1
|
Ali Y, Wright N, Charnock D, Henshaw H, Morris H, Hoare DJ. Applications of Grounded Theory Methodology to Investigate Hearing Loss: A Methodological Qualitative Systematic Review With Developed Guidelines. Ear Hear 2024; 45:550-562. [PMID: 38608196 PMCID: PMC11008453 DOI: 10.1097/aud.0000000000001459] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 11/23/2023] [Indexed: 04/14/2024]
Abstract
OBJECTIVES Qualitative methodologies are commonly adopted in hearing loss research. Grounded theory methodology is increasingly used to establish novel theories explaining experiences related to hearing loss. Establishing and improving the quality of grounded theory studies has been emphasized as critical to ensuring theoretical trustworthiness. Thus, the primary aim of the present study was to systematically review hearing loss research studies that have applied grounded theory methodology and assess the methodological quality of those grounded theory applications. Secondarily aims were to (i) explore how grounded theory methodology has been applied to investigate hearing loss, and (ii) use the findings of the review to develop a set of guidelines to aid the future high-quality application of grounded theory methodology to hearing loss research. DESIGN Original peer-reviewed studies applying grounded theory methodology and published in English were identified through systematic searches in 10 databases; Applied Social Sciences Index and Abstracts, British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, EBSCO, Global Health, MEDLINE (OvidSP), PsycINFO, PubMed, Scopus, and Web of Science. The quality of studies was assessed according to 12 grounded theory principles using the Guideline for Reporting, Evaluating, and applying the core principles of Grounded Theory studies (GUREGT) tool. Data were analyzed using qualitative inductive thematic analysis. RESULTS After the removal of duplicates, 155 articles were retrieved. Of those, 39 met the criteria for inclusion in the systematic review. An increase in the adoption of grounded theory methodology to investigate hearing loss was identified with the number of published studies tripling in the last 5 years. Critical appraisal using the GUREGT tool identified four studies as high-quality. Most included studies were of moderate study quality (n = 25), and 10 were classified as being of low study quality. Using inductive thematic analysis, the included studies investigated one of four areas relating to hearing loss: (a) Living with hearing loss, (b) Identity and hearing loss, (c) Coping strategies for hearing loss, and (d) Audiological counseling and rehabilitation. Analysis also identified four main grounded theory factors frequently overlooked in hearing loss research: the different schools of grounded theory, sampling strategy, sample size, and the depth of grounded theory application. CONCLUSIONS Use of grounded theory methodology is increasing at a rapid rate in hearing loss research. Despite this, studies conducted in the field to date do not meet and apply the full spectrum of grounded theory principles, as outlined by the GUREGT tool. To improve methodological rigor in future studies using grounded theory, we propose a set of guidelines that address the most commonly overlooked methodological considerations in hearing loss studies to date. The guidelines are designed to aid researchers to achieve high methodological quality in any field, improve qualitative rigor, and promote theoretical credibility.
Collapse
Affiliation(s)
- Yasmin Ali
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Nicola Wright
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - David Charnock
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Helen Henshaw
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Haley Morris
- Nottingham University Hospitals National Health Service (NHS) Trust, Nottingham, United Kingdom
| | - Derek J Hoare
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
2
|
Shah S, Morris H, Thiagarajah S, Gordon A, Sharma S, Haslam P, Garcia J, Ali F. Handling 'carbon footprint' in orthopaedics. Ann R Coll Surg Engl 2024. [PMID: 38563077 DOI: 10.1308/rcsann.2023.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION The National Health Service contributes 4%-5% of England and Wales' greenhouse gases and a quarter of all public sector waste. Between 20% and 33% of healthcare waste originates from a hospital's operating room, and up to 90% of waste is sent for costly and unneeded hazardous waste processing. The goal of this study was to quantify the amount and type of waste produced during a selection of common trauma and elective orthopaedic operations, and to calculate the carbon footprint of processing the waste. METHODS Waste generated for both elective and trauma procedures was separated primarily into clean and contaminated, paper or plastic, and then weighed. The annual carbon footprint for each operation at each site was subsequently calculated. RESULTS Elective procedures can generate up to 16.5kg of plastic waste per procedure. Practices such as double-draping the patient contribute to increasing the quantity of waste. Over the procedures analysed, the mean total plastic waste at the hospital sites varied from 6 to 12kg. One hospital site undertook a pilot of switching disposable gowns for reusable ones with a subsequent reduction of 66% in the carbon footprint and a cost saving of £13,483.89. CONCLUSIONS This study sheds new light on the environmental impact of waste produced during trauma and elective orthopaedic procedures. Mitigating the environmental impact of the operating room requires a collective drive for a culture change to sustainability and social responsibility. Each clinician can have an impact upon the carbon footprint of their operating theatre.
Collapse
Affiliation(s)
- S Shah
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, UK
| | - H Morris
- East Midlands North Training Rotation, UK
| | - S Thiagarajah
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, UK
| | - A Gordon
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - S Sharma
- Barnsley Hospital NHS Foundation Trust, UK
| | - P Haslam
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, UK
- Sheffield Children's NHS Foundation Trust, UK
| | - J Garcia
- Chesterfield Royal Hospital NHS Foundation Trust, UK
| | - F Ali
- Sheffield Children's NHS Foundation Trust, UK
- Chesterfield Royal Hospital NHS Foundation Trust, UK
| |
Collapse
|
3
|
Shah S, Morris H, Nicolaou N, MacInnes S, Haslam P, Shahane S, Ali F, Garcia J. The carbon footprint of arthroscopic procedures. Ann R Coll Surg Engl 2024; 106:256-261. [PMID: 37381779 PMCID: PMC10906500 DOI: 10.1308/rcsann.2023.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION The healthcare sector contributes the equivalent of 4.4% of global net emissions to the climate carbon footprint; between 20% and 70% of healthcare waste originates from a hospital's operating theatre and up to 90% of waste is sent for costly and unneeded hazardous waste processing. This study aimed to quantify the amount and type of waste produced during an arthroscopic anterior cruciate ligament reconstruction (ACLR) and an arthroscopic rotator cuff repair (RCR), calculate the carbon footprint and assess the cost of the waste disposal. METHODS The amount of waste generated from ACLR and RCR procedures was calculated across a range of hospital sites. The waste was separated primarily into clean and contaminated, paper or plastic. Both carbon footprint and cost of disposal across the hospital sites was subsequently calculated. RESULTS RCR generated 3.3-15.5kg of plastic waste and 0.9-2.3kg of paper waste. ACLR generated 2.4-9.6kg of plastic waste and 1.1-1.6kg of paper waste. The cost to process waste varies widely between hospital sites, waste disposal contractors and method of waste disposal. The annual burden of the included hospital sites for the arthroscopic procedures undertaken was 6.2 tonnes of carbon dioxide. CONCLUSIONS The data collected demonstrated a significant variability in waste production and cost for waste disposal between hospital sites. At a national level, consideration should be given to the procurement of appropriate products such that waste can be efficiently recycled or disposed of by environmentally sustainable methods.
Collapse
Affiliation(s)
| | - H Morris
- East Midlands North Training Rotation, UK
| | - N Nicolaou
- Sheffield Children’s NHS Foundation Trust, UK
| | - S MacInnes
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, UK
| | | | - S Shahane
- Chesterfield Royal Hospital NHS Foundation Trust, UK
| | - F Ali
- Chesterfield Royal Hospital NHS Foundation Trust, UK
| | - J Garcia
- Chesterfield Royal Hospital NHS Foundation Trust, UK
| |
Collapse
|
4
|
Kunert N, Hajek P, Hietz P, Morris H, Rosner S, Tholen D. Summer temperatures reach the thermal tolerance threshold of photosynthetic decline in temperate conifers. Plant Biol (Stuttg) 2022; 24:1254-1261. [PMID: 34651391 PMCID: PMC10078684 DOI: 10.1111/plb.13349] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/12/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
Climate change-related environmental stress has been recognized as a driving force in accelerating forest mortality over the last decades in Central Europe. Here, we aim to elucidate the thermal sensitivity of three native conifer species, namely Norway spruce (Picea abies), Scots pine (Pinus sylvestris) and silver fir (Abies alba), and three non-native species, namely Austrian pine (Pinus nigra), Douglas fir (Pseudotsuga menziesii) and Atlas cedar (Cedrus atlantica). Thermal sensitivity, defined here as a decline of the maximum quantum yield of photosystem II (Fv /Fm ) with increasing temperature, was measured under varying levels of heat stress and compared with the turgor loss point (πtlp ) as a drought resistance trait. We calculated three different leaf thermotolerance traits: the temperature at the onset (5%) of the Fv /Fm decline (T5), the temperature at which Fv /Fm was half the maximum value (T50) and the temperature at which only 5% Fv /Fm remained (T95). T5 ranged from 38.5 ± 0.8 °C to 43.1 ± 0.6 °C across all species, while T50 values were at least 9 to 11 degrees above the maximum air temperatures on record for all species. Only Austrian pine had a notably higher T5 value than recorded maximum air temperatures. Species with higher T5 values were characterized by a less negative πtlp compared to species with lower T5. The six species could be divided into 'drought-tolerant heat-sensitive' and 'drought-sensitive heat-tolerant' groups. Exposure to short-term high temperatures thus exhibits a considerable threat to conifer species in Central European forest production systems.
Collapse
Affiliation(s)
- N. Kunert
- Department of Integrative Biology and Biodiversity ResearchInstitute of BotanyUniversity of Natural Resources and Life SciencesViennaAustria
| | - P. Hajek
- GeobotanyUniversity of FreiburgFreiburgGermany
| | - P. Hietz
- Department of Integrative Biology and Biodiversity ResearchInstitute of BotanyUniversity of Natural Resources and Life SciencesViennaAustria
| | - H. Morris
- Department of Integrative Biology and Biodiversity ResearchInstitute of BotanyUniversity of Natural Resources and Life SciencesViennaAustria
| | - S. Rosner
- Department of Integrative Biology and Biodiversity ResearchInstitute of BotanyUniversity of Natural Resources and Life SciencesViennaAustria
| | - D. Tholen
- Department of Integrative Biology and Biodiversity ResearchInstitute of BotanyUniversity of Natural Resources and Life SciencesViennaAustria
| |
Collapse
|
5
|
Schwandt H, Boulware A, Corey J, Herrera A, Hudler E, Imbabazi C, King I, Linus J, Manzi I, Merritt M, Mezier L, Miller A, Morris H, Musemakweli D, Musekura U, Mutuyimana D, Ntakarutimana C, Patel N, Scanteianu A, Shemeza BE, Sterling-Donaldson G, Umutoni C, Uwera L, Zeiler M, Feinberg S. “She is courageous because she does not care what people think about her…”: attitudes toward adolescent contraception use among Rwandan family planning providers and adult female modern contraceptive users. Reprod Health 2022; 19:204. [PMID: 36333785 PMCID: PMC9636625 DOI: 10.1186/s12978-022-01517-4] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction In Rwanda, only 20% of sexually active unmarried young women use family planning as compared to 64% of married women. Adolescence is an important time of growth and development that often includes the initiation of sexual activity. Sexually active adolescents need support in accessing contraceptive services to prevent negative health outcomes. In sub-Saharan Africa, the adolescent population represents a large share of the total population and that proportion is predicted to expand over time. Adolescent contraceptive needs have largely been unmet, and with growing numbers, there is increased potential for negative health sequelae. Due to the low use of contraception by adolescents in Rwanda, and the growing population of adolescents, this study aims to explore the perspectives of family planning providers and adult modern contraceptive users on adolescent contraceptive use. Inclusion of adult community members in the study is a unique contribution, as research on adolescent contraceptive use in sub-Saharan Africa relies primarily on perspectives from adolescents and family planning providers. Methods This qualitative study in 2018 utilized 32 in-depth interviews with modern contraceptive users and eight focus group discussions with family planning providers. Respondents were from Musanze and Nyamasheke districts in Rwanda, the districts with the highest and lowest modern contraceptive use among married women, respectively. Coding was conducted in Atlas.ti. Results Stigma regarding premarital sex results in barriers to adolescent access to contraceptive services. Family planning providers do provide services to adolescents; however, they often recommend secondary abstinence, offer a limited method selection, and accentuate risks associated with sexual activity and contraceptive use. Providers support adolescent clients by emphasizing the need for privacy, confidentiality, and expedient services, particularly through youth corners, which are spaces within health facilities designed to meet youth needs specifically. Modern contraceptive-using adult female community members advocate for youth access to contraception, however mothers have mixed comfort discussing sexual health with their own youth. Conclusion To destigmatize premarital sexual activity, government efforts to initiate communication about this topic must occur at national and community levels with the goal of continued conversation within the family. The government should also train family planning providers and all health personnel interacting with youth on adolescent-friendly health services. Dialogue between community members and family planning providers about adolescent access to contraceptive services could also reduce barriers for adolescents due to community members’ generally supportive views on adolescent contraceptive use. Efforts to engage adolescent caregivers in how to talk to youth about sex could also contribute to expanded use. In Rwanda, youth who are having sex use family planning less than married women. This study involved asking family planning providers and adults what they think about youth using family planning. Data for this study was collected in 2018, and included 32 interviews with adult family planning users and eight group discussions with family planning providers in two areas of Rwanda. The findings show that Rwandans believe youth should not have sex before they are married. Family planning providers do provide youth with services; however, they often push stopping sexual activity, offer a smaller selection of family planning methods, and exaggerate risks associated with sex and family planning use. Family planning providers support youth by honoring their need for privacy, keeping their secrets, and providing fast services so fewer people see them at the clinic. Providers like to help adolescents in youth corners, which are special spaces within health facilities just for youth. Importantly, adult women who use family planning want youth in their community to be able to use family planning, too. In order to respond to the issues raised, the Rwandan government can start conversations in villages and more broadly about the need for youth to have access to family planning. The government should also teach family planning providers and anyone who comes into contact with youth to offer helpful and friendly services. Setting up spaces for adults to talk with family planning providers about youth access to family planning could also contribute to fewer barriers to services for adolescents.
Collapse
Affiliation(s)
- Hilary Schwandt
- grid.281386.60000 0001 2165 7413Western Washington University, Bellingham, WA USA
| | - Angel Boulware
- grid.263934.90000 0001 2215 2150Spelman College, Atlanta, USA
| | - Julia Corey
- grid.422659.e0000 0000 9111 4134Wheaton College, Norton, USA
| | - Ana Herrera
- Northwest Vista Community College, San Antonio, USA
| | - Ethan Hudler
- grid.422656.10000 0000 9839 7069Whatcom Community College, Bellingham, USA
| | | | - Ilia King
- grid.268355.f0000 0000 9679 3586Xavier University, New Orleans, USA
| | - Jessica Linus
- grid.266673.00000 0001 2177 1144University of Maryland Baltimore County, Baltimore, USA
| | | | - Madelyn Merritt
- grid.281386.60000 0001 2165 7413Western Washington University, Bellingham, WA USA
| | - Lyn Mezier
- grid.264273.60000 0000 8999 307XSUNY Oswego, Oswego, USA
| | - Abigail Miller
- grid.281386.60000 0001 2165 7413Western Washington University, Bellingham, WA USA
| | - Haley Morris
- grid.268194.00000 0000 8547 0132Western Oregon University, Monmouth, USA
| | | | - Uwase Musekura
- grid.255407.10000 0001 0579 3386Eastern Oregon University, La Grande, USA
| | | | | | - Nirali Patel
- grid.252353.00000 0001 0583 8943Arcadia University, Glenside, USA
| | | | | | | | | | - Lyse Uwera
- grid.442742.30000 0004 0435 552XINES, Ruhengeri, Rwanda
| | - Madeleine Zeiler
- grid.281386.60000 0001 2165 7413Western Washington University, Bellingham, WA USA
| | - Seth Feinberg
- grid.281386.60000 0001 2165 7413Western Washington University, Bellingham, WA USA
| |
Collapse
|
6
|
Corey J, Schwandt H, Boulware A, Herrera A, Hudler E, Imbabazi C, King I, Linus J, Manzi I, Merrit M, Mezier L, Miller A, Morris H, Musemakweli D, Musekura U, Mutuyimana D, Ntakarutimana C, Patel N, Scanteianu A, Shemeza BE, Sterling-Donaldson G, Umutoni C, Uwera L, Zeiler M, Feinberg S. Family planning demand generation in Rwanda: Government efforts at the national and community level impact interpersonal communication and family norms. PLoS One 2022; 17:e0266520. [PMID: 35390080 PMCID: PMC8989356 DOI: 10.1371/journal.pone.0266520] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 03/22/2022] [Indexed: 11/26/2022] Open
Abstract
Between 2005 and 2020, total contraceptive use among married women in Rwanda increased from 17% to 64%. The aim of this study is to better understand how the Rwandan government’s mobilization and demand generation efforts have impacted community norms and interpersonal discourse surrounding family planning. Eight focus group discussions with family planning providers and 32 in-depth interviews with experienced modern contraceptive users were conducted in 2018 in the two Rwandan districts with the highest and the lowest contraceptive prevalence rates. Results suggest that outspoken government support, mass media, and community meetings were valuable sources of information about family planning. Information received through these channels generated interpersonal dialogue about contraceptives through both conversation and observation; however, rumors and misinformation remained a significant barrier to use. A once taboo subject is now normative among married couples. Continuing to address common fears and misinformation through communication channels such as mass media and community meetings may help to further increase contraceptive uptake in Rwanda.
Collapse
Affiliation(s)
- Julia Corey
- Wheaton College, Norton, Massachusetts, United States of America
- * E-mail:
| | - Hilary Schwandt
- Fairhaven College, Western Washington University, Bellingham, Washington, United States of America
| | - Angel Boulware
- Spelman College, Atlanta, Georgia, United States of America
| | - Ana Herrera
- Northwest Vista Community College, San Antonio, Texas, United States of America
| | - Ethan Hudler
- Whatcom Community College, Bellingham, Washington, United States of America
| | | | - Ilia King
- Xavier University, New Orleans, Louisiana, United States of America
| | | | | | - Madelyn Merrit
- Department of Sociology, Western Washington University, Bellingham, Washington, United States of America
| | - Lyn Mezier
- SUNY Oswego, Oswego, New York, United States of America
| | - Abigail Miller
- Fairhaven College, Western Washington University, Bellingham, Washington, United States of America
| | - Haley Morris
- Western Oregon University, Monmouth, Oregon, United States of America
| | | | - Uwase Musekura
- Eastern Oregon University, La Grande, Oregon, United States of America
| | | | | | - Nirali Patel
- Arcadia University, Glenside, Pennsylvania, United States of America
| | | | | | | | | | | | - Madeleine Zeiler
- Fairhaven College, Western Washington University, Bellingham, Washington, United States of America
| | - Seth Feinberg
- Department of Sociology, Western Washington University, Bellingham, Washington, United States of America
| |
Collapse
|
7
|
Scanteianu A, Schwandt HM, Boulware A, Corey J, Herrera A, Hudler E, Imbabazi C, King I, Linus J, Manzi I, Merritt M, Mezier L, Miller A, Morris H, Musemakweli D, Musekura U, Mutuyimana D, Ntakarutimana C, Patel N, Shemeza BE, Sterling-Donaldson G, Umutoni C, Uwera L, Zeiler M, Feinberg S. "…the availability of contraceptives is everywhere.": coordinated and integrated public family planning service delivery in Rwanda. Reprod Health 2022; 19:22. [PMID: 35090506 PMCID: PMC8796398 DOI: 10.1186/s12978-022-01325-w] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background Contraceptive use in Rwanda tripled since 2005. This study aims to understand the role of coordinated and integrated public family planning service delivery in achieving this increase in contraceptive use in Rwanda.
Methods This qualitative study in 2018 included eight focus group discussions with family planning providers and 32 in-depth interviews with experienced family planning users. Results Results indicate a well-coordinated public family planning service delivery system with community health workers and nurses filling different and complementary roles in meeting family planning client needs at the local level. In addition, integration of family planning into other maternal and child health services is the norm.
Conclusions The coordination and integration of family planning across both providers and services may help explain the rapid increase in Rwanda’s contraceptive use and has potential applications for enhancing family planning service delivery in other settings.
Family planning use increased from 17 to 53% in Rwanda in between 2005 and 2015. The purpose of this study is to understand the roles of two types of family planning workers in providing family planning services, how those providers work together to achieve the goal to provide public services, and how the Rwandan health system includes family planning services in a variety of other types of health services. To achieve the study purpose, 32 women with experience using modern methods of contraception were interviewed. In addition, 88 providers participated in eight group discussions to discuss these topics. The results from the interviews and group discussions showed that family planning services are easy to access for Rwandans—due to two types of family planning providers filling different roles to assist Rwandans start and keep using family planning methods. Family planning services are included in services for pregnant, delivering, and postpartum mothers—as well as services for infants and children. These are all times when those adults using the services would also be in need of family planning services. The family planning service delivery team approach—as well as including family planning services in mother’s and children’s health services likely helps explain the increase in family planning use in Rwanda. Other nations might learn from Rwanda’s service delivery approach to family planning to also increase access to family planning for their citizens.
Collapse
Affiliation(s)
| | - Hilary M Schwandt
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA.
| | | | | | - Ana Herrera
- Northwest Vista Community College, San Antonio, USA
| | | | | | | | - Jessica Linus
- University of Maryland-Baltimore County, Baltimore, USA
| | | | - Madelyn Merritt
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | | | - Abigail Miller
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | | | | | | | | | | | | | | | | | | | | | - Madeleine Zeiler
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | - Seth Feinberg
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| |
Collapse
|
8
|
Bruder A, Crossley K, Culvenor A, Guermazi A, Haberfield M, Morris H, Patterson B, Whitehead T. Should return to pivoting sport be avoided for the secondary prevention of osteoarthritis after ACL reconstruction? J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
9
|
Schwandt H, Boulware A, Corey J, Herrera A, Hudler E, Imbabazi C, King I, Linus J, Manzi I, Merritt M, Mezier L, Miller A, Morris H, Musemakweli D, Musekura U, Mutuyimana D, Ntakarutimana C, Patel N, Scanteianu A, Shemeza BE, Sterling-Donaldson G, Umutoni C, Uwera L, Zeiler M, Feinberg S. Family planning providers and contraceptive users in Rwanda employ strategies to prevent discontinuation. BMC Womens Health 2021; 21:361. [PMID: 34635111 PMCID: PMC8504084 DOI: 10.1186/s12905-021-01503-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In Rwanda, nearly a third of contraceptive users discontinue within the first year of use. Family planning programs often focus more on recruitment of new users as opposed to maintaining use among current users. A focus on sustaining users and minimizing discontinuation is imperative for long-term family planning program success. This study explores the efforts providers and contraceptive users in Rwanda employ to prevent one of the greatest challenges to family planning programs: contraceptive discontinuation. METHODS This was a qualitative study conducted in Rwanda between February and July 2018. It included eight focus group discussions with 88 family planning providers and 32 in-depth interviews with experienced modern contraceptive users. Data were collected in two districts with the highest (Musanze) and lowest (Nyamasheke) rates of contraceptive use. Data were analyzed using thematic content approach. RESULTS Family planning providers in this study used the following strategies to prevent discontinuation: counseling new users on the potential for side effects and switching, reminding clients about appointments for resupply, as well as supporting dissatisfied users by providing counseling, medicine for side effects, and discussing options for switching methods. Users, on the other hand, employed the following strategies to prevent discontinuation: having an understanding that experiences of side effects vary by individuals, supporting peers to sustain use, persisting with use despite experiences of side effects, and switching methods. CONCLUSIONS The strategies used by family planning providers and users in Rwanda to prevent discontinuation suggest the possibility of long-term sustained use of contraception in the country. Harnessing and supporting such strategies could contribute to sustaining or improving further contraceptive use in the country.
Collapse
Affiliation(s)
- Hilary Schwandt
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA.
| | | | | | - Ana Herrera
- Northwest Vista Community College, San Antonio, USA
| | | | | | | | - Jessica Linus
- University of Maryland-Baltimore County, Baltimore, USA
| | | | - Madelyn Merritt
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | | | - Abigail Miller
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Madeleine Zeiler
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | - Seth Feinberg
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| |
Collapse
|
10
|
Jung J, Laverick R, Nader K, Brown T, Morris H, Wilson M, Auer DP, Rotshtein P, Hosseini AA. Altered hippocampal functional connectivity patterns in patients with cognitive impairments following ischaemic stroke: A resting-state fMRI study. Neuroimage Clin 2021; 32:102742. [PMID: 34266772 PMCID: PMC8527045 DOI: 10.1016/j.nicl.2021.102742] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 06/06/2021] [Accepted: 06/21/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Ischemic stroke with cognitive impairment is a considerable risk factor for developing dementia. Identifying imaging markers of cognitive impairment following ischemic stroke will help to develop prevention strategies against post-stroke dementia. METHODS We investigated the hippocampal functional connectivity (FC) pattern following ischemic stroke, using resting-state fMRI (rs-fMRI). Thirty-three cognitively impaired patients after ischemic stroke and sixteen age-matched controls with no known history of neurological disorder were recruited for the study. No patient had a direct ischaemic insult to hippocampus on the examination of brain imaging. Seven subfields of hippocampus were used as seeds region for FC analyses. RESULTS Across all hippocampal subfields, FC with the inferior parietal lobule was reduced in stroke patients as compared with healthy controls. This decreased FC included both supramarginal gyrus and angular gyrus. The FC of hippocampal subfields with cerebellum was increased. Importantly, the degree of the altered FC between hippocampal subfields and inferior parietal lobule was associated with their impaired memory function. CONCLUSION Our results demonstrated that decreased hippocampal-inferior parietal lobule connectivity was associated with cognitive impairment in patients with ischemic stroke. These findings provide novel insights into the role of hippocampus in cognitive impairment following ischemic stroke.
Collapse
Affiliation(s)
- JeYoung Jung
- School of Psychology, University of Nottingham, UK
| | | | - Kurdow Nader
- University Hospital Birmingham NHS Trust, Birmingham, UK
| | - Thomas Brown
- Division of Clinical Neuroscience, University of Nottingham, UK
| | - Haley Morris
- Division of Clinical Neuroscience, University of Nottingham, UK
| | | | - Dorothee P Auer
- NIHR Nottingham BRC, University of Nottingham, UK; Division of Clinical Neuroscience, University of Nottingham, UK
| | | | - Akram A Hosseini
- School of Psychology, University of Birmingham, UK; Division of Clinical Neuroscience, University of Nottingham, UK; Department of Neurology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK.
| |
Collapse
|
11
|
Schwandt H, Boulware A, Corey J, Herrera A, Hudler E, Imbabazi C, King I, Linus J, Manzi I, Merritt M, Mezier L, Miller A, Morris H, Musemakweli D, Musekura U, Mutuyimana D, Ntakarutimana C, Patel N, Scanteianu A, Shemeza BE, Stapleton M, Sterling-Donaldson G, Umutoni C, Uwera L, Zeiler M, Feinberg S. An examination of the barriers to and benefits from collaborative couple contraceptive use in Rwanda. Reprod Health 2021; 18:82. [PMID: 33874969 PMCID: PMC8054403 DOI: 10.1186/s12978-021-01135-6] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 04/02/2021] [Indexed: 11/20/2022] Open
Abstract
Background Supportive male involvement is strongly correlated with contraceptive use. In Rwanda, where the contraceptive prevalence rate among married women increased from 17 to 52% from 2005 to 2010, and stagnated at 53% in 2015, understanding the role of male partners in collaborative couple contraceptive use can help inform programs designed to further increase the use of contraception in Rwanda. Methods This study utilized qualitative methods in 2018, specifically 32 in-depth interviewers with mostly current users of modern contraceptive methods and eight focus group discussions with family planning providers—both family planning nurses and community health workers (CHWs). Respondents were from Musanze and Nyamasheke Districts, the districts with the highest and lowest modern contraceptive use, respectively, to explore the role of couple collaboration in family planning use in Rwanda. Data were analyzed using the thematic content approach in Atlas.ti (8). Results Findings demonstrate that some men are opposed to use of male methods of contraception, and some are opposed to any contraceptive use, which can lead to covert use. Women and providers prefer collaborative couple contraceptive use—as a result, providers advocate for and encourage male partner participation in contraceptive use. Women are most often burdened with seeking out information, initiating discussions, and sharing information discovered about contraceptive use with partners. Decision-making about contraceptive use, once discussed, can be collaborative and motivated by financial considerations. When couple contraceptive use is collaborative, benefits range from marital harmony to husband’s support of sustained use through reminders about appointments, joint counseling, and support in managing side effects. Conclusion Family planning providers at the community and clinic levels encourage collaborative contraceptive use among couples and some Rwandan couples communicate well about family planning use. Despite the positives, women are expected to source family planning information, share that information with their male partners, seek out family planning services, and use family planning. If more Rwandan male partners accepted use, used male methods of contraception, and participated even more in the work it takes to use family planning, the potential for sustained, and even enhanced, contraceptive use in Rwanda could be realized.
Collapse
Affiliation(s)
- Hilary Schwandt
- Western Washington University, 516 High Street, MS9118, Bellingham, WA, 98225, USA.
| | - Angel Boulware
- Spelman College, 350 Spelman Ln SW, Atlanta, GA, 30314, USA
| | - Julia Corey
- Wheaton College, 26 E Main St, Norton, MA, 02766, USA
| | - Ana Herrera
- Northwest Vista Community College, 3535 N Ellison Dr., San Antonio, TX, 78251, USA
| | - Ethan Hudler
- Whatcom Community College, 237 W Kellogg Rd, Bellingham, WA, 98226, USA
| | | | - Ilia King
- Xavier University, 1 Drexel Dr., New Orleans, LA, 70125, USA
| | | | | | - Madelyn Merritt
- Western Washington University, 516 High Street, MS9118, Bellingham, WA, 98225, USA
| | - Lyn Mezier
- SUNY Oswego, 7060 NY-104, Oswego, NY, 13126, USA
| | - Abigail Miller
- Western Washington University, 516 High Street, MS9118, Bellingham, WA, 98225, USA
| | - Haley Morris
- Western Oregon University, 345 Monmouth Ave N, Monmouth, OR, 97361, USA
| | | | - Uwase Musekura
- Eastern Oregon University, One University Blvd, La Grande, OR, 97850, USA
| | | | | | - Nirali Patel
- Arcadia University, 450 S Easton Rd, Glenside, PA, 19038, USA
| | | | | | - Madi Stapleton
- Western Washington University, 516 High Street, MS9118, Bellingham, WA, 98225, USA
| | | | | | | | - Madeleine Zeiler
- Western Washington University, 516 High Street, MS9118, Bellingham, WA, 98225, USA
| | - Seth Feinberg
- Western Washington University, 516 High Street, MS9118, Bellingham, WA, 98225, USA
| |
Collapse
|
12
|
Schwandt HM, Boulware A, Corey J, Herrera A, Hudler E, Imbabazi C, King I, Linus J, Manzi I, Merritt M, Mezier L, Miller A, Morris H, Musemakweli D, Musekura U, Mutuyimana D, Ntakarutimana C, Patel N, Scanteianu A, Shemeza BE, Sterling-Donaldson G, Umutoni C, Uwera L, Zeiler M, Feinberg S. "… the way we welcome them is how we will lead them to love family planning.": family planning providers in Rwanda foster compassionate relationships with clients despite workplace challenges. BMC Health Serv Res 2021; 21:293. [PMID: 33794871 PMCID: PMC8017655 DOI: 10.1186/s12913-021-06282-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rwanda has markedly increased the nation's contraceptive use in a short period of time, tripling contraceptive prevalence in just 5 years between 2005 and 2010. An integral aspect of family planning programs is the interactions between family planning providers and clients. This study aims to understand the client-provider relationship in the Rwandan family planning program and to also examine barriers to those relationships. METHODS This qualitative study in Rwanda utilized convenience sampling to include eight focus group discussions with family planning providers, both family planning nurses and community health workers, as well as in-depth interviews with 32 experienced modern contraceptive users. Study participants were drawn from the two districts in Rwanda with the highest and lowest modern contraceptive rates, Musanze and Nyamasheke, respectively Data analysis was guided by the thematic content approach, Atlas.ti 8 was utilized for coding the transcripts and collating the coding results, and Microsoft Excel for analyzing the data within code. RESULTS Data analysis revealed that, despite workplace related challenges - including inadequate staffing, training, and resources, relationships between providers and clients are strong. Family planning providers work hard to understand, learn from, and support clients in their initiation and sustained use of contraceptives. CONCLUSION Given the existing context of purposeful efforts on the part of family planning providers to build relationships with their clients, if the current level of government support for family planning service provision is enhanced, Rwanda will likely sustain many current users of contraception and engage even more Rwandans in contraceptive services in the future.
Collapse
Affiliation(s)
- Hilary M Schwandt
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA.
| | - Angel Boulware
- Spelman College, 350 Spelman Ln SW, Atlanta, GA, 30314, USA
| | - Julia Corey
- Wheaton College, 26 E Main St, Norton, MA, 02766, USA
| | - Ana Herrera
- Northwest Vista Community College, 3535 N Ellison Dr., San Antonio, TX, 78251, USA
| | - Ethan Hudler
- Whatcom Community College, 237 W Kellogg Rd, Bellingham, WA, 98226, USA
| | | | - Ilia King
- Xavier University, 1 Drexel Dr, New Orleans, LA, 70125, USA
| | | | | | - Madelyn Merritt
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | - Lyn Mezier
- SUNY Oswego, 7060 NY-104, Oswego, NY, 13126, USA
| | - Abigail Miller
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | - Haley Morris
- Western Oregon University, 345 Monmouth Ave N, Monmouth, OR, 97361, USA
| | | | - Uwase Musekura
- Eastern Oregon University, One University Blvd, La Grande, OR, 97850, USA
| | | | | | - Nirali Patel
- Arcadia University, 450 S Easton Rd, Glenside, PA, 19038, USA
| | | | | | | | | | | | - Madeleine Zeiler
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | - Seth Feinberg
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| |
Collapse
|
13
|
Dhillon PS, Dineen RA, Morris H, Tanasescu R, Nikfekr E, Evans J, Constantinescu CS, Hosseini AA. Neurological Disorders Associated With COVID-19 Hospital Admissions: Experience of a Single Tertiary Healthcare Center. Front Neurol 2021; 12:640017. [PMID: 33679593 PMCID: PMC7934891 DOI: 10.3389/fneur.2021.640017] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/26/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Early reports have detailed a range of neurological symptoms in patients with the SARS-CoV-2 infection. However, there is a lack of detailed description and incidence of the neurological disorders amongst hospitalized COVID-19 patients. We describe a range of neurological disorders (other than non-specific neurological symptoms), including their clinical, radiological, and laboratory findings, encountered in our cohort of COVID-19 patients admitted to a large tertiary institution. Methods: We reviewed our prospectively collated database of all adult Neurology referrals, Neurology and Stroke admissions and Neurological multi-disciplinary team meetings for all hospitalized patients with suspected or proven COVID-19 from 17 March 2020 to 31 August 2020. Results: Twenty-nine of 1,243 COVID-19 inpatients (2.3%) presented with COVID-19-related neurological disorders. The mean age was 68.9 ± 13.5(SD) years, age range of 34–97 years, and there were 16 males. Twenty two patients had confirmed, five were probable and two had suspected COVID-19 infection according to the WHO case classification. Eight patients (27%) required critical care admission. Neurological symptoms at presentation included acute confusion and delirium, seizures, and new focal neurological deficits. Based on the pre-defined neurological phenotype, COVID-19 patients were grouped into four main categories. Sixteen patients had cerebrovascular events (13 with acute ischemic stroke and three had hemorrhagic features), seven patients were found to have inflammatory, non-inflammatory and autoimmune encephalopathy (including two with known Multiple Sclerosis), whilst disorders of movement and peripheral nervous system were diagnosed in three patients each. Conclusion: Although the exact prevalence and etiology remain unclear, new onset of neurological disorders, in addition to anosmia, is non-sporadic during the acute COVID-19-infection. Longitudinal follow-up of these patients is required to determine the clinical and functional outcome, treatment response and long-term effects of the SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Permesh Singh Dhillon
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Robert A Dineen
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Haley Morris
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Radu Tanasescu
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Esmaeil Nikfekr
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Jonathan Evans
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Cris S Constantinescu
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Akram A Hosseini
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| |
Collapse
|
14
|
Morris H, Latchem-Hastings G. Final year physiotherapy studentś experiences of early mobilisation and rehabilitation for the critically ill patient. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
15
|
Thiex NJ, Erem TV, Amundson D, Boucher J, Clark A, Clark D, Coco P, Dow D, Fahey P, Hoffmann H, Mertens D, Morris H, Rittenhouse T, Wohla M. Determination of Water (Moisture) and Dry Matter in Animal Feed, Grain, and Forage (Plant Tissue) by Karl Fischer Titration: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/85.2.318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A Karl Fischer method for determining water (dry matter) in animal feed and forages was collaboratively studied. Water was extracted from animal feed or forage material into methanol–formamide (1 + 1) directly in the Karl Fischer titration vessel by high-speed homogenization. The water was titrated at 50°C with one-component Karl Fischer reagent based on imidazole. Ten blind samples were sent to 9 collaborators in the United States, Canada, and Germany. The within-laboratory relative standard deviation (repeatability) ranged from 1.14 to 6.99% for water or from 0.09 to 0.56% for dry matter. Among-laboratory (including within-) relative standard deviation (reproducibility) ranged from 5.35 to 10.73%, or from 0.44 to 0.77% for dry matter. The authors recommend that the method be adopted as Official First Action by AOAC INTERNATIONAL. A comparable alternative extraction procedure using boiling methanol is also recommended for Official First Action.
Collapse
Affiliation(s)
- Nancy J Thiex
- South Dakota State University, Oscar E. Olson Biochemistry Laboratories, Box 2170, ASC 151, Brookings, SD 57007
| | - Terri van Erem
- South Dakota State University, Oscar E. Olson Biochemistry Laboratories, Box 2170, ASC 151, Brookings, SD 57007
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Philips L, Taylor I, Mowat V, Morris H, Rye P. P276 Long term toxicity studies confirm good safety profile for OligoG dry powder for inhalation. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30569-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
17
|
Affiliation(s)
- J V Wallach
- University of the Sciences, 600 South 43rd Street, Philadelphia, PA, 19104, U.S.A
| | - H Morris
- University of the Sciences, 600 South 43rd Street, Philadelphia, PA, 19104, U.S.A
| | - S D Brandt
- School of Pharmacy and Biomedical Sciences, Liverpool John Moores University, Liverpool, U.K
| |
Collapse
|
18
|
Vachharajani AJ, Vachharajani NA, Morris H, Niesen A, Elward A, Linck DA, Mathur AM. Reducing peripherally inserted central catheters in the neonatal intensive care unit. J Perinatol 2017; 37:409-413. [PMID: 28079867 DOI: 10.1038/jp.2016.243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 11/11/2016] [Accepted: 11/15/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Our objective was to safely reduce the number of peripherally inserted central catheters (PICCs) inserted in infants with umbilical venous catheter using quality improvement methods. STUDY DESIGN In a tertiary neonatal intensive care unit, a questionnaire designed to prompt critical thinking around the decision to place a PICC, along with an updated standardized feeding guideline was introduced. PICC insertion in 86 infants with umbilical venous catheter (pre intervention) with birth weight 1000-1500 g were compared with 115 infants (post intervention) using Fisher's exact test. RESULTS PICC lines inserted after the intervention decreased by 37.5% (67/86; 77.9% vs 56/115; 48.7%; P<0.001). The proportion of central line-associated blood stream infection were 2.49 vs 2.82/1000 umbilical venous catheter days; P=0.91 in the two epochs, respectively. CONCLUSION Quality improvement methodology was successful in significantly reducing the number of PICCs inserted without an increase in central line-associated blood stream infection.
Collapse
Affiliation(s)
- A J Vachharajani
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA
| | - N A Vachharajani
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - H Morris
- St Louis Children's Hospital, St. Louis, MO, USA
| | - A Niesen
- St Louis Children's Hospital, St. Louis, MO, USA
| | - A Elward
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA
| | - D A Linck
- St Louis Children's Hospital, St. Louis, MO, USA
| | - A M Mathur
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA
| |
Collapse
|
19
|
Simpson S, Mina S, Morris H, Mahendran S, Taylor B, Boggild M. The epidemiology of multiple sclerosis in the Isle of Man: 2006-2011. Acta Neurol Scand 2015; 132:381-8. [PMID: 25891133 DOI: 10.1111/ane.12405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND We sought to determine the prevalence of MS on the Isle of Man in 2006 and 2011, and the incidence and mortality rates over this interval. METHODS Cases were identified by hospital medical record review, General Practitioners and the local MS Society. The significance of the change in prevalence over time and the significance of differences in frequencies by sex and place of birth were assessed by Poisson regression. RESULTS The 2006 prevalence was 153.64 per 100,000 persons and the 2011 prevalence was 179.89. The prevalence was higher among females and persons born in the Isle of Man at both time points. The 2006-2011 incidence rate was 6.86 per 100,000 person-years, much higher among females and persons born in the Isle of Man. The prevalence sex ratios in 2006 and 2011, 2.77 and 2.59, respectively, and the incidence sex ratio, 2.19, are similar to others found in the region. The mortality rate over the study period was 2.84 per 100,000 person-years, this solely among persons born overseas. CONCLUSIONS This is the first study of MS epidemiology in the Isle of Man, finding this area to be of high prevalence and to have one of the highest incidence rates in the UK region.
Collapse
Affiliation(s)
- S. Simpson
- Menzies Research Institute Tasmania; University of Tasmania; Hobart TAS Australia
| | - S. Mina
- Noble's Hospital; Douglas Isle of Man
| | - H. Morris
- Noble's Hospital; Douglas Isle of Man
| | - S. Mahendran
- Walton Centre for Neurology and Neurosurgery; Liverpool UK
| | - B. Taylor
- Menzies Research Institute Tasmania; University of Tasmania; Hobart TAS Australia
| | - M. Boggild
- Department of Neurology; Townsville Hospital; Douglas QLD Australia
| |
Collapse
|
20
|
Horowitz M, Morris H. In memoriam: B. E. Christopher Nordin. Osteoporos Int 2015; 26:2049-50. [PMID: 26092066 DOI: 10.1007/s00198-015-3209-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Horowitz
- School of Medicine, University of Adelaide, Adelaide, Australia
| | | |
Collapse
|
21
|
Elliott SP, Brandt SD, Wallach J, Morris H, Kavanagh PV. First Reported Fatalities Associated with the 'Research Chemical' 2-Methoxydiphenidine. J Anal Toxicol 2015; 39:287-93. [DOI: 10.1093/jat/bkv006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
|
22
|
Culvenor A, Collins N, Vicenzino B, Cook J, Whitehead T, Morris H, Crossley K. Factors associated with anterior knee pain 12 months follow hamstring tendon autograft ACL reconstruction. J Sci Med Sport 2014. [DOI: 10.1016/j.jsams.2014.11.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
23
|
Kawai T, Sachs DH, Sprangers B, Spitzer TR, Saidman SL, Zorn E, Tolkoff-Rubin N, Preffer F, Crisalli K, Gao B, Wong W, Morris H, LoCascio SA, Sayre P, Shonts B, Williams WW, Smith RN, Colvin RB, Sykes M, Cosimi AB. Long-term results in recipients of combined HLA-mismatched kidney and bone marrow transplantation without maintenance immunosuppression. Am J Transplant 2014; 14:1599-611. [PMID: 24903438 PMCID: PMC4228952 DOI: 10.1111/ajt.12731] [Citation(s) in RCA: 214] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/05/2014] [Accepted: 03/05/2014] [Indexed: 01/25/2023]
Abstract
We report here the long-term results of HLA-mismatched kidney transplantation without maintenance immunosuppression (IS) in 10 subjects following combined kidney and bone marrow transplantation. All subjects were treated with nonmyeloablative conditioning and an 8- to 14-month course of calcineurin inhibitor with or without rituximab. All 10 subjects developed transient chimerism, and in seven of these, IS was successfully discontinued for 4 or more years. Currently, four subjects remain IS free for periods of 4.5-11.4 years, while three required reinstitution of IS after 5-8 years due to recurrence of original disease or chronic antibody-mediated rejection. Of the 10 renal allografts, three failed due to thrombotic microangiopathy or rejection. When compared with 21 immunologically similar living donor kidney recipients treated with conventional IS, the long-term IS-free survivors developed significantly fewer posttransplant complications. Although most recipients treated with none or two doses of rituximab developed donor-specific antibody (DSA), no DSA was detected in recipients treated with four doses of rituximab. Although further revisions of the current conditioning regimen are planned in order to improve consistency of the results, this study shows that long-term stable kidney allograft survival without maintenance IS can be achieved following transient mixed chimerism induction.
Collapse
Affiliation(s)
- T. Kawai
- Transplant Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA,Corresponding author: Tatsuo Kawai,
| | - D. H. Sachs
- Transplantation Biology Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - B. Sprangers
- Columbia Center for Translational Immunology, Columbia University, New York, NY
| | - T. R. Spitzer
- Bone Marrow Transplant Unit, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - S. L. Saidman
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - E. Zorn
- Transplant Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - N. Tolkoff-Rubin
- Transplant Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - F. Preffer
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - K. Crisalli
- Transplant Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - B. Gao
- Transplant Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - W. Wong
- Columbia Center for Translational Immunology, Columbia University, New York, NY
| | - H. Morris
- Columbia Center for Translational Immunology, Columbia University, New York, NY
| | - S. A. LoCascio
- Columbia Center for Translational Immunology, Columbia University, New York, NY
| | - P. Sayre
- Immune Tolerance Network, San Francisco, CA
| | - B. Shonts
- Columbia Center for Translational Immunology, Columbia University, New York, NY
| | - W. W. Williams
- Transplant Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - R.-N. Smith
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - R. B. Colvin
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - M. Sykes
- Columbia Center for Translational Immunology, Columbia University, New York, NY
| | - A. B. Cosimi
- Transplant Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
24
|
Marrinan S, Bajaj N, Barker R, Ben-Shlomo Y, Emmanuel A, Foltynie T, Grosset D, Morris H, Williams N, Wood N, Burn D. 131 * GASTROPARESIS SYMPTOMS IN EARLY PARKINSON'S DISEASE. Age Ageing 2014. [DOI: 10.1093/ageing/afu047.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
25
|
Peall K, Smith D, Kurian M, Wardle M, Waite A, Hedderly T, Lin J, Smith M, Whone A, Pall H, White C, Lux A, Jardine P, Bajaj N, Lynch B, Kirov G, O'Riordan S, Samuel M, Lynch T, King M, Chinnery P, Warner T, Blake D, Owen M, Morris H. ARE PSYCHIATRIC SYMPTOMS A CORE PHENOTYPE OF MYOCLONUS DYSTONIA SYNDROME CAUSED BY SGCE MUTATIONS? J Neurol Psychiatry 2013. [DOI: 10.1136/jnnp-2013-306103.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
26
|
Ryan N, Biessels G, Bastos-Leite A, Beck J, Mead S, Morris H, Schott JM, Rossor MN, Fox NC. 1130 White matter lesions in familial Alzheimer's disease: evidence for influence of mutation position on amyloid angiopathy? J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
27
|
Morris H, Pearson JP, Kilarski LL, Wickremaratchi MM, Knipe MDW, Newsway V, Williams NM, Ben-Shlomo Y. 1636 Prevalence of mutations in parkin, PINK1, DJ-1 and LRRK2 in early onset Parkinson's Disease: a UK based study and systematic review. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
28
|
Morris H, Crossley K, Makdissi M, Lai C, Gabbe B. Hamstring tendon autograft does not protect the patellofemoral joint from osteoarthritis after anterior cruciate ligament reconstruction: 7 year follow-up. J Sci Med Sport 2011. [DOI: 10.1016/j.jsams.2011.11.223] [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]
|
29
|
Morris H, Morgan MD, Wood AM, Smith SW, Ekeowa UI, Herrmann K, Holle JU, Guillevin L, Lomas DA, Perez J, Pusey CD, Salama AD, Stockley R, Wieczorek S, McKnight AJ, Maxwell AP, Miranda E, Williams J, Savage CO, Harper L. ANCA-associated vasculitis is linked to carriage of the Z allele of α₁ antitrypsin and its polymers. Ann Rheum Dis 2011; 70:1851-6. [PMID: 21821620 DOI: 10.1136/ard.2011.153569] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Small studies have linked α1 antitrypsin (α1AT) deficiency to patients with antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV). OBJECTIVE To test the validity and the mechanism of this association between α1AT and AAV. METHODS The distribution of α1AT deficiency alleles Z and S was compared between 856 White Europeans with AAV and 1505 geographic and ethnically matched healthy controls. Genotyping was performed by allelic discrimination assay. RESULTS were compared between cases and controls using χ(2) tests. The serum and renal biopsies for α1AT polymers were compared using the polymer-specific 2C1 antibody. The role of α1AT polymers in promoting inflammation was investigated by examining their ability to prime neutrophils for ANCA activation as assessed by CD62L shedding, superoxide production and myeloperoxidase degranulation. Results The Z but not the S allele was over-represented in the patients compared with controls (HR=2.25, 95% CI 1.60 to 3.19). Higher concentrations of polymers of α1AT were detected in serum from patients carrying the Z allele than in those not carrying the Z allele (median (IQR) 1.40 (0.91-3.32) mg/dl vs 0.17 (0.06-0.28) mg/dl, p<0.001); polymers of α1AT were also seen in the renal biopsy of a patient with vasculitic glomerulonephritis. Polymers of α1AT primed neutrophils with CD62L shedding and increased superoxide production following ANCA activation. Carriage of the Z allele was not associated with disease severity, survival or relapse. CONCLUSIONS The Z but not the S deficiency allele is associated with AAV. Polymers of α1AT are present in the serum and glomeruli of at least some patients with the Z allele, which may promote inflammation through priming of neutrophils.
Collapse
Affiliation(s)
- H Morris
- School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Goff I, Coady D, Wright D, Mooney J, Poland F, Spalding N, Scott DGI, Watts R, Aquilina D, Walker D, Margham T, Bracewell C, Vila J, Burridge D, Coady D, Morris H, Ryan C, Lauchlan D, Field M, Lutalo PM, Davies U, Nandagudi A, Bruce J, Dabrera MG, Fleming CA, O'Connor MB, Bond U, Swan J, Phelan MJ, Hughes M, Amin R, Watson P, Pocock J, Gaffney K, Rao VK, Bhaskar S, Tosounidou S, Chaudhuri K, Nicolaou M, Amstrong R, Hassell AB, Walker D, Birrell F. Education research: 33. Evaluation of the First BSR Ultrasound Anatomy Training Course. Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
31
|
|
32
|
Morris H. The Bradshaw Lecture ON CANCER AND ITS ORIGIN: Delivered at the Royal College of Surgeons on December 9th. Br Med J 2011; 2:1505-11. [PMID: 20761233 DOI: 10.1136/bmj.2.2241.1505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
33
|
Morris H. The HUNTERIAN LECTURES on the SURGERY of the KIDNEY: Delivered at the Royal College of Surgeons of England. Br Med J 2011; 1:809-15. [PMID: 20757724 DOI: 10.1136/bmj.1.1943.809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
34
|
Crossley K, Lai C, Lentzos J, Gabbe B, Morris H, Tan C, Pandy M, Brukner P, Makdissi M. Hamstring tendon autograft does not protect the patellofemoral joint from osteoarthritis after anterior cruciate ligament reconstruction: 7 year follow-up. J Sci Med Sport 2010. [DOI: 10.1016/j.jsams.2010.10.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
35
|
Cohen L, Morris H, Vaughan D. Correspondence: Bench study of ventilation in simulated upper airway obstruction. Anaesthesia 2010; 65:952; author reply 952-3. [DOI: 10.1111/j.1365-2044.2010.06458.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
36
|
Roberts C, Thompson S, Furness D, Lee S, Anderson P, Morris H, Dekker G. Season, vitamin D-related genes and maternal circulating 25OH vitamin D3 associate with pregnancy complications in an Australian population. J Reprod Immunol 2010. [DOI: 10.1016/j.jri.2010.06.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
37
|
Jomová K, Kysel O, Madden J, Morris H, Enoch S, Budzak S, Young A, Cronin M, Mazur M, Valko M. Electron transfer from all-trans β-carotene to the t-butyl peroxyl radical at low oxygen pressure (an EPR spectroscopy and computational study). Chem Phys Lett 2009. [DOI: 10.1016/j.cplett.2009.07.088] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
38
|
Morris H, Thomas J. Nutritional aspects of colorectal cancer surgery care in a district general hospital. J Hum Nutr Diet 2009. [DOI: 10.1111/j.1365-277x.2009.00952_20.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
39
|
Ekanem SB, Avault JW, Graves JB, Morris H. ACUTE TOXICITY OF PROPANIL, ORDRAM AND FURADAN TO CRAWFISH (Procambarus clarkii) WHEN CHEMICALS WERE COMBINED AND USED ALONE1. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1749-7345.1981.tb00309.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
40
|
Morris H, Tallay A, Lim M, Liptak M. Minimally invasive selective bundle anterior cruciate ligament reconstruction. J Sci Med Sport 2009. [DOI: 10.1016/j.jsams.2008.12.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
41
|
Graves T, Zuberi S, Morris H, Schorge S, Kullmann D, Hanna M. D.P.2.12 Episodic ataxia type 1 in identical twins. Neuromuscul Disord 2008. [DOI: 10.1016/j.nmd.2008.06.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
42
|
Singleton A, Morris H. Association, expression, pathobiology: Is too much tau in PD a blueprint for genetic association? Neurology 2008; 71:11-2. [DOI: 10.1212/01.wnl.0000316388.84840.1f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
43
|
Divkovic M, Basketter D, Pease C, Panico M, Morris H, Dell A. P75
Molecular screening for skin sensitisation hazard in vitro using proteomics techniques. Contact Dermatitis 2008. [DOI: 10.1111/j.0105-1873.2004.00309he.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
44
|
Krumholz A, Wiebe S, Gronseth G, Shinnar S, Levisohn P, Ting T, Hopp J, Shafer P, Morris H, Seiden L, Barkley G, French J. Practice Parameter: Evaluating an apparent unprovoked first seizure in adults (an evidence-based review): [RETIRED]. Neurology 2007; 69:1996-2007. [DOI: 10.1212/01.wnl.0000285084.93652.43] [Citation(s) in RCA: 211] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
45
|
Abstract
This article discusses the educational value of the "board round", a clinical teaching forum introduced at Hope Hospital, Manchester, UK. At midday on weekdays all available consultants and middle grade doctors, and any other staff who can attend, meet to discuss a case selected from the patients currently in the department. As several experienced clinicians are available to discuss a clinical problem, the round allows a broad debate during which the merits of several management options are discussed. In addition, attending a board round addresses in part the concerns which senior clinicians may have about the balance of service delivery and protected teaching time. The paper describes several other advantages of this method of teaching, which has been adopted by other hospitals in the region.
Collapse
Affiliation(s)
- S Carley
- Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
| | | | | |
Collapse
|
46
|
Emery J, Morris H, Goodchild R, Fanshawe T, Prevost AT, Bobrow M, Kinmonth AL. The GRAIDS Trial: a cluster randomised controlled trial of computer decision support for the management of familial cancer risk in primary care. Br J Cancer 2007; 97:486-93. [PMID: 17700548 PMCID: PMC2360348 DOI: 10.1038/sj.bjc.6603897] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The objective was to evaluate the effect of an assessment strategy using the computer decision support system (the GRAIDS software), on the management of familial cancer risk in British general practice in comparison with best current practice. The design included cluster randomised controlled trial, and involved forty-five general practice teams in East Anglia, UK. Randomised to GRAIDS (Genetic Risk Assessment on the Internet with Decision Support) support (intervention n=23) or comparison (n=22). Training in the new assessment strategy and access to the GRAIDS software (GRAIDS arm) was conducted, compared with an educational session and guidelines about managing familial breast and colorectal cancer risk (comparison) were mailed. Outcomes were measured at practice, practitioner and patient levels. The primary outcome measure, at practice level, was the proportion of referrals made to the Regional Genetics Clinic for familial breast or colorectal cancer that were consistent with referral guidelines. Other measures included practitioner confidence in managing familial cancer (GRAIDS arm only) and, in patients: cancer worry, risk perception and knowledge about familial cancer. There were more referrals to the Regional Genetics Clinic from GRAIDS than comparison practices (mean 6.2 and 3.2 referrals per 10 000 registered patients per year; mean difference 3.0 referrals; 95% confidence interval (CI) 1.2–4.8; P=0.001); referrals from GRAIDS practices were more likely to be consistent with referral guidelines (odds ratio (OR)=5.2; 95% CI 1.7–15.8, P=0.006). Patients referred from GRAIDS practices had lower cancer worry scores at the point of referral (mean difference −1.44 95% CI −2.64 to −0.23, P=0.02). There were no differences in patient knowledge about familial cancer. The intervention increased GPs' confidence in managing familial cancer. Compared with education and mailed guidelines, assessment including computer decision support increased the number and quality of referrals to the Regional Genetics Clinic for familial cancer risk, improved practitioner confidence and had no adverse psychological effects in patients. Trials are registered under N0181144343 in the UK National Research Register.
Collapse
Affiliation(s)
- J Emery
- General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, 328 Stirling Highway, Claremont, Western Australia 6010, Australia.
| | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
Therapeutic ultrasound is currently enjoying increasingly widespread clinical use especially for the treatment of cancer of the prostate, liver, kidney, breast, pancreas and bone, as well as for the treatment of uterine fibroids. The optimum method of treatment delivery varies between anatomical sites, but in all cases monitoring of the treatment is crucial if extensive clinical acceptance is to be achieved. Monitoring not only provides the operating clinician with information relating to the effectiveness of treatment, but can also provide an early alert to the onset of adverse effects in normal tissue. This paper reviews invasive and non-invasive monitoring methods that have been applied to assess the extent of treatment during the delivery of therapeutic ultrasound in the laboratory and clinic (follow-up after treatment is not reviewed in detail). The monitoring of temperature and, importantly, the way in which this measurement can be used to estimate the delivered thermal dose, is dealt with as a separate special case. Already therapeutic ultrasound has reached a stage of development where it is possible to attempt real-time feedback during exposure in order to optimize each and every delivery of ultrasound energy. To date, data from MR imaging have shown better agreement with the size of regions of damage than those from diagnostic ultrasound, but novel ultrasonic techniques may redress this balance. Whilst MR currently offers the best method for non-invasive temperature measurement, the ultrasound techniques under development, which could potentially offer more rapid visualisation of results, are discussed.
Collapse
Affiliation(s)
- I Rivens
- Joint Department of Physics, Institute of Cancer Research: Royal Marsden NHS Foundation Trust, Sutton, UK.
| | | | | | | |
Collapse
|
48
|
Morris H, Brooker B, Brukner P. The infrapatellar fatpad of the knee. J Sci Med Sport 2006. [DOI: 10.1016/j.jsams.2006.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
49
|
Valko M, Mazúr M, Morris H, Klement R, Williams CJ, Melník M. EFFECT OF COORDINATED BASE ON MAGNETIC BEHAVIOR OF COPPER(II) CARBOXYLATES WITH FATTY ACID CHAINS (AN ESR STUDY). J COORD CHEM 2006. [DOI: 10.1080/00958970008022581] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M. Valko
- a Department of Physical Chemistry, Faculty of Chemical Technology , Slovak Technical University , Radlinského 9, SK-812 37 , Bratislava , Slovakia
| | - M. Mazúr
- a Department of Physical Chemistry, Faculty of Chemical Technology , Slovak Technical University , Radlinského 9, SK-812 37 , Bratislava , Slovakia
| | - H. Morris
- b School of Pharmacy and Chemistry , Liverpool John Moores University , Byrom Street, Liverpool , L3 3AF , United Kingdom
| | - R. Klement
- a Department of Physical Chemistry, Faculty of Chemical Technology , Slovak Technical University , Radlinského 9, SK-812 37 , Bratislava , Slovakia
| | - C. J. Williams
- b School of Pharmacy and Chemistry , Liverpool John Moores University , Byrom Street, Liverpool , L3 3AF , United Kingdom
| | - M. Melník
- c Department of Inorganic Chemistry, Faculty of Chemical Technology , Slovak Technical University , Radlinského 9, SK-812 37 , Bratislava , Slovakia
| |
Collapse
|
50
|
Haydon AMM, Macinnis RJ, English DR, Morris H, Giles GG. Physical activity, insulin-like growth factor 1, insulin-like growth factor binding protein 3, and survival from colorectal cancer. Gut 2006; 55:689-94. [PMID: 16299029 PMCID: PMC1856138 DOI: 10.1136/gut.2005.081547] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND Recent reports have shown that physical activity improves the outcome of patients with colorectal cancer as well as breast and prostate cancer. However, the mechanisms whereby physical activity reduces cancer mortality are not well established. METHODS Incident cases of colorectal cancer were identified among participants of the Melbourne Collaborative Cohort Study, a prospective cohort study of 41,528 Australians recruited from 1990 to 1994. Information on tumour site and stage, treatments given, recurrences, and deaths were obtained from systematic review of the medical records. Baseline assessments of physical activity and body size were made, and cases with available plasma had pre-diagnosis insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP-3) levels measured. We assessed associations between these hormones and colorectal cancer specific deaths with respect to physical activity. RESULTS A total of 526 cases of colorectal cancer were identified, of which 443 had IGF-1/IGFBP-3 levels measured. Median follow up among survivors was 5.6 years. For the physically active, increasing IGFBP-3 by 26.2 nmol/l was associated with a 48% reduction in colorectal cancer specific deaths (adjusted hazard ratio (HR) 0.52 (0.33-0.83); p = 0.006). No association was seen for IGF-1 (adjusted HR 0.90 (0.55-1.45); p = 0.65). For the physically inactive, neither IGF-1 nor IGFBP-3 was associated with disease specific survival. CONCLUSIONS This study supports the hypothesis that the beneficial effects of physical activity in reducing colorectal cancer mortality may occur through interactions with the insulin-like growth factor axis and in particular IGFBP-3.
Collapse
Affiliation(s)
- A M M Haydon
- Department of Epidemiology and Preventive Medicine, Monash Medical School, Alfred Hospital, Melbourne 3004, Australia.
| | | | | | | | | |
Collapse
|