1
|
Danyel LA, Miszczuk M, Connolly F, Villringer K, Bohner G, Rossel-Zemkouo M, Siebert E. Time Course and Clinical Correlates of Retinal Diffusion Restrictions in Acute Central Retinal Artery Occlusion. AJNR Am J Neuroradiol 2021; 42:1661-1666. [PMID: 34266868 DOI: 10.3174/ajnr.a7201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/04/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Retinal diffusion restrictions were recently identified as a regular finding in acute central retinal artery occlusion. We sought to investigate the influence of technical MR imaging and clinical parameters on the detection rate of retinal diffusion restrictions on standard brain DWI. MATERIALS AND METHODS In this retrospective cohort study, MR imaging scans of patients with central retinal artery occlusion were assessed by 2 readers for retinal diffusion restrictions on DWI performed within 2 weeks after vision loss. The influence of clinical and technical MR imaging parameters and the time interval between symptom onset and DWI on the presence of retinal diffusion restrictions were evaluated. RESULTS One hundred twenty-seven patients (mean age, 69.6 [SD 13.9] years; 59 women) and 131 DWI scans were included. Overall, the MR imaging sensitivity of retinal diffusion restrictions in acute central retinal artery occlusion was 62.6%-67.2%. Interrater and intrarater agreement for retinal diffusion restrictions was "substantial" with κinter = 0.70 (95% CI, 0.57-0.83) and κintra = 0.75 (95% CI, 0.63-0.88). Detection of retinal diffusion restrictions did not differ with differences in field strengths (1.5 versus 3T, P = .35) or sequence type (P = .22). Retinal diffusion restrictions were consistently identified within the first week with a peak sensitivity of 79% in DWI performed within 24 hours after symptom onset. Sensitivity of retinal diffusion restrictions declined in the second week (10.0%, P < .001). Absence of retinal diffusion restrictions was more prevalent in patients without fundoscopic retinal edema (60% versus 27.1%, P = .004) and with restitution of visual acuity at discharge (75% versus 28.4%, P = .006). CONCLUSIONS Retinal diffusion restrictions in acute central retinal artery occlusion can be reliably identified on DWI performed within 24 hours and 1 week after onset of visual impairment. Detectability of retinal diffusion restrictions is dependent on the clinical course of the disease.
Collapse
Affiliation(s)
- L A Danyel
- From the Department of Neurology (L.A.D., F.C.)
| | - M Miszczuk
- Institute for Neuroradiology (M.M., G.B., E.S.)
| | - F Connolly
- From the Department of Neurology (L.A.D., F.C.)
| | | | - G Bohner
- Institute for Neuroradiology (M.M., G.B., E.S.)
| | - M Rossel-Zemkouo
- Department of Ophthalmology (M.R.-Z.), Charité-Universitätsmedizin, Berlin, Germany
| | - E Siebert
- Institute for Neuroradiology (M.M., G.B., E.S.)
| |
Collapse
|
2
|
Connolly F, De Brún A, McAuliffe E. A narrative synthesis of learners' experiences of barriers and facilitators related to effective interprofessional simulation. J Interprof Care 2021; 36:222-233. [PMID: 33818255 DOI: 10.1080/13561820.2021.1880381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Interprofessional simulation has been linked to improved self-efficacy, communication, knowledge and teamwork skills in healthcare teams. However, there are few studies that synthesize learners' perceptions of interprofessional simulation-based approaches and barriers or facilitators they encounter in such learning approaches. The aim of this review was to explore these issues through synthesis of the published literature on healthcare staff engaging in interprofessional simulation to inform enhancement of instructional design processes. Searches of four major databases resulted in the retrieval of 2,727 studies. Following screening and full-text review, a total of 13 studies were included in the final review and deductive content analysis was used to collate the findings, which were then synthesized using a narrative approach. Three categories of barriers and facilitators were identified: characteristics of the simulation learning process, outcomes of interprofessional simulation, and interprofessional dynamics. Related to the latter, the findings indicate the instructional design of interprofessional simulation-based approaches may benefit from a greater focus on the context of healthcare teams that prioritizes teamwork. Furthermore, greater emphasis on designing realistic clinical situations promotes effectiveness of simulation. It is important to recognize the perspectives of healthcare team members engaging in these learning approaches and how they may affect clinical performance and influence patient outcomes.
Collapse
Affiliation(s)
- Fergal Connolly
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
| | - Eilish McAuliffe
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
| |
Collapse
|
3
|
Lydon S, Byrne D, Vellinga A, Walsh C, Madden C, Connolly F, O'Connor P. A Mixed-Methods Exploration of the Educational Climate and Safety Climate During the First Year of Clinical Practice in Ireland. Acad Med 2019; 94:1800-1805. [PMID: 31169543 DOI: 10.1097/acm.0000000000002818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Educational climate (EC) and safety climate (SC) are key determinants of residents' professional development. The goal of this study was to gather longitudinal EC data and data on perceptions of SC in residency, and provide data on practices related to perceptions of EC and SC, by identifying factors associated with and changes in perceptions of EC and SC across the first year of practice, and elucidating good and poor practice relating to key elements of EC and SC. METHOD A mixed-methods design was adopted. First, 131 first-year residents in Ireland were surveyed at the end of each of their first 3 rotations (August 2016-March 2017). The survey measured EC and SC using established measures. Next, 69 semistructured interviews were conducted with a representative sample of residents (March-May 2017). An interview schedule was developed to aid in-depth probing of EC and SC perceptions. A deductive content analysis approach was adopted. RESULTS Perceptions of EC worsened over time. The EC and SC of surgical rotations were significantly poorer than those of medical rotations. Residents were more likely to describe team practices, rather than organizational practices, that contributed positively to their perceptions of EC and SC. CONCLUSIONS Further research is necessary to facilitate improvement of EC and SC for residents, particularly within surgical training. Future research exploring the contribution of organizational practices to EC and SC, the impact of targeted improvement activities, and best practices for involving residents in quality and safety initiatives is recommended.
Collapse
Affiliation(s)
- Sinéad Lydon
- S. Lydon is behavioral psychologist and lecturer in quality and patient safety, School of Medicine, National University of Ireland Galway, Galway, Ireland. D. Byrne is professor of health care simulation, School of Medicine, National University of Ireland Galway, and director of simulation, Saolta University Health Care Group, Galway, Ireland. A. Vellinga is epidemiologist and lecturer in primary care and in bacteriology, School of Medicine, National University of Ireland Galway, Galway, Ireland. C. Walsh is a PhD candidate, Discipline of General Practice, National University of Ireland Galway, Galway, Ireland. C. Madden is a PhD candidate, Discipline of General Practice, National University of Ireland Galway, Galway, Ireland. F. Connolly is research assistant, Department of Health Systems, University College Dublin, Dublin, Ireland. P. O'Connor is human factors psychologist and lecturer in primary care, Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
| | | | | | | | | | | | | |
Collapse
|
4
|
O'Connor P, Lydon S, Mongan O, Connolly F, Mcloughlin A, McVicker L, Byrne D. A mixed-methods examination of the nature and frequency of medical error among junior doctors. Postgrad Med J 2019; 95:583-589. [PMID: 31341038 DOI: 10.1136/postgradmedj-2018-135897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 02/11/2019] [Accepted: 07/09/2019] [Indexed: 11/04/2022]
Abstract
PURPOSE OF THE STUDY To examine junior doctors' experience and perceptions of medical errors in which they had been involved. STUDY DESIGN A mixed-methods design, consisting of an error survey and critical incident technique (CIT) interviews, was used. The survey asked doctors in the first year of postgraduate training in Ireland whether they had made a medical error that had 'played on (their) mind', and if so, to identify factors that had contributed to the error. The participants in the CIT interviews were asked to describe a medical error in which they had been involved. RESULTS A total of 201 out of 332 (60.5%) respondents to the survey reported making an error that 'played on their mind'. 'Individual factors' were the most commonly identified group of factors (188/201; 93.5%), with 'high workload' (145/201; 72.1%) the most commonly identified contributory factor. Of the 28 CIT interviews which met the criteria for analysis, 'situational factors' (team, staff, task characteristics, and service user factors) were the most commonly identified group of contributory factors (24/28; 85.7%). A total of eight of the interviews were judged by subject matter experts (n=8) to be of medium risk to patients, and 20 to be of high-risk to patients. A significantly larger proportion of high-risk scenarios were attributed to 'local working conditions' than the medium-risk scenarios. CONCLUSIONS There is a need to prepare junior doctors to manage, and cope with, medical error and to ensure that healthcare professionals are adequately supported throughout their careers.
Collapse
Affiliation(s)
- Paul O'Connor
- Department of General Practice, National University of Ireland Galway, Galway, Ireland
| | - Sinéad Lydon
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway, Ireland
| | - Orla Mongan
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway, Ireland
| | - Fergal Connolly
- Department of Health Systems, University College Dublin, Dublin, Ireland
| | | | - Lyle McVicker
- Medicine, Galway University Hospital, Galway, Ireland
| | - Dara Byrne
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
5
|
O'Dowd E, O'Connor P, Lydon S, Mongan O, Connolly F, Diskin C, McLoughlin A, Rabbitt L, McVicker L, Reid-McDermott B, Byrne D. Stress, coping, and psychological resilience among physicians. BMC Health Serv Res 2018; 18:730. [PMID: 30241524 PMCID: PMC6151040 DOI: 10.1186/s12913-018-3541-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [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: 05/16/2018] [Accepted: 09/14/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Recent research has demonstrated that burnout is widespread among physicians, and impacts their wellbeing, and that of patients. Such data have prompted efforts to teach resilience among physicians, but efforts are hampered by a lack of understanding of how physicians experience resilience and stress. This study aimed to contribute to knowledge regarding how physicians define resilience, the challenges posed by workplace stressors, and strategies which enable physicians to cope with these stressors. METHODS A qualitative approach was adopted, with 68 semi-structured interviews conducted with Irish physicians. Data were analysed using deductive content-analysis. RESULTS Five themes emerged from the interviews. The first theme, 'The Nature of Resilience' captured participants' understanding of resilience. Many of the participants considered resilience to be "coping", rather than "thriving" in instances of adversity. The second theme was 'Challenges of the Profession', as participants described workplace stressors which threatened their wellbeing, including long shifts, lack of resources, and heavy workloads. The third theme, 'Job-related Gratification', captured aspects of the workplace that support resilience, such as gratification from medical efficacy. 'Resilience Strategies (Protective Practices)' summarised coping behaviours that participants considered to be beneficial to their wellbeing, including spending time with family and friends, and the final theme, 'Resilience Strategies (Attitudes)', captured attitudes which protected against stress and burnout. CONCLUSIONS This study emphasised the need for further research the mechanisms of physician coping in the workplace and how we can capitalise on insights into physicians' experiences of coping with system-level stressors to develop interventions to improve resilience.
Collapse
Affiliation(s)
- Emily O'Dowd
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway, Ireland
| | - Paul O'Connor
- School of Medicine, National University of Ireland Galway, Galway, Ireland. .,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway, Ireland.
| | - Sinéad Lydon
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway, Ireland
| | - Orla Mongan
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway, Ireland
| | - Fergal Connolly
- School of Nursing, Midwifery, and Health Systems, University College Dublin, Belfield, Dublin, Ireland
| | - Catherine Diskin
- Health Service Executive National Doctors Training and Planning, Dublin, Ireland
| | - Aoibheann McLoughlin
- Department of Psychiatry, Jonathan Swift Centre, St James' Hospital, Dublin, Ireland
| | - Louise Rabbitt
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,Department of Medicine, University Hospital Galway, Galway, Co. Galway, Ireland
| | - Lyle McVicker
- Department of Medicine, University Hospital Galway, Galway, Co. Galway, Ireland
| | - Bronwyn Reid-McDermott
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway, Ireland
| | - Dara Byrne
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
6
|
Connolly F, Byrne D, Lydon S, Walsh C, O'Connor P. Barriers and facilitators related to the implementation of a physiological track and trigger system: A systematic review of the qualitative evidence. Int J Qual Health Care 2018; 29:973-980. [PMID: 29177409 DOI: 10.1093/intqhc/mzx148] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 10/25/2017] [Indexed: 11/14/2022] Open
Abstract
Purpose To identify the barriers to, and facilitators of, the implementation of physiological track and trigger systems (PTTSs), perceived by healthcare workers, through a systematic review of the extant qualitative literature. Data sources Searches were performed in PUBMED, CINAHL, PsycInfo, Embase and Web of Science. The reference lists of included studies were also screened. Study selection The electronic searches yielded 2727 papers. After removing duplicates, and further screening, a total of 10 papers were determined to meet the inclusion criteria and were reviewed. Data extraction A deductive content analysis approach was taken to organizing and analysing the data. A framework consisting of two overarching dimensions ('User-related changes required to implement PTTSs effectively' and 'Factors that affect user-related changes'), 5 themes (staff perceptions of PTTSs and patient safety, workflow adjustment, PTTS, implementation process and local context) and 14 sub themes was used to classify the barriers and facilitators to the implementation of PTTSs. Results of data synthesis Successful implementation of a PTTS must address the social context in which it is to be implemented by ensuring that the users believe that the system is effective and benefits patient care. The users must feel invested in the PTTS and its use must be supported by training to ensure that all healthcare workers, senior and junior, understand their role in using the system. Conclusion PTTSs can improve patient safety and quality of care. However, there is a need for a robust implementation strategy or the benefits of PTTSs will not be realized.
Collapse
Affiliation(s)
- Fergal Connolly
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Co. Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland, Galway, Co. Galway, Ireland
| | - Dara Byrne
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland, Galway, Co. Galway, Ireland.,School of Medicine, National University of Ireland, Galway, Co. Galway, Ireland
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland, Galway, Co. Galway, Ireland.,School of Medicine, National University of Ireland, Galway, Co. Galway, Ireland
| | - Chloe Walsh
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Co. Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland, Galway, Co. Galway, Ireland
| | - Paul O'Connor
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Co. Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland, Galway, Co. Galway, Ireland
| |
Collapse
|
7
|
Berman JD, McCormack MC, Koehler KA, Connolly F, Clemons-Erby D, Davis MF, Gummerson C, Leaf PJ, Jones TD, Curriero FC. School environmental conditions and links to academic performance and absenteeism in urban, mid-Atlantic public schools. Int J Hyg Environ Health 2018; 221:800-808. [PMID: 29784550 DOI: 10.1016/j.ijheh.2018.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/26/2018] [Accepted: 04/30/2018] [Indexed: 10/17/2022]
Abstract
School facility conditions, environment, and perceptions of safety and learning have been investigated for their impact on child development. However, it is important to consider how the environment separately influences academic performance and attendance after controlling for school and community factors. Using results from the Maryland School Assessment, we considered outcomes of school-level proficiency in reading and math plus attendance and chronic absences, defined as missing 20 or more days, for grades 3-5 and 6-8 at 158 urban schools. Characteristics of the environment included school facility conditions, density of nearby roads, and an index industrial air pollution. Perceptions of school safety, learning, and institutional environment were acquired from a School Climate Survey. Also considered were neighborhood factors at the community statistical area, including demographics, crime, and poverty based on school location. Poisson regression adjusted for over-dispersion was used to model academic achievement and multiple linear models were used for attendance. Each 10-unit change in facility condition index, denoting worse quality buildings, was associated with a decrease in reading (1.0% (95% CI: 0.1-1.9%) and math scores (0.21% (95% CI: 0.20-0.40), while chronic absences increased by 0.75% (95% CI: 0.30-1.39). Each log increase the EPA's Risk Screening Environmental Indicator (RSEI) value for industrial hazards, resulted in a marginally significant trend of increasing absenteeism (p < 0.06), but no association was observed with academic achievement. All results were robust to school-level measures of racial composition, free and reduced meals eligibility, and community poverty and crime. These findings provide empirical evidence for the importance of the community and school environment, including building conditions and neighborhood toxic substance risk, on academic achievement and attendance.
Collapse
Affiliation(s)
- J D Berman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - M C McCormack
- Johns Hopkins School of Medicine, Baltimore, MD, United States.
| | - K A Koehler
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - F Connolly
- Baltimore Education Research Consortium, Baltimore, MD, United States.
| | - D Clemons-Erby
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - M F Davis
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - C Gummerson
- Johns Hopkins School of Medicine, Baltimore, MD, United States.
| | - P J Leaf
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - T D Jones
- Office of Achievement and Accountability, Baltimore City Public Schools, Baltimore, MD, United States.
| | - F C Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| |
Collapse
|
8
|
Fox S, Lydon S, Byrne D, Madden C, Connolly F, O’Connor P. A systematic review of interventions to foster physician resilience. Postgrad Med J 2017; 94:162-170. [DOI: 10.1136/postgradmedj-2017-135212] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/19/2017] [Accepted: 09/24/2017] [Indexed: 01/19/2023]
Abstract
This review aimed to synthesise the literature describing interventions to improve resilience among physicians, to evaluate the quality of this research and to outline the type and efficacy of interventions implemented. Searches were conducted in April 2017 using five electronic databases. Reference lists of included studies and existing review papers were screened. English language, peer-reviewed studies evaluating interventions to improve physician resilience were included. Data were extracted on setting, design, participant and intervention characteristics and outcomes. Methodological quality was assessed using the Downs and Black checklist. Twenty-two studies were included. Methodological quality was low to moderate. The most frequently employed interventional strategies were psychosocial skills training and mindfulness training. Effect sizes were heterogeneous. Methodologically rigorous research is required to establish best practice in improving resilience among physicians and to better consider how healthcare settings should be considered within interventions.
Collapse
|
9
|
Werner JD, Leithner C, Connolly F. [Herpes simplex meningitis with splenial lesion]. Nervenarzt 2016; 87:189-190. [PMID: 26646611 DOI: 10.1007/s00115-015-0033-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- J-D Werner
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Deutschland
| | - C Leithner
- Klinik, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - F Connolly
- Klinik, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| |
Collapse
|
10
|
Affiliation(s)
- N Esfahani-Bayerl
- Klinik und Poliklinik für Neurologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland,
| | | | | |
Collapse
|
11
|
Bergholz R, Salchow DJ, Hanisch M, Connolly F, Sonnleithner CV. Diagnostik der Arteriitis temporalis: Validität der Duplexsonografie und Einfluss der Probenlänge auf das Biopsieergebnis. Klin Monbl Augenheilkd 2013. [DOI: 10.1055/s-0033-1363356] [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]
|
12
|
Sulsky R, Robl JA, Biller SA, Harrity TW, Wetterau J, Connolly F, Jolibois K, Kunselman L. 5-Carboxamido-1,3,2-dioxaphosphorinanes, potent inhibitors of MTP. Bioorg Med Chem Lett 2004; 14:5067-70. [PMID: 15380200 DOI: 10.1016/j.bmcl.2004.07.069] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2004] [Revised: 07/27/2004] [Accepted: 07/29/2004] [Indexed: 11/23/2022]
Abstract
5-Carboxamido-1,3,2-dioxaphosphorinanes have been identified as potent inhibitors of microsomal triglyceride-transfer protein. The 1,3,2-dioxaphosphorine functionality acted as a neutral and stable replacement for piperidine and piperidine N-oxide.
Collapse
Affiliation(s)
- Richard Sulsky
- Department of Discovery Chemistry, Bristol-Myers Squibb Pharmaceutical Research Institute, Princeton, NJ 08543-4000, USA.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Magnin DR, Biller SA, Wetterau J, Robl JA, Dickson JK, Taunk P, Harrity TW, Lawrence RM, Sun CQ, Wang T, Logan J, Fryszman O, Connolly F, Jolibois K, Kunselman L. Microsomal triglyceride transfer protein inhibitors: discovery and synthesis of alkyl phosphonates as potent MTP inhibitors and cholesterol lowering agents. Bioorg Med Chem Lett 2003; 13:1337-40. [PMID: 12657277 DOI: 10.1016/s0960-894x(03)00116-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A series of newly synthesized phosphonate esters were evaluated for their effects on microsomal triglyceride transfer protein activity (MTP). The most potent compounds were evaluated for their ability to inhibit lipoprotein secretion in HepG2 cells and to affect VLDL secretion in rats. These inhibitors were also found to lower serum cholesterol levels in a hamster model upon oral dosing.
Collapse
Affiliation(s)
- David R Magnin
- Department of Discovery Chemistry, Bristol-Myers Squibb Pharmaceutical Research Institute, Princeton, NJ 08543-4000, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Robl JA, Sulsky R, Sun CQ, Simpkins LM, Wang T, Dickson JK, Chen Y, Magnin DR, Taunk P, Slusarchyk WA, Biller SA, Lan SJ, Connolly F, Kunselman LK, Sabrah T, Jamil H, Gordon D, Harrity TW, Wetterau JR. A novel series of highly potent benzimidazole-based microsomal triglyceride transfer protein inhibitors. J Med Chem 2001; 44:851-6. [PMID: 11300866 DOI: 10.1021/jm000494a] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [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: 11/29/2022]
Abstract
A series of benzimidazole-based analogues of the potent MTP inhibitor BMS-201038 were discovered. Incorporation of an unsubstituted benzimidazole moiety in place of a piperidine group afforded potent inhibitors of MTP in vitro which were weakly active in vivo. Appropriate substitution on the benzimidazole ring, especially with small alkyl groups, led to dramatic increases in potency, both in a cellular assay of apoB secretion and especially in animal models of cholesterol lowering. The most potent in this series, 3g (BMS-212122), was significantly more potent than BMS-201038 in reducing plasma lipids (cholesterol, VLDL/LDL, TG) in both hamsters and cynomolgus monkeys.
Collapse
Affiliation(s)
- J A Robl
- The Bristol-Myers Squibb Pharmaceutical Research Institute, P.O. Box 5400, Princeton, New Jersey 08543-5400, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
|
16
|
Wetterau JR, Gregg RE, Harrity TW, Arbeeny C, Cap M, Connolly F, Chu CH, George RJ, Gordon DA, Jamil H, Jolibois KG, Kunselman LK, Lan SJ, Maccagnan TJ, Ricci B, Yan M, Young D, Chen Y, Fryszman OM, Logan JV, Musial CL, Poss MA, Robl JA, Simpkins LM, Slusarchyk WA, Sulsky R, Taunk P, Magnin DR, Tino JA, Lawrence RM, Dickson JK, Biller SA. An MTP inhibitor that normalizes atherogenic lipoprotein levels in WHHL rabbits. Science 1998; 282:751-4. [PMID: 9784135 DOI: 10.1126/science.282.5389.751] [Citation(s) in RCA: 231] [Impact Index Per Article: 8.9] [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: 11/02/2022]
Abstract
Patients with abetalipoproteinemia, a disease caused by defects in the microsomal triglyceride transfer protein (MTP), do not produce apolipoprotein B-containing lipoproteins. It was hypothesized that small molecule inhibitors of MTP would prevent the assembly and secretion of these atherogenic lipoproteins. To test this hypothesis, two compounds identified in a high-throughput screen for MTP inhibitors were used to direct the synthesis of a highly potent MTP inhibitor. This molecule (compound 9) inhibited the production of lipoprotein particles in rodent models and normalized plasma lipoprotein levels in Watanabe-heritable hyperlipidemic (WHHL) rabbits, which are a model for human homozygous familial hypercholesterolemia. These results suggest that compound 9, or derivatives thereof, has potential applications for the therapeutic lowering of atherogenic lipoprotein levels in humans.
Collapse
Affiliation(s)
- J R Wetterau
- Department of Metabolic Diseases, Bristol-Myers Squibb Pharmaceutical Research Institute, Princeton, NJ 08543-4000, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
McCoy EP, Mirakhur RK, Maddineni VR, Loan PB, Connolly F. Administration of rocuronium (Org 9426) by continuous infusion and its reversibility with anticholinesterases. Anaesthesia 1994; 49:940-5. [PMID: 7802236 DOI: 10.1111/j.1365-2044.1994.tb04308.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [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: 01/27/2023]
Abstract
The use of rocuronium (Org 9426) as a single bolus followed by an infusion was assessed in 50 patients under anaesthesia with nitrous oxide-oxygen and halothane. Neuromuscular block was monitored using train-of-four stimulation and recording the force of contraction of the adductor pollicis muscle. Rocuronium was administered in an initial bolus dose of 0.45 mg.kg-1 followed by an infusion adjusted manually to maintain the T1, the first response in the train-of-four, at 10% of control. Following cessation of rocuronium infusion the patients were either allowed to recover spontaneously (n = 10) or were given neostigmine 50 micrograms.kg-1 or edrophonium 1 mg.kg-1 at 10 or 25% recovery of the T1 (n = 10 for each group). Adequate antagonism was defined as attaining a sustained train-of-four ratio of 0.7. Rocuronium requirements showed marked variation among individual patients but were relatively constant in individual patients. The mean (SD) time to attain stable infusion rates was 17.4 (10.9) min. The mean (SD) requirement of rocuronium for steady state 90% block of T1 was 572 (190) micrograms.kg-1.h-1 (range 242-1104 micrograms.kg-1.h-1). The mean (SD) time to attain a train-of-four ratio of 0.7 in the group allowed to recover spontaneously was 36.1 (7.3) min. This interval was 7.5 (1.9), 9.3 (7.0), 4.6 (1.9) and 1.9 (0.9) min respectively in the groups receiving neostigmine at T1 of 10%, edrophonium at T1 of 10%, neostigmine at T1 of 25% and edrophonium at T1 of 25%. The antagonism was significantly faster in those reversed at 25% (p < 0.05). Three patients in the group receiving edrophonium at T1 of 10% and one in the group receiving neostigmine at T1 of 25% failed to attain a train-of-four ratio of 0.7. It is concluded that rocuronium can be administered as a continuous infusion for stable neuromuscular block. Neostigmine may be a more reliable antagonist of deep block, whereas edrophonium is advantageous when there is a greater spontaneous recovery.
Collapse
Affiliation(s)
- E P McCoy
- Department of Anaesthetics, Queen's University of Belfast, Northern Ireland
| | | | | | | | | |
Collapse
|