patients with MM (September 2012 to April 2021) and ethnicity data, 138 were MPP. They were diagnosed younger than non-MPP (median age 63 [IQR: 57-72] vs. 70y [62-77], P < .001). Obesity (53 vs. 27%, P < .001), diabetes (24 vs. 8%, P < .001), renal insufficiency (28 vs. 17%, P = .005), pulmonary disease (10 vs. 5%, P = .02) and FISH abnormalities (54 vs. 42%, P = .04) were more common in MPP, and a lower proportion received first-line drug therapy (88 vs. 94%, P = .03) and autologous stem cell transplant (ASCT) (age <70y: 56 vs. 70%, P = .03). OS for MPP was shorter than non-MPP even after adjusting for age, comorbidities, disease stage, performance status, FISH abnormalities and treatment (HR 1.58 [1.04-2.39], P = .03). CONCLUSION MPP with MM in NZ were younger, a greater proportion had comorbidities and FISH abnormalities at diagnosis, fewer received first-line treatment and/or ASCT, and they had poorer OS than non-MPP. Investigation of modifiable factors to improve outcomes and discern why MM occurs at a younger age in MPP is needed.
Collapse
Affiliation(s)
- Elizabeth M Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | | | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | | | - Anup George
- Wellington Hospital, Wellington, New Zealand
| | - Bart Baker
- Palmerston North Hospital, Palmerston North, New Zealand
| | - Henry Chan
- North Shore Hospital, Auckland, New Zealand; University of Auckland, Auckland, New Zealand
| | - Zoe K McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew Spencer
- Alfred Hospital, Monash University, Melbourne, Australia
| |
Collapse
|
6
|
Ijadi-Maghsoodi R, Moore EM, Feller S, Cohenmehr J, Ryan GW, Kataoka S, Gelberg L. Beyond housing: Understanding community integration among homeless-experienced veteran families in the United States. Health Soc Care Community 2022; 30:e493-e503. [PMID: 33340381 PMCID: PMC9601248 DOI: 10.1111/hsc.13233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 05/02/2023]
Abstract
Community integration is important to address among homeless-experienced individuals. Little is known about helping veteran families (families with a parent who is a veteran) integrate into the community after homelessness. We sought to understand the experiences of community integration among homeless-experienced veteran families. We used a two-stage, community-partnered approach. First, we analysed 16 interviews with homeless-experienced veteran parents (parents who served in the military; n = 9) living in permanent housing and providers of homeless services (n = 7), conducted from February to September 2016, for themes of community integration. Second, we developed a workgroup of nine homeless-experienced veteran parents living in a permanent housing facility, who met four times from December 2016 to July 2017 to further understand community integration. We audio-recorded, transcribed and analysed the interviews and workgroups for community integration themes. For the analysis, we developed community integration categories based on interactions outside of the household and built a codebook describing each topic. We used the codebook to code the individual interviews and parent workgroup sessions after concluding that the workgroup and interview topics were consistent. Findings were shared with the workgroup. We describe our findings across three stages of community integration: (a) first housed, (b) adjusting to housing and the community, and (c) housing maintenance and community integration. We found that parents tended to isolate after transitioning into permanent housing. After this, families encountered new challenges and were guarded about losing housing. One facilitator to community integration was connecting through children to other parents and community institutions (e.g. schools). Although parents felt safe around other veterans, many felt judged by non-veterans. Parents and providers reported a need for resources and advocacy after obtaining housing. We share implications for improving community integration among homeless-experienced veteran families, including providing resources after obtaining housing, involving schools in facilitating social connections, and combating stigma.
Collapse
Affiliation(s)
- Roya Ijadi-Maghsoodi
- UCLA Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
- VA Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Elizabeth M. Moore
- VA Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- National Clinician Scholars Program, Division of General Internal Medicine and Health Services Research at UCLA, Los Angeles, CA, USA
| | - Sophie Feller
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jennifer Cohenmehr
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gery W. Ryan
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Sheryl Kataoka
- UCLA Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
| | - Lillian Gelberg
- VA Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Office of Healthcare Transformation and Innovation, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| |
Collapse
|
7
|
Goodsmith N, Moore EM, Siddiq H, Barceló SE, Ulloa-Flores E, Loera G, Jones F, Aguilar-Gaxiola S, Wells K, Arevian A. Community-Partnered Development of a Digital Mental Health Resource Website to Support Diverse Communities During the COVID-19 Pandemic. J Health Care Poor Underserved 2022; 33:506-516. [PMID: 35153238 PMCID: PMC10036170 DOI: 10.1353/hpu.2022.0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A state-academic-community partnership formed in response to the mental health needs fueled by the COVID-19 pandemic and the disproportionate effects on marginalized communities. Taking a community-partnered approach and using a health equity lens, the partnership developed a website to guide users through digital mental health resources, prioritizing accessibility, engagement, and community needs.
Collapse
|
8
|
Boyle S, Wellard C, Moore EM, Blacklock H, Harrison SJ, Ho PJ, Hocking J, McQuilten ZK, Quach H, Spearing R, Wood EM, Spencer A, Mollee P. Receiving four or fewer cycles of therapy predicts poor survival in newly diagnosed transplant-ineligible patients with myeloma who are treated with bortezomib-based induction. Eur J Haematol 2021; 107:497-499. [PMID: 34129711 DOI: 10.1111/ejh.13677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Stephen Boyle
- Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia
| | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elizabeth M Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Simon J Harrison
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Phoebe Joy Ho
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Jay Hocking
- Box Hill Hospital, Melbourne, VIC, Australia
| | - Zoe K McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Hang Quach
- University of Melbourne, St. Vincent's Hospital, Melbourne, VIC, Australia
| | | | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew Spencer
- The Alfred Hospital, Monash University and Australian Centre for Blood Diseases, Melbourne, VIC, Australia
| | - Peter Mollee
- Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia
| | | |
Collapse
|
9
|
Arevian AC, Jones F, Moore EM, Goodsmith N, Aguilar-Gaxiola S, Ewing T, Siddiq H, Lester P, Cheung E, Ijadi-Maghsoodi R, Gabrielian S, Sugarman OK, Bonds C, Benitez C, Innes-Gomberg D, Springgate B, Haywood C, Meyers D, Sherin JE, Wells K. Mental Health Community and Health System Issues in COVID-19: Lessons from Academic, Community, Provider and Policy Stakeholders. Ethn Dis 2020; 30:695-700. [PMID: 32989370 PMCID: PMC7518533 DOI: 10.18865/ed.30.4.695] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The coronavirus pandemic of 2019 (COVID-19) has created unprecedented changes to everyday life for millions of Americans due to job loss, school closures, stay-at-home orders and health and mortality consequences. In turn, physicians, academics, and policymakers have turned their attention to the public mental health toll of COVID-19. This commentary reporting from the field integrates perceptions of academic, community, health system, and policy leaders from state, county, and local levels in commenting on community mental health needs in the COVID-19 pandemic. Stakeholders noted the broad public health scope of mental health challenges while expressing concern about exacerbation of existing disparities in access and adverse social determinants, including for communities with high COVID-19 infection rates, such as African Americans and Latinos. They noted rapid changes toward telehealth and remote care, and the importance of understanding impacts of changes, including who may benefit or have limited access, with implications for future services delivery. Needs for expanded workforce and training in mental health were noted, as well as potential public health value of expanding digital resources tailored to local populations for enhancing resilience to stressors. The COVID-19 pandemic has led to changes in delivery of health care services across populations and systems. Concerns over the mental health impact of COVID-19 has enhanced interest in remote mental care delivery and preventive services, while being mindful of potential for enhanced disparities and needs to address social determinants of health. Ongoing quality improvement across systems can integrate lessons learned to enhance a public mental well-being.
Collapse
Affiliation(s)
- Armen C. Arevian
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Health Services and Society, Los Angeles, CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Elizabeth M. Moore
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA National Clinician Scholars Program, Los Angeles, CA
| | - Nichole Goodsmith
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA National Clinician Scholars Program, Los Angeles, CA
| | - Sergio Aguilar-Gaxiola
- Department of Clinical Internal Medicine, School of Medicine, and Center for Reducing Health Disparities, UC Davis, Davis, CA
| | - Toby Ewing
- California Mental Health Services Oversight and Accountability Commission, Sacramento, CA
| | - Hafifa Siddiq
- UCLA National Clinician Scholars Program, Los Angeles, CA
- UCLA Resource Center for Minority Aging Research, Resource Centers for Minority Aging and for Health Improvement of Minority Elderly, Los Angeles, CA
| | - Patricia Lester
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Division of Population Behavioral Health, Los Angeles, CA
| | - Erick Cheung
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Roya Ijadi-Maghsoodi
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Division of Population Behavioral Health, Los Angeles, CA
- UCLA/VA Center of Excellence for Veteran Resilience and Recovery, Los Angeles, CA
| | - Sonya Gabrielian
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA/VA Center of Excellence for Veteran Resilience and Recovery, Los Angeles, CA
| | - Olivia K. Sugarman
- Louisiana State University Health Sciences Center – New Orleans School of Medicine and School of Public Health, New Orleans, LA
| | - Curley Bonds
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Christopher Benitez
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | | | - Benjamin Springgate
- Louisiana State University Health Sciences Center – New Orleans School of Medicine and School of Public Health, New Orleans, LA
| | | | | | - Jonathan E. Sherin
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Los Angeles County Department of Mental Health, Los Angeles, CA
- University of Southern California, Los Angeles, CA
| | - Kenneth Wells
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Division of Population Behavioral Health, Los Angeles, CA
- UCLA/VA Center of Excellence for Veteran Resilience and Recovery, Los Angeles, CA
- UCLA Fielding School of Public Health, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Health Services and Society, Los Angeles, CA
| |
Collapse
|
10
|
Eisen DP, Leder K, Woods RL, Lockery JE, McGuinness SL, Wolfe R, Pilcher D, Moore EM, Shastry A, Nelson MR, Reid CM, McNeil JJ, McBryde ES. Effect of aspirin on deaths associated with sepsis in healthy older people (ANTISEPSIS): a randomised, double-blind, placebo-controlled primary prevention trial. Lancet Respir Med 2020; 9:186-195. [PMID: 32950072 DOI: 10.1016/s2213-2600(20)30411-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/06/2020] [Accepted: 08/21/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sepsis is a serious global health issue and a major cause of death and disability. The availability of a simple, community-based preventive strategy could substantially reduce the burden of sepsis. We aimed to establish whether low-dose aspirin reduced deaths or hospital admissions associated with sepsis in older people. METHODS ANTISEPSIS was a substudy of ASPREE (a randomised controlled primary prevention trial of low-dose aspirin [100 mg per day] compared with placebo in community dwelling older adults conducted in Australia and the USA), with the Australian cohort included in the ANTISEPSIS substudy. Inclusion criteria were participants aged at least 70 years who did not have major illnesses. Participants were block randomised (1:1) via a centralised web portal and stratified by general practice and age. Participants, investigators, and staff were masked to the intervention. Teams of clinical specialist investigators assessed potential sepsis events to establish if they satisfied the primary endpoint of death associated with sepsis. The analyses were by intention-to-treat with univariate survival analysis methods, the log-rank test, and Cox proportional hazards regression. This study is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613000349741. RESULTS Between March 10, 2010, and Dec 24, 2014, of 20 288 individuals assessed for eligibility, 16 703 participants aged 70 years and older at trial entry were enrolled and followed up for a median of 4·6 years (IQR 3·6-5·6). 8322 (49·8%) participants were assigned to receive aspirin and 8381 (50·2%) to placebo. 203 deaths were considered to be associated with sepsis. Univariate analysis showed similar rates of death associated with sepsis in the two study groups (hazard ratio for aspirin vs placebo 1·08, 95% CI 0·82-1·43; p=0·57). Adverse events were previously reported in the ASPREE trial. INTERPRETATION Daily low-dose aspirin treatment did not reduce deaths associated with sepsis in community dwelling older adults. Our findings do not support the use of aspirin as a primary prevention strategy to reduce the burden of sepsis in this population. FUNDING National Health and Medical Research Council of Australia, National Institutes of Health, Monash University.
Collapse
Affiliation(s)
- Damon P Eisen
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jessica E Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Infectious Diseases, Alfred Health, Prahran, VIC, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - David Pilcher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care, Alfred Health, Prahran, VIC, Australia
| | - Elizabeth M Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Adithya Shastry
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; The School of Public Health, Curtin University, Bentley, WA, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Emma S McBryde
- Australian Institute of Tropical Health and Medicine, James Cook University, Douglas, QLD, Australia
| |
Collapse
|
11
|
Moore EM, King TA, Wood EM, Ruseckaite R, Klarica D, Spencer A, Ho PJ, Quach H, Prince HM, McQuilten ZK. Patient-reported outcome measures in multiple myeloma: Real-time reporting to improve care (My-PROMPT) - a pilot randomized controlled trial. Am J Hematol 2020; 95:E178-E181. [PMID: 32243613 DOI: 10.1002/ajh.25815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/28/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Elizabeth M Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tracy A King
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Cancer Nursing Research Unit, University of Sydney, Sydney, Australia
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rasa Ruseckaite
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniela Klarica
- Department of Malignant Haematology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Andrew Spencer
- Department of Malignant Haematology, The Alfred Hospital, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - P Joy Ho
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Hang Quach
- University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - H Miles Prince
- Epworth Healthcare and University of Melbourne, Melbourne, Victoria, Australia
| | - Zoe K McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
12
|
Moore EM, Cheng TH, Castillo EG, Gelberg L, Ijadi-Maghsoodi R. Understanding Homelessness: A Call to Action and Curriculum Framework for Psychiatry Residencies. Acad Psychiatry 2020; 44:344-351. [PMID: 31898302 PMCID: PMC7242141 DOI: 10.1007/s40596-019-01154-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 11/25/2019] [Indexed: 06/10/2023]
Affiliation(s)
| | | | - Enrico G Castillo
- Los Angeles County Department of Mental Health, Los Angeles, CA, USA
| | | | - Roya Ijadi-Maghsoodi
- Jane and Terry Semel Institute for Neuroscience & Human Behavior at UCLA, Los Angeles, CA, USA
| |
Collapse
|
13
|
Warde CM, Linzer M, Schorling JB, Moore EM, Poplau S. Balancing Unbalanced Lives: A Practical Framework for Personal and Organizational Change. Mayo Clin Proc Innov Qual Outcomes 2019; 3:97-100. [PMID: 30899914 PMCID: PMC6408679 DOI: 10.1016/j.mayocpiqo.2018.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/19/2018] [Accepted: 12/10/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Carole M. Warde
- David Geffen School of Medicine at UCLA, Los Angeles, CA
- Correspondence: Address to Carole M. Warde, MD, 37 Via Di Roma, Long Beach, CA 90803.
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, MN
| | - John B. Schorling
- Public Health Sciences and Nursing, University of Virginia, Charlottesville, VA
| | - Elizabeth M. Moore
- University of California-Los Angeles Semel Institute for Neuroscience, Los Angeles, CA
| | - Sara Poplau
- Hennepin Healthcare Research Institute, Minneapolis, MN
| |
Collapse
|
14
|
Moore EM, Lucas DP, Schillinger K, Jeresano M, Jackson AM. OR44 HLA expression following lymphocyte enrichment: Tissue source still matters for deceased donor crossmatching. Hum Immunol 2018. [DOI: 10.1016/j.humimm.2018.07.049] [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]
|
15
|
Abstract
INTRODUCTION Sepsis is a leading global cause of morbidity and mortality, and is more common at the extremes of age. Moreover, the cost of in-hospital care for elderly patients with sepsis is significant. There are indications from experimental and observational studies that aspirin may reduce inflammation associated with infection. This paper describes the rationale and design of the AspiriN To Inhibit SEPSIS (ANTISEPSIS) trial, a substudy of ASPirin in Reducing Events in the Elderly (ASPREE). ANTISEPSIS primarily aims to determine whether low-dose aspirin reduces sepsis-related deaths in older people. Additionally, it will assess whether low-dose aspirin reduces sepsis-related hospitalisations and sepsis-related Intensive Care Unit (ICU) admissions. METHODS AND ANALYSIS ASPREE is a double-blinded, randomised, placebo-controlled primary prevention trial that will determine whether daily low-dose aspirin extends disability-free longevity in 19 000 healthy older people recruited in Australia and the USA. The ANTISEPSIS substudy involves additional ASPREE trial data collection to assess the impact of daily low-dose aspirin on sepsis-related events in the 16 703 ASPREE participants aged 70 years and over, recruited in Australia. The intervention is a daily 100 mg dose of enteric-coated aspirin versus matching placebo, with 1:1 randomisation. The primary outcome for the ANTISEPSIS substudy is the incidence of sepsis-related death in eligible patients. The incidence of sepsis-related hospital and ICU admissions are secondary outcomes. ANTISEPSIS is to be conducted between 2012 and 2018. DISCUSSION This substudy will determine whether aspirin, an inexpensive and accessible therapy, safely reduces sepsis-related deaths and hospitalisations in older Australians. If shown to be the case, this would have profound effects on the health of older Australians. TRIAL REGISTRATION NUMBER Pre-results, ACTRN12613000349741.
Collapse
Affiliation(s)
- Damon P Eisen
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
- Division of Tropical Health and Medicine, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth M Moore
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karin Leder
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service at the Peter Doherty Institute, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jessica Lockery
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Emma S McBryde
- Division of Tropical Health and Medicine, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Pilcher
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia
- The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE), Melbourne, Victoria, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L Woods
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
16
|
Moore EM, Tobin A, Reid D, Bellomo R. Reply: AKI Classification: One Size Doesn't Fit All. J Cardiothorac Vasc Anesth 2016; 30:e36-7. [PMID: 27236489 DOI: 10.1053/j.jvca.2016.01.028] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Elizabeth M Moore
- St Vincent's Hospital Melbourne Australia; ANZIC Research Centre Department of Epidemiology and Preventive Medicine Monash University, Melbourne, Australia
| | | | - David Reid
- St Vincent's Hospital Melbourne Australia
| | - Rinaldo Bellomo
- ANZIC Research Centre Department of Epidemiology and Preventive Medicine Monash University, Melbourne, Australia; Austin Hospital Melbourne, Australia
| |
Collapse
|
17
|
Skittrall JP, Eid-Arimoku L, Joshi M, Newport MJ, Moore EM. Rigid sigmoidoscopy: no contamination of the sigmoidoscopist's face with faecal flora in a small study. J Hosp Infect 2016; 93:112-3. [PMID: 26996086 DOI: 10.1016/j.jhin.2016.01.017] [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] [Received: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 10/22/2022]
Affiliation(s)
- J P Skittrall
- Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK.
| | - L Eid-Arimoku
- Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK
| | - M Joshi
- Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK
| | - M J Newport
- Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK
| | - E M Moore
- Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK
| |
Collapse
|
18
|
Mitchell AW, Moore EM, Roberts EJ, Hachtel KW, Brown MS. Sensory processing disorder in children ages birth-3 years born prematurely: a systematic review. Am J Occup Ther 2015; 69:6901220030. [PMID: 25553748 DOI: 10.5014/ajot.2015.013755] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This systematic review of multidisciplinary literature synthesizes evidence of the prevalence and patterns of sensory processing disorder (SPD) in children ages birth-3 yr born preterm. Forty-five articles including physiological, behavioral, temperament, and SPD research met the inclusion criteria and provided 295 findings related to SPD-130 (44%) positive (evidence of SPD) and 165 (56%) negative (no evidence of SPD). The majority of findings related to sensory modulation disorder (SMD; 43% positive). The most prevalent subcategory of SMD was sensory overresponsivity (82% of findings positive). Evidence of sensory underresponsivity and sensory-seeking SMD, sensory discrimination disorder, and sensory-based motor disorder was limited. This study supports the education of neonatologists, pediatricians, and caregivers about the symptoms and potential consequences of SPD and helps justify the need for follow-up screening for SPD in children ages birth-3 yr born preterm. Research using measures based on sensory processing theory is needed.
Collapse
Affiliation(s)
- Anita Witt Mitchell
- Anita Witt Mitchell, PhD, OTR, is Associate Professor, Occupational Therapy Department, University of Tennessee Health Science Center, Memphis;
| | - Elizabeth M Moore
- Elizabeth M. Moore, MOT, OTR/L, is Occupational Therapist, Signature Healthcare at St. Francis, Memphis, TN; At the time of the study, Elizabeth Moore, Emily Roberts, Kristen Hachtel, and Melissa Brown were Students, Department of Occupational Therapy, University of Tennessee Health Science Center, Memphis, TN
| | - Emily J Roberts
- Emily J. Roberts, MOT, OTR/L, is Occupational Therapist, Regional One Health, Memphis, TN
| | - Kristen W Hachtel
- Kristen W. Hachtel, MOT, OTR/L, is Occupational Therapist, First Choice Speech and Occupational Therapy, Hernando, MS
| | - Melissa S Brown
- Melissa S. Brown, MOT, OTR/L, is Occupational Therapist, Methodist Healthcare South Hospital, Memphis, TN
| |
Collapse
|
19
|
Moore EM, Tobin A, Reid D, Santamaria J, Bellomo R. Acute kidney injury and cardiac surgery: impact of fluid balance on AKI classification and prognosis. Crit Care 2014. [PMCID: PMC4069370 DOI: 10.1186/cc13557] [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: 12/01/2022] Open
|
20
|
Moore EM, Tobin A, Reid D, Santamaria J, Bellomo R. Fluid accumulation post cardiac surgery and risk for renal replacement therapy. Crit Care 2014. [PMCID: PMC4069369 DOI: 10.1186/cc13578] [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: 11/10/2022] Open
|
21
|
Moore EM, Nichol AD, Bernard SA, Bellomo R. Therapeutic hypothermia: benefits, mechanisms and potential clinical applications in neurological, cardiac and kidney injury. Injury 2011; 42:843-54. [PMID: 21481385 DOI: 10.1016/j.injury.2011.03.027] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [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] [Received: 01/02/2011] [Revised: 02/27/2011] [Accepted: 03/16/2011] [Indexed: 02/02/2023]
Abstract
Therapeutic hypothermia involves the controlled reduction of core temperature to attenuate the secondary organ damage which occurs following a primary injury. Clinicians have been increasingly using therapeutic hypothermia to prevent or ameliorate various types of neurological injury and more recently for some forms of cardiac injury. In addition, some recent evidence suggests that therapeutic hypothermia may also provide benefit following acute kidney injury. In this review we will examine the potential mechanisms of action and current clinical evidence surrounding the use of therapeutic hypothermia. We will discuss the ideal methodological attributes of future studies using hypothermia to optimise outcomes following organ injury, in particular neurological injury. We will assess the importance of target hypothermic temperature, time to achieve target temperature, duration of cooling, and re-warming rate on outcomes following neurological injury to gain insights into important factors which may also influence the success of hypothermia in other organ injuries, such as the heart and the kidney. Finally, we will examine the potential of therapeutic hypothermia as a future kidney protective therapy.
Collapse
Affiliation(s)
- Elizabeth M Moore
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | | | | | | |
Collapse
|
22
|
Abstract
The available treatment options for visceral leishmaniasis (VL) have problems relating to efficacy, adverse effects and cost, making treatment a complex issue. We review the evidence relating to the different methods of treatment in relation to - efficacy and toxicity of the drugs in different areas of the world; ability to monitor side effects, length of treatment; ability of patients to pay for and stay safe during treatment, ability of the healthcare services to give intramuscular, intravenous or oral therapy; the sex and child-bearing potential of the patient and the immune status of the patient. The high mortality of untreated/ poorly treated VL infection makes the decisions paramount, but a unified and coordinated response by each area is likely to be more effective and informative to future policies than an ad hoc response. For patients in resource-rich countries, liposomal amphotericin B appears to be the optimal treatment. In South Asia, miltefosine is being used; the combination of single dose liposomal amphotericin B and short course miltefosine looks encouraging but has the problem of potential reproductive toxicities in females. In Africa, the evidence to switch from SSG is not yet compelling. The need to monitor and plan for evolving drug failure, secondary to leishmania parasite resistance, is paramount. With a few drugs the options may be limited; however, we await key ongoing trials in both Africa and India to explore the effects of combination treatment. If safe and reliable combinations are revealed by the ongoing studies, it is far from clear as to whether this will avoid leishmania parasite resistance. The development of new drugs to add to the armamentarium is paramount. Lessons can be learnt from the management of diseases such as tuberculosis and malaria in terms of planning the switch to combination treatment. As important as establishing the best choice for specific antileishmanial agent is ensuring treatment centers, which can best manage the problems encountered during treatment, specifically malnutrition, bleeding, intercurrent infections, drug side effects and detecting and treating underlying immunosuppression.
Collapse
Affiliation(s)
- E M Moore
- Hospital for Tropical Diseases, University College London Hospital
| | | |
Collapse
|
23
|
Abstract
Erythropoietin is a 30.4 kDa glycoprotein produced by the kidney, which is mostly known for its physiological function in regulating red blood cell production in the bone marrow Accumulating evidence, however suggests that erythropoietin has additional organ protective effects, which may specifically be useful in protecting the brain and kidneys from injury. Experimental evidence suggests that these protective mechanisms are multi-factorial in nature and may include inhibition of apoptotic cell death, stimulation of cellular regeneration, inhibition of deleterious pathways and promotion of recovery. In this article we review the physiology of erythropoietin, assess previous work that supports the role of erythropoietin as a general tissue protective agent and explain the mechanisms by which it may achieve this tissue protective effect. We then focus on specific laboratory and clinical data that suggest that erythropoietin has a strong brain protective and kidney protective effect. In addition, we comment on the implications of these studies for clinicians at the bedside and for researchers designing controlled trials to further elucidate the true clinical utility of erythropoietin as a neuroprotective and nephroprotective agent. Finally, we describe EPO-TBI, a double-blinded multi-centre randomised controlled trial involving the authors that is being conducted to investigate the organ protective effects of erythropoietin on the brain, and also assesses its effect on the kidneys.
Collapse
Affiliation(s)
- E M Moore
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | | | | |
Collapse
|
24
|
Moore EM, Bellomo R, Nichol A, Harley N, Macisaac C, Cooper DJ. The incidence of acute kidney injury in patients with traumatic brain injury. Ren Fail 2011; 32:1060-5. [PMID: 20863210 DOI: 10.3109/0886022x.2010.510234] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
There is limited information on the incidence of acute kidney injury (AKI) in patients with traumatic brain injury (TBI) although AKI may contribute to morbidity and mortality. We investigated the incidence of AKI in patients with moderate and severe TBI and the association of AKI with risk factors and outcomes in these patients. We studied all TBI patients over 16 years of age admitted to the two designated trauma hospitals in the state of Victoria, Australia from 1 January to 31 December 2008. Patients were included if they had head trauma and presented with a Glasgow coma scale (GCS) <13. Prospectively collected data from the hospital trauma registries, ICUs, and pathology databases were analyzed retrospectively. Risk injury failure loss end (RIFLE) criteria were used to categorize renal function. The incidence of AKI was 9.2% (19/207). Patients who developed AKI were older, had higher severity of illness scores, and a lower GCS. Overall 42.1% of these patients died in hospital compared with 18.1% in patients without AKI. In univariable linear regression analysis, age, severity of illness, and admitting hospital were associated with AKI. After multivariable logistic regression, the occurrence of AKI was associated with age (p < 0.001) and higher APACHE III scores (p = 0.016). AKI is relatively common even in patients with TBI. Its association with age and APACHE III scores helps identify patients at higher risk of AKI.
Collapse
Affiliation(s)
- Elizabeth M Moore
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care (ANZIC) Research Centre, Monash University, Melbourne, VIC, Australia.
| | | | | | | | | | | |
Collapse
|
25
|
Moore EM, Tobin AE. The association between preoperative eGFR and outcomes in cardiac surgical patients. CRIT CARE RESUSC 2009; 11:310-311. [PMID: 20001885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
26
|
Moore EM. Orthopaedic instrument ideal for manual evacuation of faeces. Ann R Coll Surg Engl 2005; 87:211-2. [PMID: 15920800 PMCID: PMC1963898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Affiliation(s)
- E M Moore
- Department of Surgery, Queen Alexandra Hospital, Portsmouth, UK.
| |
Collapse
|
27
|
Abstract
This work describes the development of a quality control protocol, which can be implemented to assess the accuracy, precision and reproducibility of the apparent diffusion coefficient (ADC) measurement on a clinical magnetic resonance imaging (MRI) system. The precision and accuracy of the ADC measurement are analysed with regard to MRI system noise, signal reproducibility and differences between nominal and effective b values. Two aqueous test-solutions of CuSO4 and sucrose are prepared for the quality control protocol. ADC measurement with the CuSO4 solution is more sensitive to differences between nominal and effective b values, on account of the solution's high ADC. ADC measurement with the sucrose solution is more sensitive to signal reproducibility due to the solution's low baseline signal intensity. The ADC of the test-solutions is measured on an MRI system at our centre with a sequence used for clinical studies using diffusion imaging. Two parameters, Q and R, are defined for the analysis of the quality control ADC values. The Q parameter is the ratio of the standard deviation of the quality control mean ADC values over time to the optimal standard deviation, as derived from the effect of thermal noise on the ADC measurement uncertainty. Analysis with the Q parameter indicates that signal reproducibility errors contribute to ADC variations on our MRI system when imaging with high b values (b > 500 mm s(-2)), whereas differences between nominal and effective b values have a greater impact on the ADC measurement when imaging with low b values (b < 500 mm s(-2)). The R parameter is defined as the ratio of the directional variation of the ADC quality control values to the uncertainty of the ADC measurement. Analysis with the R parameter shows that the effect of directional variation of the ADC measurement on our MRI system is more pronounced when imaging with low b values. The quality control protocol identified a systematic error, which introduced a small system-induced anisotropy in the ADC measurement. This error is currently taken into account in the analysis of clinical studies employing the diffusion imaging sequence used in this quality control protocol.
Collapse
Affiliation(s)
- Ioannis Delakis
- Department of Bioengineering (Bagrit Centre), Imperial College London, MagNET, Exhibition Road, South Kensington, London SW7 2AZ, UK
| | | | | | | |
Collapse
|
28
|
Connor SE, O'Gorman R, Summers P, Simmons A, Moore EM, Chandler C, Jarosz JM. SPAMM, cine phase contrast imaging and fast spin-echo T2-weighted imaging in the study of intracranial cerebrospinal fluid (CSF) flow. Clin Radiol 2001; 56:763-72. [PMID: 11585399 DOI: 10.1053/crad.2001.0761] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To compare the qualitative assessment of cerebrospinal fluid (CSF) flow using a SPAMM (spatial modulation of magnetization) technique with cine phase contrast images (cine PC) and fast spin echo (FSE) T2-weighted images. MATERIALS AND METHODS SPAMM, PC and T2-weighted sequences were performed on 22 occasions in 19 patients. Eleven of the studies were performed following a neuroendoscopic third ventriculostomy (NTV), and in these cases, the success of the NTV was determined by clinical follow-up. Two observers used consensus to grade the presence of CSF flow at nine different sites for each study. RESULTS At 14 of the 178 matched sites, which could be assessed by both SPAMM and cine PC, SPAMM CSF flow grade was higher than that of cine PC. At a further 14/178 matched sites, the cine PC grade was higher than that of SPAMM. There was definite CSF flow at 113/182 (62%) of all the cine PC sites assessed, and 110/181 (61%) of all SPAMM sites assessed whilst 108/198 (54%) of FSE T2-weighted image sites demonstrated flow voids. Cine PC grades were higher than SPAMM at the cerebral aqueduct (P < 0.05, Wilcoxon sign rank test). Definite CSF flow within the anterior third ventricle was present in 4/5 (SPAMM) and 3/5 (cine PC) successful NTVs, 0/2 (SPAMM and cine PC) unsuccessful NTVs and 1/10 (SPAMM and cine PC) patients without NTV. CONCLUSION SPAMM provides a comparable assessment of intracranial CSF flow to that of cine phase contrast imaging at all CSF sites except the cerebral aqueduct.
Collapse
Affiliation(s)
- S E Connor
- Department of Neuroradiology, King's College Hospital, London
| | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
BACKGROUND An outcomes analysis study was performed to quantify the benefit of directed diagnostic imaging of selected very young women (defined as < or = 30 years of age) in our population. Summary results are presented. PATIENTS AND METHODS Women's Imaging Services were queried for studies performed between April 1, 1997 and December 31, 1998 on women < or = 30 years of age. The authors' referral pathway mandates breast examination by a general surgeon or by the head of Women's Imaging before mammography in all such patients. Studies were excluded if there were reviews of scans performed at other sites. The resulting 142 mammograms were evaluated. RESULTS Ninety percent of the 142 studies were within normal limits. Only 11 mammograms indicated any required action (7.8%), and only 5 of these merited biopsy. All biopsies revealed benign disease. No carcinomas were detected by biopsy or on clinical follow-up in this cohort of women. These values are congruent with the scarce literature on mammography in this population. CONCLUSIONS The yield of mammography in the age < or = 30 years population is low.
Collapse
Affiliation(s)
- P A Johnstone
- Radiation Oncology Division, Naval Medical Center, San Diego, California 92134-5000, USA.
| | | | | | | |
Collapse
|
30
|
Abstract
PURPOSE To analyze the frequency and clinical importance of proctitis and hematochezia after radiation therapy for prostate cancer. MATERIALS AND METHODS Of 63 patients with prostate cancer treated with curative intent by a single radiation oncologist between July 1, 1993, and December 31, 1997, 30 were asymptomatic, but 33 had heme-positive digital rectal examination (DRE) results or hematochezia at routine follow-up. Twenty-six of these patients underwent endoscopy of the sigmoid colon or colon for evaluation of these symptoms. Median doses of 60.0 Gy at postoperative radiation therapy and 68.4 Gy at definitive radiation therapy were delivered to four fields daily by using blocking customized on the basis of computed tomographically documented evidence of disease. The Fisher exact test and the Kaplan-Meier method were used to analyze the results. RESULTS The frequency of rectal bleeding approached 80% at 3 years after radiation therapy in definitively treated patients. Only 14 patients had proctitis: eight as the only sign, and six in association with other disease. Six patients had other disease without proctitis, and four patients had normal examination findings. The frequency of rectal bleeding in the presence of proctitis was similar to that in the presence of other disease (Fisher exact test, P =.68). CONCLUSION Hematochezia or positive DRE findings are frequent sequelae of definitive radiation therapy for prostate cancer; however, causes other than proctitis are often documented at endoscopy. Symptomatic individuals warrant rigorous evaluation to rule out serious coexistent disease.
Collapse
Affiliation(s)
- E M Moore
- General Surgery Department and the Clinical Investigation Department, Naval Medical Center San Diego, Suite 5, 34800 Bob Wilson Dr, San Diego CA 92134-1014, USA
| | | | | |
Collapse
|
31
|
Moore EM. A useful mnemonic for severity stratification in acute pancreatitis. Ann R Coll Surg Engl 2000; 82:16-7. [PMID: 10700760 PMCID: PMC2503457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Affiliation(s)
- E M Moore
- General Surgery Department, Torbay Hospital, Devon, UK
| |
Collapse
|
32
|
Moore EM. Malone antegrade continence enema for faecal incontinence and constipation in adults. Br J Surg 1998; 85:1594. [PMID: 9823924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
|
33
|
Bourgouin PM, McLoud TC, Fitzgibbon JF, Mark EJ, Shepard JA, Moore EM, Rummeny E, Brady TJ. Differentiation of bronchogenic carcinoma from postobstructive pneumonitis by magnetic resonance imaging: histopathologic correlation. J Thorac Imaging 1991; 6:22-7. [PMID: 1856898 DOI: 10.1097/00005382-199104000-00006] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Obstructive pneumonitis frequently occurs distal to hilar bronchogenic carcinomas or in lung adjacent to peripheral tumors. The article evaluates the role of MRI in the differentiation of tumor from pneumonitis. Twelve patients underwent MRI of the thorax before surgery. T1-weighted (SE 310/20) and T2-weighted (SE 2000/60-120) images were obtained through the tumor and presumed areas of pneumonitis. Five histologic types of pneumonitis were identified on pathologic examination of the 12 specimens. Cholesterol pneumonitis, found in 7 patients, was the most common type. Organizing pneumonitis, bronchiectasis with mucus plugs, atelectasis, and abscess were found in 3, 4, 2, and 1 patients, respectively. MRI was able to differentiate tumor from pneumonitis in 5 of 6 patients with a hilar mass and in 5 of 6 patients with a peripheral tumor. This was achieved by a visual difference in signal intensity on heavily T2-weighted (SE 2000/120) images. Cholesterol pneumonitis and bronchiectasis with mucus plugs were always hyperintense relative to tumor, and organizing pneumonitis and atelectasis were isointense and indistinguishable from tumor. MRI can differentiate tumor from pneumonitis provided that pneumonitis is of the cholesterol type or if there are mucus plugs in the collapsed lung.
Collapse
Affiliation(s)
- P M Bourgouin
- Department of Radiology, Massachusetts General Hospital, Boston 02114
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Lopez WM, Moore EM. Lateral gaze deficit suggesting multiple sclerosis. Oral Surg Oral Med Oral Pathol 1986; 62:657-8. [PMID: 3467291 DOI: 10.1016/0030-4220(86)90260-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The case of a 26-year-old white man with multiple sclerosis is presented. Although the patient was unaware of his condition, the signs and symptoms that he presented were highly suggestive of multiple sclerosis. The case is unusual in that initial diagnosis was made by a senior dental student in a social rather than a clinical setting and without a presenting complaint by the patient. The significance of a thorough clinical examination and the responsibility of a general practitioner as a primary health provider to be observant of signs of disease such as multiple sclerosis are discussed.
Collapse
|
35
|
Hollinger JO, Moore EM, Brady JM, Lorton L. Clinical and laboratory comparison of three adhesive resins for restoring noncarious cervical lesions. Gen Dent 1981; 29:504-9. [PMID: 6459970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
36
|
Hollinger JO, Moore EM. Cardiovascular considerations in general dentistry. Dent Surv 1978; 54:16-22. [PMID: 289600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
37
|
Clarkson DR, Moore EM. Reticulocyte size in nutritional anemias. Blood 1976; 48:669-77. [PMID: 974264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Alterations in reticulocyte size occur 2-3 days after the onset of iron deficient or megaloblastic erythropoiesis and precede, by several weeks, changes in mean corpuscular volume (MCV). Iron-deficiency anemia induced in a normal subject by repeated phlebotomies was characterized by the initial development of larger than normal reticulocytes followed by an abrupt decrease in reticulocyte size. Microreticulocytes appeared 3 days after the fall in per cent iron saturation and antedated the decrease in MCV to below normal by 6 wk. Mean reticulocyte size was disproportionately smaller than normal in patients presenting with iron deficiency. In contrast, reticulocyte size increased abruptly in a patient (and rats) 2-3 days after administration of methotrexate. Mean reticulocyte size was disproportionately larger than normal in patients presenting with folate or vitamin B12 deficiency. Specific replacement therapy with iron, folate, or vitamin B12 was quickly followed by normalization of reticulocyte size.
Collapse
|
38
|
Moore MC, Moore EM, Beasley CD, Hankins GJ, Judlin BC. Dietary-atherosclerosis study on deceased persons. J Am Diet Assoc 1970; 56:13-22. [PMID: 5411065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
39
|
Moore MC, Moore EM, Beasley CD. Dietary-atherosclerosis study on deceased persons. J Am Diet Assoc 1970; 56:23-8. [PMID: 5460749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
40
|
|
41
|
Pennock CW, Moore EM. Transactions of the Pathological Society of Philadelphia: Report of Experiments upon the Action of the Heart. Med Exam (Phila) 1839; 2:693-697. [PMID: 38118880 PMCID: PMC10237943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Affiliation(s)
- C W Pennock
- Physician to the Philadelphia Hospital; Philadelphia
| | - E M Moore
- Late Resident Physician to the Frankford Asylum; Philadelphia
| |
Collapse
|