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Gliddon HD, Ward Z, Heinsbroek E, Croxford S, Edmundson C, Hope VD, Simmons R, Mitchell H, Hickman M, Vickerman P, Stone J. Has the HCV cascade of care changed among people who inject drugs in England since the introduction of direct-acting antivirals? Int J Drug Policy 2024:104324. [PMID: 38218700 DOI: 10.1016/j.drugpo.2024.104324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND In England, over 80 % of those with hepatitis C virus (HCV) infection have injected drugs. We quantified the HCV cascade of care (CoC) among people who inject drugs (PWID) in England and determined whether this improved after direct-acting antivirals (DAAs) were introduced. METHODS We analysed data from nine rounds of national annual cross-sectional surveys of PWID recruited from drug services (2011-2019; N = 12,320). Study rounds were grouped as: 'Pre-DAAs' (2011-2014), 'Prioritised DAAs' (2015-2016) and 'Unrestricted DAAs' (2017-2019). Participants were anonymously tested for HCV antibodies and RNA and completed a short survey. We assessed the proportion of PWID recently (current/previous year) tested for HCV. For participants ever HCV treatment eligible (past chronic infection with history of treatment or current chronic infection), we assessed the CoC as: HCV testing (ever), received a positive test result, seen a specialist nurse/doctor, and ever treated. We used logistic regression to determine if individuals progressed through the CoC differently depending on time-period, whether time-period was associated with recent testing (all participants) and lifetime HCV treatment (ever eligible participants), and predictors of HCV testing and treatment in the Unrestricted DAAs period. RESULTS The proportion of ever HCV treatment eligible PWID reporting lifetime HCV treatment increased from 12.5 % in the Pre-DAAs period to 25.6 % in the Unrestricted DAAs period (aOR:2.40, 95 %CI:1.95-2.96). There were also increases in seeing a specialist nurse/doctor. The largest loss in the CoC was at treatment for all time periods. During the Unrestricted DAAs period, recent (past year) homelessness (vs never, aOR:0.66, 95 %CI:0.45-0.97), duration of injecting (≤3 years vs >3 years; aOR:0.26, 95 %CI:0.12-0.60), never (vs current, aOR:0.31, 95 %CI:0.13-0.75) or previously being prescribed OAT (vs current, aOR:0.67, 95 %CI:0.47-0.95), and never using a NSP (vs past year, aOR:0.27, 95 %CI:0.08-0.89) were negatively associated with lifetime HCV treatment. The proportion of PWID reporting recent HCV testing was higher during Unrestricted DAAs (56 %) compared to Pre-DAAs (48 %; aOR:1.28, 95 %CI:1.06-1.54). CONCLUSION COC stages from seeing a specialist onwards improved after DAAs became widely available. Further improvements in HCV testing are needed to eliminate HCV in England.
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Affiliation(s)
- H D Gliddon
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; National Public Health Specialty Training Programme, South West, United Kingdom
| | - Z Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom
| | - E Heinsbroek
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - S Croxford
- National Public Health Speciality Training Programme, West Midlands, United Kingdom
| | - C Edmundson
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - V D Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | - R Simmons
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - H Mitchell
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - M Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom
| | - P Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom
| | - J Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom.
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Mitchell H, Cairnduff V, O'Hare S, Simpson L, White R, Gavin AT. Factors associated with emergency admission for people dying from cancer in Northern Ireland: an observational data linkage study. BMC Health Serv Res 2023; 23:1184. [PMID: 37907903 PMCID: PMC10617099 DOI: 10.1186/s12913-023-10228-w] [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] [Received: 06/14/2023] [Accepted: 10/27/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Many people living with cancer are admitted as an emergency, some just prior to diagnosis and others in their last year of life. Factors associated with accessing emergency care for people dying of cancer are complex and not well understood. This can make it difficult to have the resources and staffing in place to best care for individuals in their last year of life and their families. METHODS This study uses routinely collected administrative data from people who died of cancer in N. Ireland (NI) during 2015 and explores how personal characteristics (e.g., gender, age) and disease related factors (e.g., tumour site, cancer stage at initial diagnosis) were associated with having an emergency admission to hospital in the last year and the last 28 days of their lives, using multivariate logistic regression. RESULTS Almost three in four people had at least one emergency admission in the last year of life, and over one in three had an emergency admission the last 28 days of life. Patterns were similar for both time outcomes with males, people with haematological, lung or brain cancers, younger persons, those diagnosed with late-stage cancer, and people diagnosed close to time of death, being significantly more likely to have an emergency admission. While there was no significant association between deprivation and emergency admission rates, those living in urban areas were more likely to have an emergency admission in their last month of life compared to rural dwellers. Late diagnosis was evident with 538 people (12.8% of all deaths from cancer) being diagnosed within one month of death and 1242 (29%) within 3 months of death. CONCLUSION The high level of emergency admissions points to gaps in routine end-of-life care, and the need for additional training for hospital staff including frontline emergency department (ED) staff who are often the 'gatekeepers' to emergency inpatient care for people living with cancer. The levels of late diagnosis indicate a need for increased population awareness of cancer symptoms and system change to promote earlier diagnosis.
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Affiliation(s)
- H Mitchell
- Centre for Public Health, Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
| | - V Cairnduff
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - S O'Hare
- Centre for Public Health, Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - L Simpson
- Centre for Public Health, Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - R White
- Macmillan Cancer Support, London, England, United Kingdom
| | - A T Gavin
- Centre for Public Health, Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
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Ronchi E, Wahlqvist J, Ardinge A, Rohaert A, Gwynne SMV, Rein G, Mitchell H, Kalogeropoulos N, Kinateder M, Bénichou N, Kuligowski E, Kimball A. The verification of wildland-urban interface fire evacuation models. Nat Hazards (Dordr) 2023; 117:1493-1519. [PMID: 37251348 PMCID: PMC10220130 DOI: 10.1007/s11069-023-05913-2] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/07/2023] [Indexed: 05/31/2023]
Abstract
This paper introduces a protocol for the verification of multi-physics wildfire evacuation models, including a set of tests used to ensure that the conceptual modelling representation of each modelling layer is accurately implemented, as well as the interactions between different modelling layers and sub-models (wildfire spread, pedestrian movement, traffic evacuation, and trigger buffers). This work presents a total of 24 verification tests, including (1) 4 tests related to pedestrians, (2) 15 tests for traffic evacuation, (3) 5 tests concerning the interaction between different modelling layers, along with 5 tests for wildfire spread and trigger buffers. The evacuation tests are organized in accordance with different core components related to evacuation modelling, namely Population, Pre-evacuation, Movement, Route/destination selection, Flow constraints, Events, Wildfire spread and Trigger buffers. A reporting template has also been developed to facilitate the application of the verification testing protocol. An example application of the testing protocol has been performed using an open wildfire evacuation modelling platform called WUI-NITY and its associated trigger buffer model k-PERIL. The verification testing protocol is deemed to improve the credibility of wildfire evacuation model results and stimulate future modelling efforts in this domain. Supplementary Information The online version contains supplementary material available at 10.1007/s11069-023-05913-2.
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Affiliation(s)
- E. Ronchi
- Department of Fire Safety Engineering, Lund University, Lund, Sweden
| | - J. Wahlqvist
- Department of Fire Safety Engineering, Lund University, Lund, Sweden
| | - A. Ardinge
- Department of Fire Safety Engineering, Lund University, Lund, Sweden
| | - A. Rohaert
- Department of Fire Safety Engineering, Lund University, Lund, Sweden
| | - S. M. V. Gwynne
- Department of Fire Safety Engineering, Lund University, Lund, Sweden
- Movement Strategies, London, UK
| | - G. Rein
- Imperial College London, London, UK
| | | | | | | | | | - E. Kuligowski
- Royal Melbourne Institute of Technology, Melbourne, Australia
| | - A. Kimball
- Fire Protection Research Foundation, Quincy, USA
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Snell LB, Vink JP, Verlander NQ, Miah S, Lackenby A, Williams D, Mitchell H, Beviz C, Kabia M, Cunningham E, Batra R, Edgeworth JD, Zambon M, Nebbia G. Nosocomial acquisition of influenza is associated with significant morbidity and mortality: Results of a prospective observational study. J Infect Public Health 2022; 15:1118-1123. [PMID: 36137361 PMCID: PMC10166711 DOI: 10.1016/j.jiph.2022.08.021] [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: 06/07/2022] [Revised: 08/04/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Nosocomial acquisition of influenza is known to occur but the risk after exposure to a known case and the outcomes after acquisition are poorly defined. METHODS Prospective observational study of patients exposed to influenza from another patient in a multi-site healthcare organisation, with follow-up of 7 days or until discharge, and PCR-confirmation of symptomatic disease. Multivariable analysis was used to investigate association of influenza acquisition with high dependency unit/intensive care unit (HDU/ITU) admission and in-hospital mortality. RESULTS 23/298 (7.7%) contacts of 11 cases were subsequently symptomatic and tested influenza-positive during follow-up. HDU/ITU admission was significantly higher in these secondary cases (6/23, 26%) compared to flu-negative contacts (20/275, 7.2%; p = 0.002). In-hospital mortality was significantly higher in secondary cases (5/23, 21.7%) compared to flu-negative contacts (11/275, 4%; p < 0.001). In multivariable analysis, age (OR 1.25 95% CI: 1.01-1.54, p = 0.02) and being a secondary case (OR 4.77, 95% CI: 1.63-13.9, p = 0.008) were significantly associated with HDU/ITU admission in contacts. Age (OR 1.00, 95% CI: 0.93-1.00, p = 0.02), being a secondary case after exposure to influenza (OR 3.81, 95% CI 1.09-13.3, p = 0.049) and co-morbidity (OR 1.29 per unit increment in the Charlson score, 95% CI 1.02-1.61, p = 0.03) were significantly associated with in-hospital mortality in contacts. CONCLUSIONS Nosocomial acquisition of influenza was significantly associated with increased risk of HDU/ITU admission and in-hospital mortality.
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Affiliation(s)
- L B Snell
- Centre for Clinical Infection and Diagnostics Research, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Department of Infection, Guy's and St Thomas' NHS Foundation Trust, UK.
| | - J P Vink
- Centre for Clinical Infection and Diagnostics Research, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - S Miah
- UK Health Security Agency, Colindale, UK
| | - A Lackenby
- UK Health Security Agency, Colindale, UK
| | - D Williams
- UK Health Security Agency, Colindale, UK
| | - H Mitchell
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, UK
| | - C Beviz
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, UK
| | - M Kabia
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, UK
| | | | - R Batra
- Centre for Clinical Infection and Diagnostics Research, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - J D Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Department of Infection, Guy's and St Thomas' NHS Foundation Trust, UK
| | - M Zambon
- UK Health Security Agency, Colindale, UK
| | - G Nebbia
- Centre for Clinical Infection and Diagnostics Research, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Department of Infection, Guy's and St Thomas' NHS Foundation Trust, UK
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Blair R, Harkin DW, Lim A, Johnston D, McFetridge L, Mitchell H. Open Surgery for Abdominal Aortic Aneurysm: 994 Consecutive Patient Outcomes. Eur J Vasc Endovasc Surg 2022. [DOI: 10.1016/j.ejvs.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Solway L, Mitchell H, Meade S, Benghiat H, Augustus H, Stange R, Jackson T, Heyes G, Monksfield P, Kay A, Irving R, Chavda S, Hartley A, Sanghera P. PO-1125 Long-term efficacy and toxicity following CyberKnife radiation for Vestibular Schwannoma. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03089-4] [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: 10/18/2022]
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Kwiatkowska M, Ahmed S, Ardern‐Jones M, Bhatti LA, Bleiker TO, Gavin A, Hussain S, Huws DW, Irvine L, Langan SM, Millington GWM, Mitchell H, Murphy R, Paley L, Proby CM, Thomson CS, Thomas R, Turner C, Vernon S, Venables ZC. An updated report on the incidence and epidemiological trends of keratinocyte cancers in the United Kingdom 2013-2018. Skin Health Dis 2021; 1:e61. [PMID: 35663774 PMCID: PMC9060124 DOI: 10.1002/ski2.61] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 12/29/2022]
Abstract
Introduction The most common cancers in the UK are keratinocyte cancers (KCs): the combined term for basal cell carcinomas (BCCs) and cutaneous squamous cell carcinomas (cSCCs). Registration of KC is challenging due to high numbers and multiplicity of tumours per person. Methods We provide an updated report on the descriptive epidemiology of trends in KC incidence for the resident populations of UK countries (England, Northern Ireland, Scotland and Wales) using population-based cancer registry and pathology report data, 2013-18. Results Substantial increases in cSCC incidence in England, Scotland and Northern Ireland can be detected for the period of 2013-18, and the incidence of cSCC also increased in Wales from 2016 to 2018. In contrast, however, the pattern of annual change in the incidence of BCC across the nations differs. In England, the incidence of BCC declined slightly from 2016 to 2018, however, the overall trend across 2013-18 is not statistically significant. In Scotland, the incidence of BCC shows some variability, declining in 2017 before increasing in 2018, and the overall trend across 2013-18 was also not statistically significant. In Northern Ireland, the incidence of BCC increased significantly over the study period, and in Wales, the incidence of BCC increased from 2016 to 2018. One in five people will develop non-melanoma skin cancers (NMSC) in their lifetime in England. This estimate is much higher than the lifetime risk of melanoma (1 in 36 males and 1 in 47 females born after 1960 in the UK), which further highlights the burden of the disease and importance of early prevention strategies. Conclusions We highlight how common these tumours are by publishing the first ever lifetime incidence of NMSC. Additionally, the first time reporting of the age standardised incidence of KC in Wales further confirms the scale of the disease burden posed by these cancers in the UK. With approximately one in five people developing NMSC in their lifetime, optimisation of skin cancer prevention, management and research are essential.
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Affiliation(s)
- M. Kwiatkowska
- National Cancer Registration and Analysis ServiceLondonUK
- British Association of DermatologistsLondonUK
| | - S. Ahmed
- British Association of DermatologistsLondonUK
| | - M. Ardern‐Jones
- Department of Clinical Experimental SciencesFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | | | - T. O. Bleiker
- University Hospitals of Derby and Burton NHS Foundation TrustDerbyUK
| | - A. Gavin
- North Ireland Cancer RegistryBelfastUK
| | - S. Hussain
- British Association of DermatologistsLondonUK
| | | | - L. Irvine
- National Cancer Registration and Analysis ServiceLondonUK
| | - S. M. Langan
- London School of Hygiene & Tropical MedicineSt. John's Institute of DermatologyLondonUK
| | - G. W. M. Millington
- Department of DermatologyNorfolk and Norwich University HospitalNorwichUK
- University of East Anglia Norwich Medical SchoolNorwichUK
| | | | - R. Murphy
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - L. Paley
- National Cancer Registration and Analysis ServiceLondonUK
| | - C. M. Proby
- Department of DermatologyNinewells Hospital and Medical SchoolDundeeUK
| | | | | | - C. Turner
- National Cancer Registration and Analysis ServiceLondonUK
| | - S. Vernon
- National Cancer Registration and Analysis ServiceLondonUK
| | - Z. C. Venables
- National Cancer Registration and Analysis ServiceLondonUK
- Department of DermatologyNorfolk and Norwich University HospitalNorwichUK
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8
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Kwiatkowska MM, Ahmed S, Ardern-Jones MR, Bhatti LA, Bleiker TO, Gavin A, Hussain S, Huws DW, Irvine L, Langan SM, Millington GWM, Mitchell H, Murphy R, Paley L, Proby CM, Thomson C, Thomas R, Turner C, Vernon S, Venables ZC. A summary of the updated report on the incidence and epidemiological trends of keratinocyte cancers in the United Kingdom 2013-2018. Br J Dermatol 2021; 186:367-369. [PMID: 34564854 DOI: 10.1111/bjd.20764] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/04/2021] [Accepted: 09/22/2021] [Indexed: 11/30/2022]
Abstract
Skin cancer is the commonest cancer in the UK. Skin cancer referrals via the two-week wait (urgent suspected cancer) pathway outnumber any other suspected malignancy.1, 2 The commonest skin cancers are keratinocyte cancers (KCs) which represents Basal Cell Carcinomas (BCC) and Cutaneous Squamous Cell Carcinomas (cSCC). Accurate KC incidence reporting is crucial for healthcare planning.
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Affiliation(s)
- M M Kwiatkowska
- Public Health England London Region, London, U.K.,British Association of Dermatologists, London, U.K
| | - S Ahmed
- British Association of Dermatologists, London, U.K
| | - M R Ardern-Jones
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, U.K
| | - L A Bhatti
- London School of Hygiene and Tropical Medicine and St. John's Institute of Dermatology, London, U.K
| | - T O Bleiker
- British Association of Dermatologists, London, U.K.,University Hospital of Derby, Burton NHS Foundation Trust, Derby, U.K
| | - A Gavin
- Northern Ireland Cancer Registry, Belfast, U.K
| | - S Hussain
- British Association of Dermatologists, London, U.K
| | - D W Huws
- Welsh Cancer Intelligence and Surveillance Unit, Health Intelligence Division
| | - L Irvine
- Public Health England London Region, London, U.K
| | - S M Langan
- London School of Hygiene and Tropical Medicine and St. John's Institute of Dermatology, London, U.K
| | - G W M Millington
- British Association of Dermatologists, London, U.K.,Department of Dermatology, Norfolk and Norwich University Hospital, U.K.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - H Mitchell
- Northern Ireland Cancer Registry, Belfast, U.K
| | - R Murphy
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | - L Paley
- Public Health England London Region, London, U.K
| | - C M Proby
- Ninewells Hospital & Medical School, University of Dundee, Dundee, U.K
| | - C Thomson
- Scottish Cancer Registry, Public Health Scotland (PHS)
| | - R Thomas
- Welsh Cancer Intelligence and Surveillance Unit, Health Intelligence Division
| | - C Turner
- Public Health England London Region, London, U.K
| | - S Vernon
- Public Health England London Region, London, U.K
| | - Z C Venables
- Public Health England London Region, London, U.K.,British Association of Dermatologists, London, U.K.,Department of Dermatology, Norfolk and Norwich University Hospital, U.K
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Vink JP, Snell LB, Bernard K, Mitchell H, Heathcock RT, Cordery R, Newsholme W. Mapping a nosocomial outbreak of measles, coinciding with a period of sustained transmission in South London in 2018. J Hosp Infect 2020; 105:747-751. [PMID: 32544506 DOI: 10.1016/j.jhin.2020.06.004] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/03/2020] [Indexed: 11/25/2022]
Abstract
A measles outbreak in London is described, involving 34 cases across two hospitals and a local community across two countries. After a single introduction to hospital, spread propagated via unvaccinated retail shop workers to healthcare staff, highlighting the importance of expanding occupational health policies to non-clinical hospital staff. Further spread into an under-vaccinated Traveller community is a reminder that measles can spread in the absence of herd immunity. Subsequently endemic measles transmission has been re-established in the UK.
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Affiliation(s)
- J P Vink
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Clinical Infection and Diagnostics Research, King's College London, London, UK.
| | - L B Snell
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Clinical Infection and Diagnostics Research, King's College London, London, UK
| | - K Bernard
- South London Health Protection Team, Public Health England, London, UK
| | - H Mitchell
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R T Heathcock
- South London Health Protection Team, Public Health England, London, UK
| | - R Cordery
- South London Health Protection Team, Public Health England, London, UK
| | - W Newsholme
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Cicutto L, Gleason M, Haas-Howard C, White M, Hollenbach JP, Williams S, McGinn M, Villarreal M, Mitchell H, Cloutier MM, Vinick C, Langton C, Shocks DJ, Stempel DA, Szefler SJ. Building Bridges for Asthma Care Program: A School-Centered Program Connecting Schools, Families, and Community Health-Care Providers. J Sch Nurs 2020; 36:168-180. [PMID: 30336726 PMCID: PMC7222283 DOI: 10.1177/1059840518805824] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Asthma imposes tremendous burden on children, families, and society. Successful management requires coordinated care among children, families, health providers, and schools. Building Bridges for Asthma Care Program, a school-centered program to coordinate care for successful asthma management, was developed, implemented, and evaluated. The program consists of five steps: (1) identify students with asthma; (2) assess asthma risk/control; (3) engage the family and student at risk; (4) provide case management and care coordination, including engagement of health-care providers; and (5) prepare for next school year. Implementation occurred in 28 schools from two large urban school districts in Colorado and Connecticut. Significant improvements were noted in the proportions of students with completed School Asthma Care Plans, a quick-relief inhaler at school, Home Asthma Action/Treatment Plans and inhaler technique (p < .01 for all variables). Building Bridges for Asthma Care was successfully implemented extending asthma care to at-risk children with asthma through engagement of schools, health providers, and families.
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Affiliation(s)
- Lisa Cicutto
- Community Outreach and Research, National Jewish Health, Denver, CO, USA
- Clinical Science Program, College of Nursing, Anschutz Medical Campus, University of Colorado, Denver, CO, USA
| | - Melanie Gleason
- Building Bridges Asthma Program, Children's Hospital of Colorado, Aurora, CO, USA
- Department of Pediatrics, Section of Pediatric Pulmonary Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Christy Haas-Howard
- Nursing and Student Health Services, Denver Public Schools, Denver, CO, USA
- Asthma Grant Program, Colorado Department of Education, Denver, CO, USA
| | - Marty White
- Children's Hospital Colorado/Denver Public Schools, Denver, CO, USA
| | - Jessica P. Hollenbach
- Department of Pediatrics, School of Medicine, University of Connecticut, Hartford, CT, USA
- Asthma Center, Connecticut Children's Medical Center, Hartford, CT, USA
| | | | | | | | | | - Michelle M. Cloutier
- Asthma Center, Connecticut Children's Medical Center, Hartford, CT, USA
- Department of Pediatrics, UConn Health, Farmington, CT, USA
| | - Carol Vinick
- Asthma Center, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Christine Langton
- Asthma Center, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Donna J. Shocks
- Nursing and Student Health Services, Denver Public Schools, Denver, CO, USA
| | - David A. Stempel
- Propeller Health, San Francisco, CA, USA
- GlaxoSmithKline, Sacramento, CA, USA
| | - Stanley J. Szefler
- Pediatric Asthma Research Program, Breathing Institute, Section of Pediatric Pulmonary Medicine, Aurora, CO, USA
- Denver School of Medicine, University of Colorado, Aurora, CO, USA
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LAMBERT K, Lau K, Davison S, Mitchell H, Harman A, Carrie M. SAT-254 USE OF A RENAL DIET SPECIFIC QUESTION PROMPT SHEET INCREASES PATIENT CENTEREDNESS AND PATIENT ENGAGEMENT IN RENAL DIETETIC CLINICS. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Triolo TM, Fouts A, Pyle L, Yu L, Gottlieb PA, Steck AK, Greenbaum CJ, Atkinson M, Baidal D, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Clements M, Colman P, DiMeglio L, Gitelman S, Goland R, Gottlieb P, Herold K, Knip M, Krischer J, Lernmark A, Moore W, Moran A, Muir A, Palmer J, Peakman M, Philipson L, Raskin P, Redondo M, Rodriguez H, Russell W, Spain L, Schatz D, Sosenko J, Wentworth J, Wherrett D, Wilson D, Winter W, Ziegler A, Anderson M, Antinozzi P, Benoist C, Blum J, Bourcier K, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Insel R, Kaufman F, Kay T, Leschek E, Mahon J, Marks J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Pugliese A, Roep B, Roncarolo M, Savage P, Simell O, Sherwin R, Siegelman M, Skyler J, Steck A, Thomas J, Trucco M, Wagner J, Krischer JP, Leschek E, Rafkin L, Bourcier K, Cowie C, Foulkes M, Insel R, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Rafkin L, Sosenko JM, Kenyon NS, Santiago I, Krischer JP, Bundy B, Abbondondolo M, Dixit S, Pasha M, King K, Adcock H, Atterberry L, Fox K, Englert N, Mauras J, Permuy K, Sikes T, Adams T, Berhe B, Guendling L, McLennan L, Paganessi C, Murphy M, Draznin M, Kamboj S, Sheppard V, Lewis L, Coates W, Amado D, Moore G, Babar J, Bedard D, Brenson-Hughes J, Cernich M, Clements R, Duprau S, Goodman L, Hester L, Huerta-Saenz A, Asif I, Karmazin T, Letjen S, Raman D, Morin W, Bestermann E, Morawski J, White A, Brockmyer R, Bays S, Campbell A, Boonstra M, Stapleton N, Stone A, Donoho H, Everett H, Hensley M, Johnson C, Marshall N, Skirvin P, Taylor R, Williams L, Burroughs C, Ray C, Wolverton D, Nickels C, Dothard P, Speiser M, Pellizzari L, Bokor K, Izuora S, Abdelnour P, Cummings S, Cuthbertson D, Paynor M, Leahy M, Riedl S, Shockley R, Saad T, Briones S, Casella C, Herz K, Walsh J, Greening F, Deemer M, Hay S, Hunt N, Sikotra L, Simons D, Karounos R, Oremus L, Dye L, Myers D, 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A, Eisenbarth G, Fain P, Fiallo-Scharer R, Frank N, Goettle H, Haarhues M, Harris S, Horton L, Hutton J, Jeffrrey J, Jenison R, Jones K, Kastelic W, King MA, Lehr D, Lungaro J, Mason K, Maurer H, Nguyen L, Proto A, Realsen J, Schmitt K, Schwartz M, Skovgaard S, Smith J, Vanderwel B, Voelmle M, Wagner R, Wallace A, Walravens P, Weiner L, Westerhoff B, Westfall E, Widmer K, Wright H, Schatz D, Abraham A, Atkinson M, Cintron M, Clare-Salzler M, Ferguson J, Haller M, Hosford J, Mancini D, Rohrs H, Silverstein J, Thomas J, Winter W, Cole G, Cook R, Coy R, Hicks E, Lewis N, Marks J, Pugliese A, Blaschke C, Matheson D, Pugliese A, Sanders-Branca N, Ray Arce LA, Cisneros M, Sabbag S, Moran A, Gibson C, Fife B, Hering B, Kwong C, Leschyshyn J, Nathan B, Pappenfus B, Street A, Boes MA, Peterson Eck S, Finney L, Albright Fischer T, Martin A, Jacqueline Muzamhindo C, Rhodes M, Smith J, Wagner J, Wood B, Becker D, Delallo K, Diaz A, Elnyczky B, Libman I, Pasek B, Riley K, Trucco M, Copemen B, Gwynn 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Manning G, Hendry B, Taylor S, Jones W, Strader M, Bencomo T, Bailey L, Bedolla C, Roldan C, Moudiotis B, Vaidya C, Anning S, Bunce S, Estcourt E, Folland E, Gordon C, Harrill J, Ireland J, Piper L, Scaife K, Sutton S, Wilkins M, Costelloe J, Palmer L, Casas C, Miller M, Burgard C, Erickson J, Hallanger-Johnson P, Clark W, Taylor A, Lafferty S, Gillett C, Nolan M, Pathak L, Sondrol T, Hjelle S, Hafner J, Kotrba R, Hendrickson A, Cemeroglu T, Symington M, Daniel Y, Appiagyei-Dankah D, Postellon M, Racine L, Kleis K, Barnes S, Godwin H, McCullough K, Shaheen G, Buck L, Noel M, Warren S, Weber S, Parker I, Gillespie B, Nelson C, Frost J, Amrhein E, Moreland A, Hayes J, Peggram J, Aisenberg M, Riordan J, Zasa E, Cummings K, Scott T, Pinto A, Mokashi K, McAssey E, Helden P, Hammond L, Dinning S, Rahman S, Ray C, Dimicri S, Guppy H, Nielsen C, Vogel C, Ariza L, Morales Y, Chang R, Gabbay L, Ambrocio L, Manley R, Nemery W, Charlton P, Smith L, Kerr B, Steindel-Kopp M, Alamaguer D, Liljenquist G, Browning T, Coughenour M, Sulk E, Tsalikan M, Tansey J, Cabbage N. Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes. Diabetes Care 2019; 42:192-199. [PMID: 30061316 PMCID: PMC6341285 DOI: 10.2337/dc18-0288] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/28/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings. RESEARCH DESIGN AND METHODS Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years. RESULTS At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects. CONCLUSIONS Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.
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Affiliation(s)
- Taylor M. Triolo
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Alexandra Fouts
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Liping Yu
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Peter A. Gottlieb
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Andrea K. Steck
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
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McLean K, Glasbey J, Borakati A, Brooks T, Chang H, Choi S, Goodson R, Nielsen M, Pronin S, Salloum N, Sewart E, Vanniasegaram D, Drake T, Gillies M, Harrison E, Chapman S, Khatri C, Kong C, Claireaux H, Bath M, Mohan M, McNamee L, Kelly M, Mitchell H, Fitzgerald J, Bhangu A, Nepogodiev D, Antoniou I, Dean R, Davies N, Trecarten S, Henderson I, Holmes C, Wylie J, Shuttleworth R, Jindal A, Hughes F, Gouda P, Fleck R, Hanrahan M, Karunakaran P, Chen J, Sykes M, Sethi R, Suresh S, Patel P, Patel M, Varma R, Mushtaq J, Gundogan B, Bolton W, Khan T, Burke J, Morley R, Favero N, Adams R, Thirumal V, Kennedy E, Ong K, Tan Y, Gabriel J, Bakhsh A, Low J, Yener A, Paraoan V, Preece R, Tilston T, Cumber E, Dean S, Ross T, McCance E, Amin H, Satterthwaite L, Clement K, Gratton R, Mills E, Chiu S, Hung G, Rafiq N, Hayes J, Robertson K, Dynes K, Huang H, Assadullah S, Duncumb J, Moon R, Poo S, Mehta J, Joshi K, Callan R, Norris J, Chilvers N, Keevil H, Jull P, Mallick S, Elf D, Carr L, Player C, Barton E, Martin A, Ratu S, Roberts E, Phan P, Dyal A, Rogers J, Henson A, Reid N, Burke D, Culleton G, Lynne S, Mansoor S, Brennan C, Blessed R, Holloway C, Hill A, Goldsmith T, Mackin S, Kim S, Woin E, Brent G, Coffin J, Ziff O, Momoh Z, Debenham R, Ahmed M, Yong C, Wan J, Copley H, Raut P, Chaudhry F, Nixon G, Dorman C, Tan R, Kanabar S, Canning N, Dolaghan M, Bell N, McMenamin M, Chhabra A, Duke K, Turner L, Patel T, Chew L, Mirza M, Lunawat S, Oremule B, Ward N, Khan M, Tan E, Maclennan D, McGregor R, Chisholm E, Griffin E, Bell L, Hughes B, Davies J, Haq H, Ahmed H, Ungcharoen N, Whacha C, Thethi R, Markham R, Lee A, Batt E, Bullock N, Francescon C, Davies J, Shafiq N, Zhao J, Vivekanantham S, Barai I, Allen J, Marshall D, McIntyre C, Wilson H, Ashton A, Lek C, Behar N, Davis-Hall M, Seneviratne N, Esteve L, Sirakaya M, Ali S, Pope S, Ahn J, Craig-McQuaide A, Gatfield W, Leong S, Demetri A, Kerr A, Rees C, Loveday J, Liu S, Wijesekera M, Maru D, Attalla M, Smith N, Brown D, Sritharan P, Shah A, Charavanamuttu V, Heppenstall-Harris G, Ng K, Raghvani T, Rajan N, Hulley K, Moody N, Williams M, Cotton A, Sharifpour M, Lwin K, Bright M, Chitnis A, Abdelhadi M, Semana A, Morgan F, Reid R, Dickson J, Anderson L, McMullan R, Ahern N, Asmadi A, Anderson L, Boon Xuan JL, Crozier L, McAleer S, Lees D, Adebayo A, Das M, Amphlett A, Al-Robeye A, Valli A, Khangura J, Winarski A, Ali A, Woodward H, Gouldthrope C, Turner M, Sasapu K, Tonkins M, Wild J, Robinson M, Hardie J, Heminway R, Narramore R, Ramjeeawon N, Hibberd A, Winslow F, Ho W, Chong B, Lim K, Ho S, Crewdson J, Singagireson S, Kalra N, Koumpa F, Jhala H, Soon W, Karia M, Rasiah M, Xylas D, Gilbert H, Sundar-Singh M, Wills J, Akhtar S, Patel S, Hu L, Brathwaite-Shirley C, Nayee H, Amin O, Rangan T, Turner E, McCrann C, Shepherd R, Patel N, Prest-Smith J, Auyoung E, Murtaza A, Coates A, Prys-Jones O, King M, Gaffney S, Dewdney C, Nehikhare I, Lavery J, Bassett J, Davies K, Ahmad K, Collins A, Acres M, Egerton C, Cheng K, Chen X, Chan N, Sheldon A, Khan S, Empey J, Ingram E, Malik A, Johnstone M, Goodier R, Shah J, Giles J, Sanders J, McLure S, Pal S, Rangedara A, Baker A, Asbjoernsen C, Girling C, Gray L, Gauntlett L, Joyner C, Qureshi S, Mogan Y, Ng J, Kumar A, Park J, Tan D, Choo K, Raman K, Buakuma P, Xiao C, Govinden S, Thompson O, Charalambos M, Brown E, Karsan R, Dogra T, Bullman L, Dawson P, Frank A, Abid H, Tung L, Qureshi U, Tahmina A, Matthews B, Harris R, O'Connor A, Mazan K, Iqbal S, Stanger S, Thompson J, Sullivan J, Uppal E, MacAskill A, Bamgbose F, Neophytou C, Carroll A, Rookes C, Datta U, Dhutia A, Rashid S, Ahmed N, Lo T, Bhanderi S, Blore C, Ahmed S, Shaheen H, Abburu S, Majid S, Abbas Z, Talukdar S, Burney L, Patel J, Al-Obaedi O, Roberts A, Mahboob S, Singh B, Sheth S, Karia P, Prabhudesai A, Kow K, Koysombat K, Wang S, Morrison P, Maheswaran Y, Keane P, Copley P, Brewster O, Xu G, Harries P, Wall C, Al-Mousawi A, Bonsu S, Cunha P, Ward T, Paul J, Nadanakumaran K, Tayeh S, Holyoak H, Remedios J, Theodoropoulou K, Luhishi A, Jacob L, Long F, Atayi A, Sarwar S, Parker O, Harvey J, Ross H, Rampal R, Thomas G, Vanmali P, McGowan C, Stein J, Robertson V, Carthew L, Teng V, Fong J, Street A, Thakker C, O'Reilly D, Bravo M, Pizzolato A, Khokhar H, Ryan M, Cheskes L, Carr R, Salih A, Bassiony S, Yuen R, Chrastek D, Rosen O'Sullivan H, Amajuoyi A, Wang A, Sitta O, Wye J, Qamar M, Major C, Kaushal A, Morgan C, Petrarca M, Allot R, Verma K, Dutt S, Chilima C, Peroos S, Kosasih S, Chin H, Ashken L, Pearse R, O'Loughlin R, Menon A, Singh K, Norton J, Sagar R, Jathanna N, Rothwell L, Watson N, Harding F, Dube P, Khalid H, Punjabi N, Sagmeister M, Gill P, Shahid S, Hudson-Phillips S, George D, Ashwood J, Lewis T, Dhar M, Sangal P, Rhema I, Kotecha D, Afzal Z, Syeed J, Prakash E, Jalota P, Herron J, Kimani L, Delport A, Shukla A, Agarwal V, Parthiban S, Thakur H, Cymes W, Rinkoff S, Turnbull J, Hayat M, Darr S, Khan U, Lim J, Higgins A, Lakshmipathy G, Forte B, Canning E, Jaitley A, Lamont J, Toner E, Ghaffar A, McDowell M, Salmon D, O'Carroll O, Khan A, Kelly M, Clesham K, Palmer C, Lyons R, Bell A, Chin R, Waldron R, Trimble A, Cox S, Ashfaq U, Campbell J, Holliday R, McCabe G, Morris F, Priestland R, Vernon O, Ledsam A, Vaughan R, Lim D, Bakewell Z, Hughes R, Koshy R, Jackson H, Narayan P, Cardwell A, Jubainville C, Arif T, Elliott L, Gupta V, Bhaskaran G, Odeleye A, Ahmed F, Shah R, Pickard J, Suleman Y, North A, McClymont L, Hussain N, Ibrahim I, Ng G, Wong V, Lim A, Harris L, Tharmachandirar T, Mittapalli D, Patel V, Lakhani M, Bazeer H, Narwani V, Sandhu K, Wingfield L, Gentry S, Adjei H, Bhatti M, Braganza L, Barnes J, Mistry S, Chillarge G, Stokes S, Cleere J, Wadanamby S, Bucko A, Meek J, Boxall N, Heywood E, Wiltshire J, Toh C, Ward A, Shurovi B, Horth D, Patel B, Ali B, Spencer T, Axelson T, Kretzmer L, Chhina C, Anandarajah C, Fautz T, Horst C, Thevathasan A, Ng J, Hirst F, Brewer C, Logan A, Lockey J, Forrest P, Keelty N, Wood A, Springford L, Avery P, Schulz T, Bemand T, Howells L, Collier H, Khajuria A, Tharakan R, Parsons S, Buchan A, McGalliard R, Mason J, Cundy O, Li N, Redgrave N, Watson R, Pezas T, Dennis Y, Segall E, Hameed M, Lynch A, Chamberlain M, Peck F, Neo Y, Russell G, Elseedawy M, Lee S, Foster N, Soo Y, Puan L, Dennis R, Goradia H, Qureshi A, Osman S, Reeves T, Dinsmore L, Marsden M, Lu Q, Pitts-Tucker T, Dunn C, Walford R, Heathcote E, Martin R, Pericleous A, Brzyska K, Reid K, Williams M, Wetherall N, McAleer E, Thomas D, Kiff R, Milne S, Holmes M, Bartlett J, Lucas de Carvalho J, Bloomfield T, Tongo F, Bremner R, Yong N, Atraszkiewicz B, Mehdi A, Tahir M, Sherliker G, Tear A, Pandey A, Broyd A, Omer H, Raphael M, Chaudhry W, Shahidi S, Jawad A, Gill C, Fisher IH, Adeleja I, Clark I, Aidoo-Micah G, Stather P, Salam G, Glover T, Deas G, Sim N, Obute R, Wynell-Mayow W, Sait M, Mitha N, de Bernier G, Siddiqui M, Shaunak R, Wali A, Cuthbert G, Bhudia R, Webb E, Shah S, Ansari N, Perera M, 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M, Sinha Y, Jenvey C, Kitt H, Slade R, Craig A, Deall C, Reakes T, Chervenkoff J, Strange E, O'Bryan M, Murkin C, Joshi D, Bergara T, Naqib S, Wylam D, Scotcher S, Hewitt C, Stoddart M, Kerai A, Trist A, Cole S, Knight C, Stevens S, Cooper G, Ingham R, Dobson J, O'Kane A, Moradzadeh J, Duffy A, Henderson C, Ashraf S, McLaughin C, Hoskins T, Reehal R, Bookless L, McLean R, Stone E, Wright E, Abdikadir H, Roberts C, Spence O, Srikantharajah M, Ruiz E, Matthews J, Gardner E, Hester E, Naran P, Simpson R, Minhas M, Cornish E, Semnani S, Rojoa D, Radotra A, Eraifej J, Eparh K, Smith D, Mistry B, Hickling S, Din W, Liu C, Mithrakumar P, Mirdavoudi V, Rashid M, Mcgenity C, Hussain O, Kadicheeni M, Gardner H, Anim-Addo N, Pearce J, Aslanyan A, Ntala C, Sorah T, Parkin J, Alizadeh M, White A, Edozie F, Johnston J, Kahar A, Navayogaarajah V, Patel B, Carter D, Khonsari P, Burgess A, Kong C, Ponweera A, Cody A, Tan Y, Ng A, Croall A, Allan C, Ng S, Raghuvir V, Telfer R, Greenhalgh A, McKerr C, 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Bhome R, Wilson H, Teoh P, Raji K, Jayakody N, Matthams J, Chong J, Luk C, Greig R, Trail M, Charalambous G, Rocke A, Gardiner N, Bulley F, Warren N, Brennan E, Fergurson P, Wilson R, Whittingham H, Brown E, Khanijau R, Gandhi K, Morris S, Boulton A, Chandan N, Barthorpe A, Maamari R, Sandhu S, McCann M, Higgs L, Balian V, Reeder C, Diaper C, Sale T, Ali H, Archer C, Clarke A, Heskin J, Hurst P, Farmer J, O'Flynn L, Doan L, Shuker B, Stott G, Vithanage N, Hoban K, Nesargikar P, Kennedy H, Grossart C, Tan E, Roy C, Sim P, Leslie K, Sim D, Abul M, Cody N, Tay A, Woon E, Sng S, Mah J, Robson J, Shakweh E, Wing V, Mills H, Li M, Barrow T, Balaji S, Jordan H, Phillips C, Naveed H, Hirani S, Tai A, Ratnakumaran R, Sahathevan A, Shafi A, Seedat M, Weaver R, Batho A, Punj R, Selvachandran H, Bhatt N, Botchey S, Khonat Z, Brennan K, Morrison C, Devlin E, Linton A, Galloway E, McGarvie S, Ramsay N, McRobbie H, Whewell H, Dean W, Nelaj S, Eragat M, Mishra A, Kane T, Zuhair M, Wells M, Wilkinson D, Woodcock N, Sun E, Aziz N, Ghaffar MKA. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. Br J Anaesth 2019; 122:42-50. [PMID: 30579405 DOI: 10.1016/j.bja.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. METHODS This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. RESULTS Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. CONCLUSIONS After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
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Hollenbach J, Villarreal M, Simoneau T, Langton C, Mitchell H, Flores G, M Cloutier M, Szefler S. Inaccuracy of asthma-related self-reported health-care utilization data compared to Medicaid claims. J Asthma 2018; 56:947-950. [PMID: 30091938 DOI: 10.1080/02770903.2018.1502302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jessica Hollenbach
- a Department of Pediatrics, Connecticut Children's Medical Center , Hartford , Connecticut , USA.,b Department of Pediatrics, University of Connecticut School of Medicine , Farmington , Connecticut , USA
| | | | - Tregony Simoneau
- b Department of Pediatrics, University of Connecticut School of Medicine , Farmington , Connecticut , USA.,d Asthma Center, Connecticut Children's Medical Center , Hartford , Connecticut , USA
| | - Christine Langton
- d Asthma Center, Connecticut Children's Medical Center , Hartford , Connecticut , USA
| | | | - Glenn Flores
- a Department of Pediatrics, Connecticut Children's Medical Center , Hartford , Connecticut , USA
| | - Michelle M Cloutier
- f Pediatric Pulmonology, University of Connecticut Health Center , Farmington , Connecticut , USA
| | - Stanley Szefler
- g Pediatric Pulmonary Medicine, University of Colorado Denver School of Medicine , Aurora , Colorado , USA
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Redondo MJ, Geyer S, Steck AK, Sharp S, Wentworth JM, Weedon MN, Antinozzi P, Sosenko J, Atkinson M, Pugliese A, Oram RA, Antinozzi P, Atkinson M, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Colman P, Gottlieb P, Herold K, Insel R, Kay T, Knip M, Marks J, Moran A, Palmer J, Peakman M, Philipson L, Pugliese A, Raskin P, Rodriguez H, Roep B, Russell W, Schatz D, Wherrett D, Wilson D, Winter W, Ziegler A, Benoist C, Blum J, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Kaufman F, Leschek E, Mahon J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Roncarolo M, Simell O, Sherwin R, Siegelman M, Steck A, Thomas J, Trucco M, Wagner J, Greenbaum ,CJ, Bourcier K, Insel R, Krischer JP, Leschek E, Rafkin L, Spain L, Cowie C, Foulkes M, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Kenyon NS, Santiago I, Sosenko JM, Bundy B, Abbondondolo M, Adams T, Amado D, Asif I, Boonstra M, Bundy B, Burroughs C, Cuthbertson D, Deemer M, Eberhard C, Fiske S, Ford J, Garmeson J, Guillette H, Browning G, Coughenour T, Sulk M, Tsalikan E, Tansey M, Cabbage J, Dixit N, Pasha S, King M, Adcock K, Geyer S, Atterberry H, Fox L, Englert K, Mauras N, Permuy J, Sikes K, Berhe T, Guendling B, McLennan L, Paganessi L, Hays B, Murphy C, Draznin M, Kamboj M, Sheppard S, Lewis V, Coates L, Moore W, Babar G, Bedard J, Brenson-Hughes D, Henderson C, Cernich J, Clements M, Duprau R, Goodman S, Hester L, Huerta-Saenz L, Karmazin A, Letjen T, Raman S, Morin D, Henry M, Bestermann W, Morawski E, White J, Brockmyer A, Bays R, Campbell S, Stapleton A, Stone N, Donoho A, Everett H, Heyman K, Hensley H, Johnson M, Marshall C, Skirvin N, Taylor P, Williams R, Ray L, Wolverton C, Nickels D, Dothard C, Hsiao B, Speiser P, Pellizzari M, Bokor L, Izuora K, Abdelnour S, Cummings P, Paynor S, Leahy M, Riedl M, Shockley S, Karges C, Saad R, Briones T, Casella S, Herz C, Walsh K, Greening J, Hay F, Hunt S, 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DeRaad L, Eckert K, Gough J, Isaacson E, Kuhn H, Carroll A, Schubert M, Francis G, Hagan S, Le T, Penn M, Wickham E, Leyva C, Ginem J, Rivera K, Padilla J, Rodriguez I, Jospe N, Czyzyk J, Johnson B, Nadgir U, Marlen N, Prakasam G, Rieger C, Granger M, Glaser N, Heiser E, Harris B, Foster C, Slater H, Wheeler K, Donaldson D, Murray M, Hale D, Tragus R, Holloway M, Word D, Lynch J, Pankratz L, Rogers W, Newfield R, Holland S, Hashiguchi M, Gottschalk M, Philis-Tsimikas A, Rosal R, Kieffer M, Franklin S, Guardado S, Bohannon N, Garcia M, Aguinaldo T, Phan J, Barraza V, Cohen D, Pinsker J, Khan U, Lane P, Wiley J, Jovanovic L, Misra P, Wright M, Cohen D, Huang K, Skiles M, Maxcy S, Pihoker C, Cochrane K, Nallamshetty L, Fosse J, Kearns S, Klingsheim M, Wright N, Viles L, Smith H, Heller S, Cunningham M, Daniels A, Zeiden L, Parrimon Y, Field J, Walker R, Griffin K, Bartholow L, Erickson C, Howard J, Krabbenhoft B, Sandman C, Vanveldhuizen A, Wurlger J, Paulus K, Zimmerman A, Hanisch K, 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Shridharani R, Rusk B, Tessman E, Huffman D, Abrams H, Biederman B, Jones M, Leathers V, Brickman W, Petrie P, Zimmerman D, Howard J, Miller L, Alemzadeh R, Mihailescu D, Melgozza-Walker R, Abdulla N, Boucher-Berry C, Ize-Ludlow D, Levy R, Swenson Brousell C, Scott R, Heenan H, Lunt H, Kendall D, Willis J, Darlow B, Crimmins N, Edler D, Weis T, Schultz C, Rogers D, Latham D, Mawhorter C, Switzer C, Spencer W, Konstantnopoulus P, Broder S, Klein J, Bachrach B, Gardner M, Eichelberger D, Knight L, Szadek L, Welnick G, Thompson B, Hoffman R, Revell A, Cherko J, Carter K, Gilson E, Haines J, Arthur G, Bowen B, Zipf W, Graves P, Lozano R, Seiple D, Spicer K, Chang A, Fregosi J, Harbinson J, Paulson C, Stalters S, Wright P, Zlock D, Freeth A, Victory J, Maheshwari H, Maheshwari A, Holmstrom T, Bueno J, Arguello R, Ahern J, Noreika L, Watson V, Hourse S, Breyer P, Kissel C, Nicholson Y, Pfeifer M, Almazan S, Bajaj J, Quinn M, Funk K, McCance J, Moreno E, Veintimilla R, Wells A, Cook J, Trunnel S, Transue D, Surhigh J, Bezzaire D, Moltz K, Zacharski E, Henske J, Desai S, Frizelis K, Khan F, Sjoberg R, Allen K, Manning P, Hendry G, Taylor B, Jones S, Couch R, Danchak R, Lieberman D, Strader W, Bencomo M, Bailey T, Bedolla L, Roldan C, Moudiotis C, Vaidya B, Anning C, Bunce S, Estcourt S, Folland E, Gordon E, Harrill C, Ireland J, Piper J, Scaife L, Sutton K, Wilkins S, Costelloe M, Palmer J, Casas L, Miller C, Burgard M, Erickson C, Hallanger-Johnson J, Clark P, Taylor W, Galgani J, Banerjee S, Banda C, McEowen D, Kinman R, Lafferty A, Gillett S, Nolan C, Pathak M, Sondrol L, Hjelle T, Hafner S, Kotrba J, Hendrickson R, Cemeroglu A, Symington T, Daniel M, Appiagyei-Dankah Y, Postellon D, Racine M, Kleis L, Barnes K, Godwin S, McCullough H, Shaheen K, Buck G, Noel L, Warren M, Weber S, Parker S, Gillespie I, Nelson B, Frost C, Amrhein J, Moreland E, Hayes A, Peggram J, Aisenberg J, Riordan M, Zasa J, Cummings E, Scott K, Pinto T, Mokashi A, McAssey K, Helden E, Hammond P, Dinning L, Rahman S, Ray S, Dimicri C, Guppy S, Nielsen H, Vogel C, Ariza C, Morales L, Chang Y, Gabbay R, Ambrocio L, Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Affiliation(s)
- Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Seth Sharp
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | - John M. Wentworth
- Walter and Eliza Hall Institute of Medical Research and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | | | | | | | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
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Szefler SJ, Cloutier MM, Villarreal M, Hollenbach JP, Gleason M, Haas-Howard C, Vinick C, Calatroni A, Cicutto L, White M, Williams S, McGinn M, Langton C, Shocks D, Mitchell H, Stempel DA. Building Bridges for Asthma Care: Reducing school absence for inner-city children with health disparities. J Allergy Clin Immunol 2018; 143:746-754.e2. [PMID: 30055181 DOI: 10.1016/j.jaci.2018.05.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/16/2018] [Accepted: 05/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children with asthma are at increased risk for experiencing health and educational disparities because of increased school absence. School nurses are well positioned to support asthma management and improve school attendance. OBJECTIVE We sought to implement and assess the effect of the Building Bridges for Asthma Care Program on improving school attendance and measures of asthma control. METHODS Children with asthma (age, 5-14 years) in the Denver Public School System (n = 240) and the Hartford Public School System (n = 223) were enrolled in the Building Bridges Program during the 2013-2014 and 2014-2015 school years and followed until the end of the second school year. The primary outcome was school absence, with secondary outcomes, including asthma control, measured based on Childhood Asthma Control Test or the Asthma Control Test scores and rescue inhaler use. RESULTS Participants experienced a 22% absolute decrease in school absenteeism, the number of children with an Asthma Control Test/Childhood Asthma Control Test score of less than the control threshold of 20 decreased from 42.7% to 28.8%, and bronchodilator use greater than 2 times per week decreased from 35.8% to 22.9% (all changes were significant, P < .01). CONCLUSIONS Children enrolled in the Building Bridges for Asthma Care Program experienced reduced school absence and improved asthma control.
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Affiliation(s)
- Stanley J Szefler
- Pediatric Asthma Research Program and the Breathing Institute, Children's Hospital Colorado, and the Section of Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colo.
| | - Michelle M Cloutier
- Pediatrics and Medicine, UCONN Health, and the Asthma Center, Connecticut Children's Medical Center, Hartford, Conn
| | | | - Jessica P Hollenbach
- Department of Pediatrics, University of Connecticut School of Medicine, and the Asthma Center, Connecticut Children's Medical Center, Hartford, Conn
| | - Melanie Gleason
- Building Bridges Asthma Program, Children's Hospital Colorado, and the Department of Pediatrics, Section of Pediatric Pulmonary Medicine, University of Colorado School of Medicine, Aurora, Colo
| | - Christy Haas-Howard
- Denver Public Schools, Nursing and Student Health Services, and the Colorado Department of Education, Asthma Grant Program, Denver, Colo
| | - Carol Vinick
- Building Bridges Coordinator, Asthma Center, and the Connecticut Children's Medical Center, Hartford, Conn
| | | | - Lisa Cicutto
- Community Outreach and Research, National Jewish Health, and the Clinical Science Program, University of Colorado Denver AMC, Denver, Colo
| | - Marty White
- Children's Hospital Colorado/Denver Public Schools, Denver, Colo
| | | | | | - Christine Langton
- Building Bridges Coordinator, Asthma Center, and the Connecticut Children's Medical Center, Hartford, Conn
| | - Donna Shocks
- Denver Public Schools, Nursing and Student Health Services, Denver, Colo
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Abstract
STUDY QUESTION What is the impact of endometriosis on male partners of women with the condition? SUMMARY ANSWER Endometriosis significantly impacts men across several life domains and can negatively impact emotional well-being. WHAT IS KNOWN ALREADY Endometriosis has been shown to negatively impact women's quality of life and may strain intimate relationships. Little is known about the impact on male partners. STUDY DESIGN, SIZE, DURATION The ENDOPART study was a cross-sectional, qualitative study of 22 women with endometriosis and their male partners (n = 44) in the UK (2012–2013). PARTICIPANTS/MATERIALS, SETTING, METHODS Inclusion criteria: laparoscopic diagnosis of endometriosis; the presence of symptoms for at least a year; partners living together. Data were collected via face to face, semi structured interviews with partners interviewed separately. Data were analysed thematically, assisted by NVivo 10. MAIN RESULTS AND THE ROLE OF CHANCE Men reported that endometriosis affected many life domains including sex and intimacy, planning for and having children, working lives and household income. It also required them to take on additional support tasks and roles. Endometriosis also had an impact on men's emotions, with responses including helplessness, frustration, worry and anger. The absence of professional or wider societal recognition of the impact on male partners, and a lack of support available to men, results in male partners having a marginalized status in endometriosis care. LIMITATIONS REASONS FOR CAUTION Self-selection of participants may have resulted in a sample representing those with more severe symptoms. Couples included are in effect ‘survivors’ in relationship terms, therefore, findings may underestimate the contribution of endometriosis to relationship breakdown. WIDER IMPLICATIONS OF THE FINDINGS The study extends knowledge about the impact of endometriosis on relationships, which thus far has been drawn largely from studies with women, by providing new insights about how this condition affects male partners. Healthcare practitioners need to take a more couple-centred, biopsychosocial approach toward the treatment of endometriosis, inclusive of partners and relationship issues. The findings demonstrate a need for information and support resources aimed at partners and couples. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the Economic and Social Research Council (reference ES/J003662/1). The authors have no conflicts of interest.
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Affiliation(s)
- L Culley
- School of Applied Social Sciences, Faculty of Health and Life Sciences, The Gateway, De Montfort University, Hawthorn Building, Leicester LE1 9BH, UK
| | - C Law
- School of Applied Social Sciences, Faculty of Health and Life Sciences, The Gateway, De Montfort University, Hawthorn Building, Leicester LE1 9BH, UK
| | - N Hudson
- School of Applied Social Sciences, Faculty of Health and Life Sciences, The Gateway, De Montfort University, Hawthorn Building, Leicester LE1 9BH, UK
| | - H Mitchell
- School of Applied Social Sciences, Faculty of Health and Life Sciences, The Gateway, De Montfort University, Hawthorn Building, Leicester LE1 9BH, UK
| | - E Denny
- Faculty of Health, Education and Life Sciences, Birmingham City University, Westbourne Road, Edgbaston, Birmingham B15 3TN, UK
| | - N Raine-Fenning
- Nurture Fertility, East Midlands Fertility Centre, 25 Business Park, Bostocks Lane, Sandiacre, Nottingham NG10 5QS, UK.,Division of Obstetrics and Gynaecology, School of Clinical Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK
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Ting A, May M, Mitchell H, Carver C, Kim Y. 0865 Dyadic Effects of Daily Stress and Satisfaction on Sleep Efficiency: A Preliminary Report among Colorectal Cancer Survivors and Their Spouses. Sleep 2018. [DOI: 10.1093/sleep/zsy061.864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Ting
- University of Miami, Coral Gables, FL
| | - M May
- University of Miami, Coral Gables, FL
| | | | - C Carver
- University of Miami, Coral Gables, FL
| | - Y Kim
- University of Miami, Coral Gables, FL
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Filella X, Ballesta A, Fox M, Mitchell H, Molina R, Pürstner P, Thome H. Multicentre Clinical Evaluation of the COBAS CORE CEA, CA 125 II and PSA Tumor Marker Assays. Int J Biol Markers 2018. [DOI: 10.1177/172460089601100108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of our study was to evaluate the clinical usefulness of the tumor markers CEA, CA 125 and PSA using the COBAS CORE system from Roche Diagnostic Systems. Our results demonstrate that determination of these markers on the COBAS CORE immunoassasy analyser provides the performance required for routine use in clinical practice. The results obtained in this clinical trial validate the correlation with disease extension, a characteristic that defines and determines the clinical utility of the tumor markers. We also conclude that learning to operate the COBAS CORE system is simple, as is management of the system through the user-friendly software.
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Affiliation(s)
- X. Filella
- Department of Clinical Biochemistry (Unit for Cancer Research), Hospital Clinic Provincial, Barcelona - Spain
| | - A.M. Ballesta
- Department of Clinical Biochemistry (Unit for Cancer Research), Hospital Clinic Provincial, Barcelona - Spain
| | - M. Fox
- Department of Medical Oncology, Charing Cross Hospital, London - United Kingdom
| | - H. Mitchell
- Department of Medical Oncology, Charing Cross Hospital, London - United Kingdom
| | - R. Molina
- Department of Clinical Biochemistry (Unit for Cancer Research), Hospital Clinic Provincial, Barcelona - Spain
| | - P. Pürstner
- Endocrinology Laboratory, University Hospital for Women, Graz - Austria
| | - H. Thome
- Department of Biochemistry, Hospital of Chambéry, Chambéry - France
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Eng N, Chen C, Aldridge M, Osborne A, Vega J, Mitchell H, Smith A, Hurtik M, Morris A, Gupta D, Bhatt K, Laskar S, Cole R. Preemptive vs. Upfront CMV Prophylaxis Strategies and Risk of Non-CMV Herpesvirus Infections in Intermediate Risk Heart Transplant Recipients. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.432] [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: 10/17/2022] Open
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Walker T, Edge D, Shaw J, Wilson H, McNair L, Mitchell H, Gutridge K, Senior J, Sutton M, Meacock R, Abel K. Contemporary women's secure psychiatric services in the United Kingdom: A qualitative analysis of staff views. J Psychiatr Ment Health Nurs 2017; 24:660-670. [PMID: 28783204 DOI: 10.1111/jpm.12416] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Three pilot UK-only Women's Enhanced Medium Secure Services (WEMSS) was opened in 2007 to support women's movement from high secure care and provide a bespoke, women-only service. Evidence suggests that women's secure services are particularly challenging environments to work in and staffing issues (e.g., high turnover) can cause difficulties in establishing a therapeutic environment. Research in this area has focused on the experiences of service users. Studies which have examined staff views have focused on their feelings towards women in their care and the emotional burden of working in women's secure services. No papers have made a direct comparison between staff working in different services. WHAT DOES THIS STUDY ADD TO EXISTING KNOWLEDGE?: This is the first study to explore the views and experiences of staff in the three UK WEMSS pilot services and contrast them with staff from women's medium secure services. Drawing upon data from eighteen semi-structured interviews (nine WEMSS, nine non-WEMSS), key themes cover staff perceptions of factors important for women's recovery and their views on operational aspects of services. This study extends our understanding of the experiences of staff working with women in secure care and bears relevance for staff working internationally, as well as in UK services. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The study reveals the importance of induction and training for bank and agency staff working in women's secure services. Further, regular clinical supervision should be mandatory for all staff so they are adequately supported. ABSTRACT Introduction Women's Enhanced Medium Secure Services (WEMSS) is bespoke, gender-sensitive services which opened in the UK in 2007 at three pilot sites. This study is the first of its kind to explore the experiences of WEMSS staff, directly comparing them to staff in a standard medium secure service for women. The literature to date has focused on the experiences of service users or staff views on working with women in secure care. Aim This qualitative study, embedded in a multimethod evaluation of WEMSS, aimed to explore the views and experiences of staff in WEMSS and comparator medium secure services. Methods Qualitative interviews took place with nine WEMSS staff and nine comparator medium secure staff. Interviews focused on factors important for recovery, barriers to facilitating recovery and operational aspects of the service. Discussion This study provides a rare insight into the perspectives of staff working in UK women's secure services, an under-researched area in the UK and internationally. Findings suggest that the success of services, including WEMSS, is compromised by operational factors such as the use of bank staff. Implications for practice Comprehensive training and supervision should be mandatory for all staff, so best practice is met and staff adequately supported.
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Affiliation(s)
- T Walker
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - D Edge
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - J Shaw
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Offender Health Research Network, University of Manchester, Manchester, UK
| | - H Wilson
- Lancashire Care NHS Foundation Trust, Preston, UK
| | - L McNair
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - H Mitchell
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - K Gutridge
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - J Senior
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Offender Health Research Network, University of Manchester, Manchester, UK
| | - M Sutton
- Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | - R Meacock
- Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | - K Abel
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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Hollis A, Quinn L, Begum R, Mitchell H, Hodson J, Whiting J, Griffiths E. Tumour Length in Oesophageal Cancer. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Furegato M, Mitchell H, Ogaz D, Woodhall S, Connor N, Hughes G, Nardone A, Mohammed H. The role of frequent HIV testing in diagnosing HIV in men who have sex with men. HIV Med 2017; 19:118-122. [PMID: 28984407 DOI: 10.1111/hiv.12558] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In the UK, quarterly HIV testing is recommended for high-risk men who have sex with men (MSM). In this manuscript we determined the risk of being newly diagnosed with HIV in MSM by their HIV testing history, considering both the frequency and periodicity of testing. METHODS Data on HIV incidence in MSM attending a sexual health clinic (SHC) in England in 2013-2014 with testing history (previous 2 years) were obtained from GUMCAD, the national sexually transmitted infection (STI) surveillance system in England. HIV testing patterns among MSM were defined using the frequency and periodicity of testing, based on 3 month intervals, in the year preceding the first attendance during the study period. Cox proportional hazards regression was used to determine the association between HIV testing pattern and time to HIV diagnosis with and without adjustment for demographic confounders. Analyses were stratified by risk stratum, with 'high risk' defined as a history of a bacterial STI in the past year. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) are reported. RESULTS Among the 37 702 HIV-negative MSM attending an SHC in 2013-2014, 1105 (3%) were diagnosed with HIV infection within 1 year of their first attendance. The probability of HIV diagnosis was highest in MSM who were tested quarterly compared with those who were not tested in the past year (aHR 2.51; 95% CI 1.33-4.74); this increased 1.8-fold among high-risk MSM (aHR 4.48; 95% CI 0.97-21.17). CONCLUSIONS The probability of subsequent HIV diagnosis was greatest in high-risk MSM who were tested most frequently. Quarterly HIV testing increased the likelihood of identifying undiagnosed HIV infection and should remain a continued recommendation for high-risk MSM.
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Affiliation(s)
- M Furegato
- National Infection Service, Public Health England, London, UK
| | - H Mitchell
- National Infection Service, Public Health England, London, UK
| | - D Ogaz
- National Infection Service, Public Health England, London, UK
| | - S Woodhall
- National Infection Service, Public Health England, London, UK
| | - N Connor
- National Infection Service, Public Health England, London, UK
| | - G Hughes
- National Infection Service, Public Health England, London, UK
| | - A Nardone
- National Infection Service, Public Health England, London, UK
| | - H Mohammed
- National Infection Service, Public Health England, London, UK
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Gold DR, Adamkiewicz G, Arshad SH, Celedón JC, Chapman MD, Chew GL, Cook DN, Custovic A, Gehring U, Gern JE, Johnson CC, Kennedy S, Koutrakis P, Leaderer B, Mitchell H, Litonjua AA, Mueller GA, O'Connor GT, Ownby D, Phipatanakul W, Persky V, Perzanowski MS, Ramsey CD, Salo PM, Schwaninger JM, Sordillo JE, Spira A, Suglia SF, Togias A, Zeldin DC, Matsui EC. NIAID, NIEHS, NHLBI, and MCAN Workshop Report: The indoor environment and childhood asthma-implications for home environmental intervention in asthma prevention and management. J Allergy Clin Immunol 2017; 140:933-949. [PMID: 28502823 PMCID: PMC5632590 DOI: 10.1016/j.jaci.2017.04.024] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [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: 03/01/2017] [Accepted: 04/14/2017] [Indexed: 01/19/2023]
Abstract
Environmental exposures have been recognized as critical in the initiation and exacerbation of asthma, one of the most common chronic childhood diseases. The National Institute of Allergy and Infectious Diseases; National Institute of Environmental Health Sciences; National Heart, Lung, and Blood Institute; and Merck Childhood Asthma Network sponsored a joint workshop to discuss the current state of science with respect to the indoor environment and its effects on the development and morbidity of childhood asthma. The workshop included US and international experts with backgrounds in allergy/allergens, immunology, asthma, environmental health, environmental exposures and pollutants, epidemiology, public health, and bioinformatics. Workshop participants provided new insights into the biologic properties of indoor exposures, indoor exposure assessment, and exposure reduction techniques. This informed a primary focus of the workshop: to critically review trials and research relevant to the prevention or control of asthma through environmental intervention. The participants identified important limitations and gaps in scientific methodologies and knowledge and proposed and prioritized areas for future research. The group reviewed socioeconomic and structural challenges to changing environmental exposure and offered recommendations for creative study design to overcome these challenges in trials to improve asthma management. The recommendations of this workshop can serve as guidance for future research in the study of the indoor environment and on environmental interventions as they pertain to the prevention and management of asthma and airway allergies.
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Affiliation(s)
- Diane R Gold
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass.
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Syed Hasan Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, and Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Juan C Celedón
- Division of Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pa
| | | | - Ginger L Chew
- Centers for Disease Control and Prevention (CDC), National Center for Environmental Health, Division of Environmental Hazards and Health Effects | Air Pollution and Respiratory Health Branch, Atlanta, Ga
| | - Donald N Cook
- Immunity, Inflammation and Disease Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - Adnan Custovic
- Section of Paediatrics and MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - James E Gern
- Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Christine C Johnson
- Department of Public Health Sciences, Henry Ford Hospital & Health System, Detroit, Mich
| | - Suzanne Kennedy
- Department of Pediatrics, NC Children's Hospital, University of North Carolina, Chapel Hill, NC
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Brian Leaderer
- Yale School of Public Health, Yale School of Medicine, Yale School of Forestry and Environmental Studies, Center for Perinatal, Pediatric and Environmental Epidemiology (CPPEE), New Haven, Conn
| | | | - Augusto A Litonjua
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Geoffrey A Mueller
- Genome Integrity and Structural Biology Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - George T O'Connor
- Pulmonary Center, Boston University School of Medicine, Boston, Mass
| | - Dennis Ownby
- Division of Allergy-Immunology and Rheumatology, Department of Pediatrics, Augusta University, Augusta, Ga
| | - Wanda Phipatanakul
- Asthma, Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Victoria Persky
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Ill
| | - Matthew S Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Clare D Ramsey
- Departments of Medicine and Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Päivi M Salo
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - Julie M Schwaninger
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Md
| | - Joanne E Sordillo
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Avrum Spira
- Division of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Shakira F Suglia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Ga
| | - Alkis Togias
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Md
| | - Darryl C Zeldin
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - Elizabeth C Matsui
- Division of Pediatric Allergy/Immunology, Johns Hopkins University, Baltimore, Md
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Kennedy S, Bailey R, Jaffee K, Markus A, Gerstein M, Stevens DM, Lesch JK, Malveaux FJ, Mitchell H. Effectiveness of Evidence-Based Asthma Interventions. Pediatrics 2017; 139:peds.2016-4221. [PMID: 28562279 DOI: 10.1542/peds.2016-4221] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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] [Accepted: 03/22/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Researchers often struggle with the gap between efficacy and effectiveness in clinical research. To bridge this gap, the Community Healthcare for Asthma Management and Prevention of Symptoms (CHAMPS) study adapted an efficacious, randomized controlled trial that resulted in evidence-based asthma interventions in community health centers. METHODS Children (aged 5-12 years; N = 590) with moderate to severe asthma were enrolled from 3 intervention and 3 geographically/capacity-matched control sites in high-risk, low-income communities located in Arizona, Michigan, and Puerto Rico. The asthma intervention was tailored to the participant's allergen sensitivity and exposure, and it comprised 4 visits over the course of 1 year. Study visits were documented and monitored prospectively via electronic data capture. Asthma symptoms and health care utilization were evaluated at baseline, and at 6 and 12 months. RESULTS A total of 314 intervention children and 276 control children were enrolled in the study. Allergen sensitivity testing (96%) and home environmental assessments (89%) were performed on the majority of intervention children. Overall study activity completion (eg, intervention visits, clinical assessments) was 70%. Overall and individual site participant symptom days in the previous 4 weeks were significantly reduced compared with control findings (control, change of -2.28; intervention, change of -3.27; difference, -0.99; P < .001), and this result was consistent with changes found in the rigorous evidence-based interventions. CONCLUSIONS Evidence-based interventions can be successfully adapted into primary care settings that serve impoverished, high-risk populations, reducing the morbidity of asthma in these high-need populations.
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Affiliation(s)
| | | | | | - Anne Markus
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC; and
| | - Maya Gerstein
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC; and
| | - David M Stevens
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC; and
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Fernando S, Okonta L, Sandri I, Wardley A, Mitchell H, Conway A. Changes in Ejection Fraction (EF) Following Sequential Anthracycline and Trastuzumab in Patients with HER2+ Early Breast Cancer (EBC) – Is There a Need for Two Echocardiograms Pre-trastuzumab? Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2017.01.020] [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: 10/19/2022]
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Fernando S, Conway A, Mitchell H, Sandri I, Wardley A, Okonta L, Mansi J. ATwo-Centre Audit on Changes in Ejection Fraction (EF) following sequential anthracycline chemotherapy and Trastuzumab (T) in patients with HER2+ Early Breast Cancer (EBC). Breast 2017. [DOI: 10.1016/s0960-9776(17)30399-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Stempel DA, Szefler SJ, Pedersen S, Zeiger RS, Yeakey AM, Lee LA, Liu AH, Mitchell H, Kral KM, Raphiou IH, Prillaman BA, Buaron KS, Yun Kirby S, Pascoe SJ. Safety of Adding Salmeterol to Fluticasone Propionate in Children with Asthma. N Engl J Med 2016; 375:840-9. [PMID: 27579634 DOI: 10.1056/nejmoa1606356] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Long-acting beta-agonists (LABAs) have been shown to increase the risk of asthma-related death among adults and the risk of asthma-related hospitalization among children. It is unknown whether the concomitant use of inhaled glucocorticoids with LABAs mitigates those risks. This trial prospectively evaluated the safety of the LABA salmeterol, added to fluticasone propionate, in a fixed-dose combination in children. METHODS We randomly assigned, in a 1:1 ratio, children 4 to 11 years of age who required daily asthma medications and had a history of asthma exacerbations in the previous year to receive fluticasone propionate plus salmeterol or fluticasone alone for 26 weeks. The primary safety end point was the first serious asthma-related event (death, endotracheal intubation, or hospitalization), as assessed in a time-to-event analysis. The statistical design specified that noninferiority would be shown if the upper boundary of the 95% confidence interval of the hazard ratio for the primary safety end point was less than 2.675. The main efficacy end point was the first severe asthma exacerbation that led to treatment with systemic glucocorticoids, as assessed in a time-to-event analysis. RESULTS Among the 6208 patients, 27 patients in the fluticasone-salmeterol group and 21 in the fluticasone-alone group had a serious asthma-related event (all were hospitalizations); the hazard ratio with fluticasone-salmeterol versus fluticasone alone was 1.28 (95% confidence interval [CI], 0.73 to 2.27), which showed the noninferiority of fluticasone-salmeterol (P=0.006). A total of 265 patients (8.5%) in the fluticasone-salmeterol group and 309 (10.0%) in the fluticasone-alone group had a severe asthma exacerbation (hazard ratio, 0.86; 95% CI, 0.73 to 1.01). CONCLUSIONS In this trial involving children with asthma, salmeterol in a fixed-dose combination with fluticasone was associated with the risk of a serious asthma-related event that was similar to the risk with fluticasone alone. (Funded by GlaxoSmithKline; VESTRI ClinicalTrials.gov number, NCT01462344 .).
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Affiliation(s)
- David A Stempel
- From Respiratory Clinical Development (D.A.S., A.M.Y., L.A.L., I.H.R., K.S.B., S.Y.K., S.J.P.) and Research and Development, Clinical Platforms and Sciences, Clinical Statistics (K.M.K.), GlaxoSmithKline, Research Triangle Park, Rho, Chapel Hill (H.M.), and Biostatistics, Parexel International, Durham (B.A.P.) - all in North Carolina; the Department of Pediatrics, Breathing Institute, Pediatric Pulmonary Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora (S.J.S., A.H.L.); the Department of Pediatrics, Center Lillebælt, Fredericia and Kolding Hospital, Odense, Denmark (S.P.); and the Department of Allergy and Research and Evaluation, Kaiser Permanente Research, San Diego, CA (R.S.Z.)
| | - Stanley J Szefler
- From Respiratory Clinical Development (D.A.S., A.M.Y., L.A.L., I.H.R., K.S.B., S.Y.K., S.J.P.) and Research and Development, Clinical Platforms and Sciences, Clinical Statistics (K.M.K.), GlaxoSmithKline, Research Triangle Park, Rho, Chapel Hill (H.M.), and Biostatistics, Parexel International, Durham (B.A.P.) - all in North Carolina; the Department of Pediatrics, Breathing Institute, Pediatric Pulmonary Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora (S.J.S., A.H.L.); the Department of Pediatrics, Center Lillebælt, Fredericia and Kolding Hospital, Odense, Denmark (S.P.); and the Department of Allergy and Research and Evaluation, Kaiser Permanente Research, San Diego, CA (R.S.Z.)
| | - Søren Pedersen
- From Respiratory Clinical Development (D.A.S., A.M.Y., L.A.L., I.H.R., K.S.B., S.Y.K., S.J.P.) and Research and Development, Clinical Platforms and Sciences, Clinical Statistics (K.M.K.), GlaxoSmithKline, Research Triangle Park, Rho, Chapel Hill (H.M.), and Biostatistics, Parexel International, Durham (B.A.P.) - all in North Carolina; the Department of Pediatrics, Breathing Institute, Pediatric Pulmonary Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora (S.J.S., A.H.L.); the Department of Pediatrics, Center Lillebælt, Fredericia and Kolding Hospital, Odense, Denmark (S.P.); and the Department of Allergy and Research and Evaluation, Kaiser Permanente Research, San Diego, CA (R.S.Z.)
| | - Robert S Zeiger
- From Respiratory Clinical Development (D.A.S., A.M.Y., L.A.L., I.H.R., K.S.B., S.Y.K., S.J.P.) and Research and Development, Clinical Platforms and Sciences, Clinical Statistics (K.M.K.), GlaxoSmithKline, Research Triangle Park, Rho, Chapel Hill (H.M.), and Biostatistics, Parexel International, Durham (B.A.P.) - all in North Carolina; the Department of Pediatrics, Breathing Institute, Pediatric Pulmonary Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora (S.J.S., A.H.L.); the Department of Pediatrics, Center Lillebælt, Fredericia and Kolding Hospital, Odense, Denmark (S.P.); and the Department of Allergy and Research and Evaluation, Kaiser Permanente Research, San Diego, CA (R.S.Z.)
| | - Anne M Yeakey
- From Respiratory Clinical Development (D.A.S., A.M.Y., L.A.L., I.H.R., K.S.B., S.Y.K., S.J.P.) and Research and Development, Clinical Platforms and Sciences, Clinical Statistics (K.M.K.), GlaxoSmithKline, Research Triangle Park, Rho, Chapel Hill (H.M.), and Biostatistics, Parexel International, Durham (B.A.P.) - all in North Carolina; the Department of Pediatrics, Breathing Institute, Pediatric Pulmonary Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora (S.J.S., A.H.L.); the Department of Pediatrics, Center Lillebælt, Fredericia and Kolding Hospital, Odense, Denmark (S.P.); and the Department of Allergy and Research and Evaluation, Kaiser Permanente Research, San Diego, CA (R.S.Z.)
| | - Laurie A Lee
- From Respiratory Clinical Development (D.A.S., A.M.Y., L.A.L., I.H.R., K.S.B., S.Y.K., S.J.P.) and Research and Development, Clinical Platforms and Sciences, Clinical Statistics (K.M.K.), GlaxoSmithKline, Research Triangle Park, Rho, Chapel Hill (H.M.), and Biostatistics, Parexel International, Durham (B.A.P.) - all in North Carolina; the Department of Pediatrics, Breathing Institute, Pediatric Pulmonary Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora (S.J.S., A.H.L.); the Department of Pediatrics, Center Lillebælt, Fredericia and Kolding Hospital, Odense, Denmark (S.P.); and the Department of Allergy and Research and Evaluation, Kaiser Permanente Research, San Diego, CA (R.S.Z.)
| | - Andrew H Liu
- From Respiratory Clinical Development (D.A.S., A.M.Y., L.A.L., I.H.R., K.S.B., S.Y.K., S.J.P.) and Research and Development, Clinical Platforms and Sciences, Clinical Statistics (K.M.K.), GlaxoSmithKline, Research Triangle Park, Rho, Chapel Hill (H.M.), and Biostatistics, Parexel International, Durham (B.A.P.) - all in North Carolina; the Department of Pediatrics, Breathing Institute, Pediatric Pulmonary Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora (S.J.S., A.H.L.); the Department of Pediatrics, Center Lillebælt, Fredericia and Kolding Hospital, Odense, Denmark (S.P.); and the Department of Allergy and Research and Evaluation, Kaiser Permanente Research, San Diego, CA (R.S.Z.)
| | - Herman Mitchell
- From Respiratory Clinical Development (D.A.S., A.M.Y., L.A.L., I.H.R., K.S.B., S.Y.K., S.J.P.) and Research and Development, Clinical Platforms and Sciences, Clinical Statistics (K.M.K.), GlaxoSmithKline, Research Triangle Park, Rho, Chapel Hill (H.M.), and Biostatistics, Parexel International, Durham (B.A.P.) - all in North Carolina; the Department of Pediatrics, Breathing Institute, Pediatric Pulmonary Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora (S.J.S., A.H.L.); the Department of Pediatrics, Center Lillebælt, Fredericia and Kolding Hospital, Odense, Denmark (S.P.); and the Department of Allergy and Research and Evaluation, Kaiser Permanente Research, San Diego, CA (R.S.Z.)
| | - Kenneth M Kral
- From Respiratory Clinical Development (D.A.S., A.M.Y., L.A.L., I.H.R., K.S.B., S.Y.K., S.J.P.) and Research and Development, Clinical Platforms and Sciences, Clinical Statistics (K.M.K.), GlaxoSmithKline, Research Triangle Park, Rho, Chapel Hill (H.M.), and Biostatistics, Parexel International, Durham (B.A.P.) - all in North Carolina; the Department of Pediatrics, Breathing Institute, Pediatric Pulmonary Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora (S.J.S., A.H.L.); the Department of Pediatrics, Center Lillebælt, Fredericia and Kolding Hospital, Odense, Denmark (S.P.); and the Department of Allergy and Research and Evaluation, Kaiser Permanente Research, San Diego, CA (R.S.Z.)
| | - Ibrahim H Raphiou
- From Respiratory Clinical Development (D.A.S., A.M.Y., L.A.L., I.H.R., K.S.B., S.Y.K., S.J.P.) and Research and Development, Clinical Platforms and Sciences, Clinical Statistics (K.M.K.), GlaxoSmithKline, Research Triangle Park, Rho, Chapel Hill (H.M.), and Biostatistics, Parexel International, Durham (B.A.P.) - all in North Carolina; the Department of Pediatrics, Breathing Institute, Pediatric Pulmonary Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora (S.J.S., A.H.L.); the Department of Pediatrics, Center Lillebælt, Fredericia and Kolding Hospital, Odense, Denmark (S.P.); and the Department of Allergy and Research and Evaluation, Kaiser Permanente Research, San Diego, CA (R.S.Z.)
| | - Barbara A Prillaman
- From Respiratory Clinical Development (D.A.S., A.M.Y., L.A.L., I.H.R., K.S.B., S.Y.K., S.J.P.) and Research and Development, Clinical Platforms and Sciences, Clinical Statistics (K.M.K.), GlaxoSmithKline, Research Triangle Park, Rho, Chapel Hill (H.M.), and Biostatistics, Parexel International, Durham (B.A.P.) - all in North Carolina; the Department of Pediatrics, Breathing Institute, Pediatric Pulmonary Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora (S.J.S., A.H.L.); the Department of Pediatrics, Center Lillebælt, Fredericia and Kolding Hospital, Odense, Denmark (S.P.); and the Department of Allergy and Research and Evaluation, Kaiser Permanente Research, San Diego, CA (R.S.Z.)
| | - Kathleen S Buaron
- From Respiratory Clinical Development (D.A.S., A.M.Y., L.A.L., I.H.R., K.S.B., S.Y.K., S.J.P.) and Research and Development, Clinical Platforms and Sciences, Clinical Statistics (K.M.K.), GlaxoSmithKline, Research Triangle Park, Rho, Chapel Hill (H.M.), and Biostatistics, Parexel International, Durham (B.A.P.) - all in North Carolina; the Department of Pediatrics, Breathing Institute, Pediatric Pulmonary Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora (S.J.S., A.H.L.); the Department of Pediatrics, Center Lillebælt, Fredericia and Kolding Hospital, Odense, Denmark (S.P.); and the Department of Allergy and Research and Evaluation, Kaiser Permanente Research, San Diego, CA (R.S.Z.)
| | - Suyong Yun Kirby
- From Respiratory Clinical Development (D.A.S., A.M.Y., L.A.L., I.H.R., K.S.B., S.Y.K., S.J.P.) and Research and Development, Clinical Platforms and Sciences, Clinical Statistics (K.M.K.), GlaxoSmithKline, Research Triangle Park, Rho, Chapel Hill (H.M.), and Biostatistics, Parexel International, Durham (B.A.P.) - all in North Carolina; the Department of Pediatrics, Breathing Institute, Pediatric Pulmonary Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora (S.J.S., A.H.L.); the Department of Pediatrics, Center Lillebælt, Fredericia and Kolding Hospital, Odense, Denmark (S.P.); and the Department of Allergy and Research and Evaluation, Kaiser Permanente Research, San Diego, CA (R.S.Z.)
| | - Steven J Pascoe
- From Respiratory Clinical Development (D.A.S., A.M.Y., L.A.L., I.H.R., K.S.B., S.Y.K., S.J.P.) and Research and Development, Clinical Platforms and Sciences, Clinical Statistics (K.M.K.), GlaxoSmithKline, Research Triangle Park, Rho, Chapel Hill (H.M.), and Biostatistics, Parexel International, Durham (B.A.P.) - all in North Carolina; the Department of Pediatrics, Breathing Institute, Pediatric Pulmonary Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora (S.J.S., A.H.L.); the Department of Pediatrics, Center Lillebælt, Fredericia and Kolding Hospital, Odense, Denmark (S.P.); and the Department of Allergy and Research and Evaluation, Kaiser Permanente Research, San Diego, CA (R.S.Z.)
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Lichtveld M, Kennedy S, Krouse RZ, Grimsley F, El-Dahr J, Bordelon K, Sterling Y, White L, Barlow N, DeGruy S, Paul D, Denham S, Hayes C, Sanders M, Mvula MM, Thornton E, Chulada P, Mitchell H, Martin WJ, Stephens KU, Cohn RD. From Design to Dissemination: Implementing Community-Based Participatory Research in Postdisaster Communities. Am J Public Health 2016; 106:1235-42. [PMID: 27196662 DOI: 10.2105/ajph.2016.303169] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To review how disasters introduce unique challenges to conducting population-based research and community-based participatory research (CBPR). METHODS From 2007-2009, we conducted the Head-off Environmental Asthma in Louisiana (HEAL) Study in the aftermath of Hurricane Katrina in a Gulf Coast community facing an unprecedented triple burden: Katrina's and other disasters' impact on the environment and health, historic health disparities, and persistent environmental health threats. RESULTS The unique triple burden influenced every research component; still, most existing CBPR principles were applicable, even though full adherence was not always feasible and additional tailored principles govern postdisaster settings. CONCLUSIONS Even in the most challenging postdisaster conditions, CBPR can be successfully designed, implemented, and disseminated while adhering to scientific rigor.
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Affiliation(s)
- Maureen Lichtveld
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Suzanne Kennedy
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Rebecca Z Krouse
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Faye Grimsley
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Jane El-Dahr
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Keith Bordelon
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Yvonne Sterling
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - LuAnn White
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Natasha Barlow
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Shannon DeGruy
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Dorothy Paul
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Stacey Denham
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Claire Hayes
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Margaret Sanders
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Mosanda M Mvula
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Eleanor Thornton
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Patricia Chulada
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Herman Mitchell
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - William J Martin
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Kevin U Stephens
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Richard D Cohn
- At the time of the study, Maureen Lichtveld, Faye Grimsley, LuAnn White, Natasha Barlow, Shannon DeGruy, and Dorothy Paul were with the School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Suzanne Kennedy, Rebecca Z. Krouse, and Herman Mitchell were with Rho Federal Systems Division Inc, Chapel Hill, NC. Jane El-Dahr was with the Department of Pediatrics, Tulane University School of Medicine, New Orleans. Keith Bordelon and Richard D. Cohn were with the Constella Group, LLC, Durham, NC. Yvonne Sterling was with the Health Sciences Center School of Nursing, Louisiana State University, New Orleans. Stacey Denham, Claire Hayes, Margaret Sanders, Mosanda M. Mvula, and Kevin U. Stephens were with the New Orleans Health Department, New Orleans. Eleanor Thornton was with Visionary Consulting Partners, LLC, Fairfax, VA. Patricia Chulada and William J. Martin II were with the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
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Bobdiwala S, Guha S, Van Calster B, Ayim F, Mitchell-Jones N, Al-Memar M, Mitchell H, Stalder C, Bottomley C, Kothari A, Timmerman D, Bourne T. The clinical performance of the M4 decision support model to triage women with a pregnancy of unknown location as at low or high risk of complications. Hum Reprod 2016; 31:1425-35. [PMID: 27165655 DOI: 10.1093/humrep/dew105] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 11/05/2015] [Accepted: 04/07/2016] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What are the adverse outcomes associated with using the M4 model in everyday clinical practice for women with pregnancy of unknown location (PUL)? SUMMARY ANSWER There were 17/835 (2.0%) adverse events and no serious adverse events associated with the performance of the M4 model in clinical practice. WHAT IS KNOWN ALREADY The M4 model has previously been shown to stratify women classified as a PUL as at low or high risk of complications with a good level of test performance. The triage performance of the M4 model is better than single measurements of serum progesterone or the hCG ratio (serum hCG at 48 h/hCG at presentation). STUDY DESIGN, SIZE, DURATION A prospective multi-centre cohort study of 1022 women with a PUL carried out between August 2012 and December 2013 across 2 university teaching hospitals and 1 district general hospital. PARTICIPANTS/MATERIALS, SETTING, METHODS All women presenting with a PUL to the early pregnancy units of the three hospitals were recruited. The final outcome for PUL was either a failed PUL (FPUL), intrauterine pregnancy (IUP) or ectopic pregnancy (EP) (including persistent PUL (PPUL)), with EP and PPUL considered high-risk PUL. Their hCG results at 0 and 48 h were entered into the M4 model algorithm. If the risk of EP was ≥5%, the PUL was predicted to be high-risk and the participant was asked to re-attend 48 h later for a repeat hCG and transvaginal ultrasound scan by a senior clinician. If the PUL was classified as 'low risk, likely failed PUL', the participant was asked to perform a urinary pregnancy test 2 weeks later. If the PUL was classified as 'low risk, likely intrauterine', the participant was scheduled for a repeat scan in 1 week. Deviations from the management protocol were recorded as either an 'unscheduled visit (participant reason)', 'unscheduled visit (clinician reason)' or 'differences in timing (blood test/ultrasound)'. Adverse events were assessed using definitions outlined in the UK Good Clinical Practice Guidelines' document. MAIN RESULTS AND THE ROLE OF CHANCE A total of 835 (82%) women classified as a PUL were managed according to the M4 model (9 met the exclusion criteria, 69 were lost to follow-up, 109 had no hCG result at 48 h). Of these, 443 (53%) had a final outcome of FPUL, 298 (36%) an IUP and 94 (11%) an EP. The M4 model predicted 70% (585/835) PUL as low risk, of which 568 (97%) were confirmed as FPUL or IUP. Of the 17 EP and PPUL misclassified as low risk, 5 had expectant management, 7 medical management with methotrexate and 5 surgical intervention.Nineteen PUL had an unscheduled visit (participant reason), 38 PUL had an unscheduled visit (clinician reason) and 68 PUL had deviations from protocol due to a difference in timing (blood test/ultrasound).Adverse events were reported in 26 PUL and 1 participant had a serious adverse event. A total of 17/26 (65%) adverse events were misclassifications of a high risk PUL as low risk by the M4 model, while 5/26 (19%) adverse events were related to incorrect clinical decisions. Four of the 26 adverse events (15%) were secondary to unscheduled admissions for pain/bleeding. The serious adverse event was due to an incorrect clinical decision. LIMITATIONS, REASONS FOR CAUTION A limitation of the study was that 69/1022 (7%) of PUL were lost to follow-up. A 48 h hCG level was missing for 109/1022 (11%) participants. WIDER IMPLICATIONS OF THE FINDINGS The low number of adverse events (2.0%) suggests that expectant management of PUL using the M4 prediction model is safe. The model is an effective way of triaging women with a PUL as being at high- and low-risk of complications and rationalizing follow-up. The multi-centre design of the study is more likely to make the performance of the M4 model generalizable in other populations. STUDY FUNDING/COMPETING INTERESTS None. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- S Bobdiwala
- Tommy's National Early Miscarriage Research Centre, Queen Charlottes & Chelsea Hospital, Imperial College, Du Cane Road, London W12 0HS, UK
| | - S Guha
- Tommy's National Early Miscarriage Research Centre, Queen Charlottes & Chelsea Hospital, Imperial College, Du Cane Road, London W12 0HS, UK West Middlesex University Hospital, Twickenham Road, Isleworth, London TW7 6AF, UK
| | - B Van Calster
- Department of Development and Regeneration, KU Leuven, Herestraat 49 Box 7003, Leuven B-3000, Belgium
| | - F Ayim
- Hillingdon Hospital, Pield Heath Road, Uxbridge UB8 3NN, UK
| | - N Mitchell-Jones
- Chelsea & Westminster Hospital, 329 Fulham Road, London SW10 9NH, UK
| | - M Al-Memar
- Tommy's National Early Miscarriage Research Centre, Queen Charlottes & Chelsea Hospital, Imperial College, Du Cane Road, London W12 0HS, UK
| | - H Mitchell
- Hillingdon Hospital, Pield Heath Road, Uxbridge UB8 3NN, UK
| | - C Stalder
- Tommy's National Early Miscarriage Research Centre, Queen Charlottes & Chelsea Hospital, Imperial College, Du Cane Road, London W12 0HS, UK
| | - C Bottomley
- Chelsea & Westminster Hospital, 329 Fulham Road, London SW10 9NH, UK
| | - A Kothari
- Hillingdon Hospital, Pield Heath Road, Uxbridge UB8 3NN, UK
| | - D Timmerman
- Department of Development and Regeneration, KU Leuven, Herestraat 49 Box 7003, Leuven B-3000, Belgium Department of Obstetrics and Gynaecology, University Hospitals Leuven, Campus Gasthuisberg, KU Leuven, Belgium
| | - T Bourne
- Tommy's National Early Miscarriage Research Centre, Queen Charlottes & Chelsea Hospital, Imperial College, Du Cane Road, London W12 0HS, UK Department of Development and Regeneration, KU Leuven, Herestraat 49 Box 7003, Leuven B-3000, Belgium Department of Obstetrics and Gynaecology, University Hospitals Leuven, Campus Gasthuisberg, KU Leuven, Belgium
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Conway A, Mitchell H, Morrisey D, Armstrong A, Wardley A, Howell S. Cardiac Events and Cardiac Monitoring in Adjuvant Trastuzumab Patients at The Christie: a Retrospective Audit. Clin Oncol (R Coll Radiol) 2016. [DOI: 10.1016/j.clon.2016.01.018] [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: 10/22/2022]
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Thornton E, Kennedy S, Hayes-Watson C, Krouse RZ, Mitchell H, Cohn RD, Wildfire J, Mvula MM, Lichtveld M, Grimsley F, Martin WJ, Stephens KU. Adapting and implementing an evidence-based asthma counseling intervention for resource-poor populations. J Asthma 2016; 53:825-34. [PMID: 27049234 DOI: 10.3109/02770903.2016.1155219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To report implementation strategies and outcomes of an evidence-based asthma counseling intervention. The Head-off Environmental Asthma in Louisiana (HEAL) intervention integrated asthma counseling (AC) capacity and addressed challenges facing children with asthma in post-disaster New Orleans. METHODS The HEAL intervention enrolled 182 children (4-12 years) with moderate-to-severe persistent asthma. Recruitment occurred from schools in the Greater New Orleans area for one year. Participants received home environmental assessments and tailored asthma counseling sessions during the study period based on the National Cooperative Inner City Asthma Study and the Inner City Asthma Study. Primary (i.e., asthma symptoms) and secondary outcomes (i.e., healthcare utilization) were captured. During the study, changes were made to meet the demands of a post-hurricane and resource-poor environment which included changes to staffing, training, AC tools, and AC sessions. RESULTS After study changes were made, the AC visit rate increased by 92.3%. Significant improvements were observed across several adherence measures (e.g., running out of medications (p = 0.009), financial/insurance problems for appointments (p = 0.006), worried about medication side-effects (p = 0.01), felt medications did not work (p < 0.001)). Additionally, an increasing number of AC visits was modestly associated with a greater reduction in symptoms (test-for-trend p = 0.059). CONCLUSION By adapting to the needs of the study population and setting, investigators successfully implemented a counseling intervention that improved participant behaviors and clinical outcomes. The strategies for implementing the AC intervention may serve as a guide for managing asthma and other chronic conditions in resource-poor settings.
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Affiliation(s)
- Eleanor Thornton
- a Visionary Consulting Partners, LLC, Mason Enterprise Center-Fairfax , Fairfax , Virginia , USA
| | - Suzanne Kennedy
- b Rho Federal Systems Division, Inc. , Chapel Hill , North Carolina , USA
| | - Claire Hayes-Watson
- a Visionary Consulting Partners, LLC, Mason Enterprise Center-Fairfax , Fairfax , Virginia , USA
| | - Rebecca Z Krouse
- b Rho Federal Systems Division, Inc. , Chapel Hill , North Carolina , USA
| | - Herman Mitchell
- b Rho Federal Systems Division, Inc. , Chapel Hill , North Carolina , USA
| | - Richard D Cohn
- c Social & Scientific Systems, Inc. , Durham , North Carolina , USA
| | - Jeremy Wildfire
- b Rho Federal Systems Division, Inc. , Chapel Hill , North Carolina , USA
| | - Mosanda M Mvula
- d New Orleans Health Department , New Orleans , Louisiana , USA
| | - Maureen Lichtveld
- e School of Public Health and Tropical Medicine, Tulane University , New Orleans , Louisiana , USA
| | - Faye Grimsley
- e School of Public Health and Tropical Medicine, Tulane University , New Orleans , Louisiana , USA
| | - William J Martin
- f National Institute of Child Health and Development, National Institutes of Health , Department of Health and Human Services , Bethesda , Maryland , USA
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Holmes EA, Bonsall MB, Hales SA, Mitchell H, Renner F, Blackwell SE, Watson P, Goodwin GM, Di Simplicio M. Applications of time-series analysis to mood fluctuations in bipolar disorder to promote treatment innovation: a case series. Transl Psychiatry 2016; 6:e720. [PMID: 26812041 PMCID: PMC5068881 DOI: 10.1038/tp.2015.207] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/09/2015] [Accepted: 11/10/2015] [Indexed: 01/09/2023] Open
Abstract
Treatment innovation for bipolar disorder has been hampered by a lack of techniques to capture a hallmark symptom: ongoing mood instability. Mood swings persist during remission from acute mood episodes and impair daily functioning. The last significant treatment advance remains Lithium (in the 1970s), which aids only the minority of patients. There is no accepted way to establish proof of concept for a new mood-stabilizing treatment. We suggest that combining insights from mood measurement with applied mathematics may provide a step change: repeated daily mood measurement (depression) over a short time frame (1 month) can create individual bipolar mood instability profiles. A time-series approach allows comparison of mood instability pre- and post-treatment. We test a new imagery-focused cognitive therapy treatment approach (MAPP; Mood Action Psychology Programme) targeting a driver of mood instability, and apply these measurement methods in a non-concurrent multiple baseline design case series of 14 patients with bipolar disorder. Weekly mood monitoring and treatment target data improved for the whole sample combined. Time-series analyses of daily mood data, sampled remotely (mobile phone/Internet) for 28 days pre- and post-treatment, demonstrated improvements in individuals' mood stability for 11 of 14 patients. Thus the findings offer preliminary support for a new imagery-focused treatment approach. They also indicate a step in treatment innovation without the requirement for trials in illness episodes or relapse prevention. Importantly, daily measurement offers a description of mood instability at the individual patient level in a clinically meaningful time frame. This costly, chronic and disabling mental illness demands innovation in both treatment approaches (whether pharmacological or psychological) and measurement tool: this work indicates that daily measurements can be used to detect improvement in individual mood stability for treatment innovation (MAPP).
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Affiliation(s)
- E A Holmes
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK,Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,University Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK,Medical Research Council Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge CB2 7EF, UK. E-mail:
| | - M B Bonsall
- Mathematical Ecology Research Group, Department of Zoology, University of Oxford, Oxford, UK,St Peter's College, University of Oxford, Oxford, UK
| | - S A Hales
- University Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - H Mitchell
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - F Renner
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - S E Blackwell
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - P Watson
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - G M Goodwin
- University Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - M Di Simplicio
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
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Malek R, Mitchell H, Furegato M, Simms I, Mohammed H, Nardone A, Hughes G. Contribution of transmission in HIV-positive men who have sex with men to evolving epidemics of sexually transmitted infections in England: an analysis using multiple data sources, 2009-2013. ACTA ACUST UNITED AC 2015; 20. [PMID: 25953130 DOI: 10.2807/1560-7917.es2015.20.15.21093] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
HIV seroadaptive behaviours may have contributed to greater sexually transmitted infection (STI) transmission in HIV-positive men who have sex with men(MSM) and to the global increase in STIs. Using multiple national surveillance data sources and population survey data, we estimated the risk of STIs in HIV-positive MSM and assessed whether transmission in HIV-positive MSM has contributed to recent STI epidemics in England. Since 2009, an increasing proportion of STIs has been diagnosed in HIV-positive MSM, and currently, the population rate of acute bacterial STIs is up to four times that of HIV-negative or undiagnosed MSM. Almost one in five of all diagnosed HIV-positive MSM in England had an acute STI diagnosed in 2013. From 2009 to 2013, the odds of being diagnosed with syphilis increased from 2.71 (95% confidence interval (CI) 2.41–3.05, p<0.001) to 4.05 (95%CI 3.70-4.45, p<0.001) in HIV-positive relative to HIV negative/undiagnosed MSM. Similar trends were seen for gonorrhoea and chlamydia. Bacterial STI re-infection rates were considerably higher in HIV-positive MSM over a five-year follow-up period, indicative of rapid transmission in more dense sexual networks.These findings strongly suggest that the sexual health of HIV-positive MSM in England is worsening, which merits augmented public health interventions and continued monitoring.
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Affiliation(s)
- R Malek
- Public Health England, London, United Kingdom
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Desai S, Croxford S, Brown AE, Mitchell H, Hughes G, Delpech V. An overview of the HIV epidemic among men who have sex with men in the United Kingdom, 1999-2013. ACTA ACUST UNITED AC 2015; 20. [PMID: 25884147 DOI: 10.2807/1560-7917.es2015.20.14.21086] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe epidemiological trends in HIV among men who have sex with men (MSM) in the United Kingdom (UK) to inform prevention strategies. National HIV surveillance data were analysed for trends. Multivariable analyses identified predictors of late diagnosis (<350 copies/µL) and mortality. Between 1999 and 2013, 37,560 MSM (≥15 years) were diagnosed with HIV in the UK. New diagnoses rose annually from 1,440 in 1999 to 3,250 in 2013. The majority of MSM were of white ethnicity (85%) and UK-born (68%). Median CD4 count increased steadily from 350 cells/µL to 463 cells/µL. HIV testing in England increased from 10,900 tests in 1999 to 102,600 in 2013. One-year death rates after diagnosis declined among late presenters (4.7% to 1.9%). Despite declining late diagnosis (50% to 31%), the number of men diagnosed late annually has remained high since 2004. Older age (≥50 years), and living outside London were predictors of late presentation; older age and late presentation were predictors of one-year mortality. Increases in new diagnoses reflect increased testing and ongoing transmission. Over 900 men present late each year and mortality in this group remains high and preventable. Appropriate prevention and testing strategies require strengthening to reduce HIV transmission and late diagnosis.
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Affiliation(s)
- S Desai
- HIV and STI Department, Centre for Infectious Disease Surveillance and Control, Health Protection England, London, United Kingdom
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Affiliation(s)
| | - J. Porter
- Dietetics; Eastern Health; VIC Australia
- Nutrition & Dietetics; Monash University; Notting Hill VIC Australia
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Hollenbach JP, Cloutier MM, Steciak D, Mitchell H, Villarreal M, Williams S, Gleason MC, Szefler SJ. Agreement Between Caregiver Report and Hospital and School Records. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1480] [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: 11/24/2022]
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Salo PM, Jaramillo R, Rose KM, Calatroni A, Mitchell H, Zeldin DC. Predictors of Bedroom Allergen Exposures in U.S. Homes. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pfau T, Jennings C, Mitchell H, Olsen E, Walker A, Egenvall A, Tröster S, Weller R, Rhodin M. Lungeing on hard and soft surfaces: Movement symmetry of trotting horses considered sound by their owners. Equine Vet J 2014; 48:83-9. [PMID: 25297461 DOI: 10.1111/evj.12374] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/30/2014] [Indexed: 11/30/2022]
Abstract
REASONS FOR PERFORMING STUDY Lungeing is often part of the clinical lameness examination. The difference in movement symmetry, which is a commonly employed lameness measure, has not been quantified between surfaces. OBJECTIVES To compare head and pelvic movement symmetry between surfaces and reins during lungeing. STUDY DESIGN Quantitative gait analysis in 23 horses considered sound by their owners. METHODS Twenty-three horses were assessed in-hand and on the lunge on both reins on hard and soft surfaces with inertial sensors. Seven movement symmetry parameters were quantified and used to establish 2 groups, namely symmetrical (n = 9) and forelimb-lame horses (n = 14), based on values from straight-line assessment. Movement symmetry values for left rein measurements were side corrected to allow comparison of the amount of movement symmetry between reins. A mixed model (P<0.05) was used to study effects on movement symmetry of surface (hard/soft) and rein (inside/outside with respect to movement symmetry on the straight). RESULTS In forelimb-lame horses, surface and rein were identified as significantly affecting all head movement symmetry measures (rein, all P<0.0001; surface, all P<0.042). In the symmetrical group, no significant influence of surface or rein was identified for head movement symmetry (rein, all P>0.245; surface, all P>0.073). No significant influence of surface or rein was identified for any of the pelvic movement symmetry measures in either group. CONCLUSIONS While more symmetrical horses showed a consistent amount of movement symmetry across surfaces/reins, horses objectively quantified as lame on the straight showed decreased movement symmetry during lungeing, in particular with the lame limb on the inside of a hard circle. The variation within group questions straight-line movement symmetry as a sole measure of lameness without quantification of movement symmetry on the lunge, ideally on hard and soft surfaces to evaluate differences between reins and surfaces. In future, thresholds for lungeing need to be determined using simultaneous visual and objective assessment.
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Affiliation(s)
- T Pfau
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK
| | - C Jennings
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK
| | - H Mitchell
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK
| | - E Olsen
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK.,Department of Large Animal Sciences, Faculty of Health and Medical Science, University of Copenhagen, Taastrup, Denmark
| | - A Walker
- Equine Studies, Moulton College, Moulton, UK
| | - A Egenvall
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - S Tröster
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK
| | - R Weller
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK
| | - M Rhodin
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Gordon AL, Mjojo J, Forrester-Paton C, Forrester-Paton J, Bracewell N, Mitchell H, Masud T, Gladman JRF, Blundell AG. 95 * UPDATING THE BRITISH GERIATRICS SOCIETY RECOMMENDED UNDERGRADUATE CURRICULUM AGAINST TOMORROW'S DOCTOR'S 3. Age Ageing 2014. [DOI: 10.1093/ageing/afu041.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zabel RA, Gergen PJ, Sorkness CA, Wildfire J, Calatroni A, Mitchell H. Determining Risk Levels Of The Composite Asthma Severity Index (CASI). J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Taylor MJ, Gregory R, Mitchell H, Alblihed M, Alsabih A, Tomlins P, Sahota TS. Insulin pump users would not rule out using an implantable artificial pancreas. Practical Diabetes 2014. [DOI: 10.1002/pdi.1822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Mitchell H, Jennings C, Olsen E, Walker A, Weller R, Pfau T. Lunging on soft and hard ground: differences between sound and mildly lame horses. J Equine Vet Sci 2013. [DOI: 10.1016/j.jevs.2013.08.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mitchell H, Jennings C, Olsen E, Walker A, Weller R, Pfau T. Movement Symmetry Patterns During Lungeing in Trot on Hard and Soft Surface Differ Between Sound and Mildly Forelimb Lame Horses. Equine Vet J 2013. [DOI: 10.1111/evj.12145_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H. Mitchell
- Royal Veterinary College; North Mymms; Hertfordshire; UK
| | - C. Jennings
- Royal Veterinary College; North Mymms; Hertfordshire; UK
| | - E. Olsen
- Royal Veterinary College; North Mymms; Hertfordshire; UK
| | - A. Walker
- Royal Veterinary College; North Mymms; Hertfordshire; UK
| | - R. Weller
- Royal Veterinary College; North Mymms; Hertfordshire; UK
| | - T. Pfau
- Royal Veterinary College; North Mymms; Hertfordshire; UK
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Culley L, Hudson N, Law C, Denny E, Mitchell H, Raine-Fenning N. Disrupted reproduction: the impact of endometriosis on couples’ plans for childbearing. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Van Parys H, Wyverkens E, Provoost V, Ravelingien A, Raes I, Somers S, Stuyver I, De Sutter P, Pennings G, Buysse A, Anttila VS, Salevaara M, Suikkari AM, Listijono DR, Mooney S, Chapman MG, Res Muravec U, Pusica S, Lomsek M, Cizek Sajko M, Parames S, Semiao-Francisco L, Sato H, Ueno J, van den Wijngaard L, Mochtar MH, van Dam H, van der Veen F, van Wely M, Derks-Smeets IAP, Habets JJG, Tibben A, Tjan-Heijnen VCG, Meijer-Hoogeveen M, Geraedts JPM, van Golde R, Gomez-Garcia E, de Die-Smulders CEM, van Osch LADM, Habets JJG, Derks-Smeets IAP, Tibben A, Tjan-Heijnen VCG, Geraedts JPM, van Golde R, Gomez-Garcia E, Kets CM, de Die-Smulders CEM, van Osch LADM, Gullo S, Donarelli Z, Coco GL, Marino A, Volpes A, Sammartano F, Allegra A, Nekkebroeck J, Tournaye H, Stoop D, Donarelli Z, Lo Coco G, Gullo S, Marino A, Volpes A, Coffaro F, Allegra A, Diaz DG, Gonzalez MA, Tirado M, Chamorro S, Dolz P, Gil MA, Ballesteros A, Velilla E, Castello C, Moina N, Lopez-Teijon M, Chan CHY, Chan CLW, Leong MKH, Cheung IKM, Chan THY, Hui BNL, van Dongen AJCM, Huppelschoten AG, Kremer JAM, Nelen WLDM, Verhaak CM, Sun HG, Lee KH, Park IH, Kim SG, Lee JH, Kim YY, Kim HJ, Cho JD, Yoo YJ, Frokjaer V, Pinborg A, Larsen EC, Heede M, Stenbaek DS, Henningsson S, Nielsen AP, Svarer C, Holst KK, Knudsen GM, Emery M, DeJonckheere L, Rothen S, Wisard M, Germond M, Stenbaek DS, Toftager M, Hjordt LV, Jensen PS, Holst K, Holland T, Bryndorf T, Bogstad J, Hornnes P, Frokjaer VG, Dornelles LMN, MacCallum F, Lopes RCS, Piccinini CA, Passos EP, Bruegge C, Thorn P, Daniels K, Imrie S, Jadva V, Golombok S, Arens Y, De Krom G, Van Golde RJT, Coonen E, Van Ravenswaaij-Arts CMA, Meijer-Hoogeveen M, Evers JLH, Geraedts JPM, De Die-Smulders CEM, Ghazeeri G, Awwad J, Fakih A, Abbas H, Harajly S, Tawidian L, Maalouf F, Ajdukovic D, Pibernik-Okanovic M, Alebic MS, Baccino G, Calatayud C, Ricciarelli E, de Miguel ERH, Stuyver I, Wierckx K, Verstraelen H, Van Glabeke L, Van den Abbeel E, Gerris J, T'Sjoen G, De Sutter P, Monica B, Calonge RN, Peregrin PC, Cserepes R, Kollar J, Wischmann T, Bugan A, Pinkard C, Harrison C, Bunting L, Boivin J, Fulford B, Boivin J, Theusink-Kirchhoff N, van Ravenswaaij-Arts CMA, Bakker MK, Volks C, Papaligoura Z, Papadatou D, Bellali TH, Thorn P, Wischmann T, Wischmann T, Thorn P, Jarvholm S, Broberg M, Thurin-Kjellberg A, Weitzman G, Van Der Putten-Landau TM, Chudnoff S, Panagopoulou E, Tarlatzis B, Tamhankar V, Jones GL, Magill P, Skull JD, Ledger W, Hvidman HW, Specht IO, Pinborg A, Schmidt KT, Larsen EC, Andersen AN, Freeman T, Zadeh S, Smith V, Golombok S, Whitaker LHR, Reid J, Wilson J, Critchley HOD, Horne AW, Zadeh S, Freeman T, Smith V, Golombok S, Peterson B, Pirritano M, Schmidt L, Volgsten H, Wyverkens E, Van Parys H, Provoost V, Ravelingien A, Raes I, Somers S, Stuyver I, Pennings G, De Sutter P, Buysse A, Hudson N, Culley L, Law C, Denny E, Mitchell H, Baumgarten M, Raine-Fenning N, Blake L, Jadva V, Golombok S, Lee KH, Sun HG, Park IH, Kim SG, Lee JH, Kim YY, Kim HJ, Kim KH. Psychology and counselling. Hum Reprod 2013. [DOI: 10.1093/humrep/det218] [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: 11/13/2022] Open
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Lara M, Ramos-Valencia G, González-Gavillán JA, López-Malpica F, Morales-Reyes B, Marín H, Rodríguez-Sánchez MH, Mitchell H. Reducing quality-of-care disparities in childhood asthma: La Red de Asma Infantil intervention in San Juan, Puerto Rico. Pediatrics 2013; 131 Suppl 1:S26-37. [PMID: 23457147 DOI: 10.1542/peds.2012-1427d] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Although children living in Puerto Rico have the highest asthma prevalence of all US children, little is known regarding the quality-of-care disparities they experience nor the adaptability of existing asthma evidence-based interventions to reduce these disparities. The objective of this study was to describe our experience in reducing quality-of-care disparities among Puerto Rican children with asthma by adapting 2 existing evidence-based asthma interventions. METHODS We describe our experience in adapting and implementing 2 previously tested asthma evidence-based interventions: the Yes We Can program and the Inner-City Asthma Study intervention. We assessed the feasibility of combining key components of the 2 interventions to reduce asthma symptoms and estimated the potential cost savings associated with reductions in asthma-related hospitalizations and emergency department visits. A total of 117 children with moderate and severe asthma participated in the 12-month intervention in 2 housing projects in San Juan, Puerto Rico. A community-academic team with the necessary technical and cultural competences adapted and implemented the intervention. RESULTS Our case study revealed the feasibility of implementing the combined intervention, henceforth referred to as La Red intervention, in the selected Puerto Rican communities experiencing a disproportionately high level of asthma burden. After 1-year follow-up, La Red intervention significantly reduced asthma symptoms and exceeded reductions of the original interventions. Asthma-related hospitalizations and emergency department use, and their associated high costs, were also significantly reduced. CONCLUSIONS Asthma evidence-based interventions can be adapted to improve quality of care for children with asthma in a different cultural community setting.
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Affiliation(s)
- Marielena Lara
- RAND Corporation, 1776 Main St, PO Box 2138, Santa Monica, CA 90407-2138, USA.
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Chulada PC, Kennedy S, Mvula MM, Jaffee K, Wildfire J, Thornton E, Cohn RD, Grimsley LF, Mitchell H, El-Dahr J, Sterling Y, Martin WJ, White L, Stephens KU, Lichtveld M. The Head-off Environmental Asthma in Louisiana (HEAL) study--methods and study population. Environ Health Perspect 2012; 120:1592-9. [PMID: 22895349 PMCID: PMC3556602 DOI: 10.1289/ehp.1104239] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 08/07/2012] [Indexed: 05/27/2023]
Abstract
BACKGROUND In the city of New Orleans, Louisiana, and surrounding parishes (NOLA), children with asthma were perilously impacted by Hurricane Katrina as a result of disrupted health care, high home mold and allergen levels, and high stress. OBJECTIVES The Head-off Environmental Asthma in Louisiana (HEAL) study was conducted to examine relationships between the post-Katrina environment and childhood asthma in NOLA and assess a novel asthma counselor intervention that provided case management and guidance for reducing home mold and allergen levels. METHODS Children (4-12 years old) with moderate-to-severe asthma were recruited from NOLA schools. Over 1 year, they received two clinical evaluations, three home environmental evaluations, and the asthma intervention. Quarterly end points included symptom days, medication use, and unscheduled emergency department or clinic visits. A community advisory group was assembled and informed HEAL at all phases. RESULTS Of the children (n = 182) enrolled in HEAL, 67% were African American, and 25% came from households with annual incomes < $15,000. HEAL children were symptomatic, averaging 6.6 symptom days in the 2 weeks before baseline, and had frequent unscheduled visits to clinics or emergency departments (76% had at least one unscheduled visit in the preceding 3 months). In this report, we describe study design and baseline characteristics of HEAL children. CONCLUSIONS Despite numerous challenges faced by investigators, study staff, and participants, including destroyed infrastructure, disrupted lives, and lost jobs, HEAL was successful in terms of recruitment and retention, the high quality of data collected that will provide insight into asthma-allergen relationships, and the asthma intervention. This success was attributable to using an adaptive approach and refining processes as needed.
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Affiliation(s)
- Patricia C Chulada
- Clinical Research Program, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA.
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Grimsley LF, Chulada PC, Kennedy S, White L, Wildfire J, Cohn RD, Mitchell H, Thornton E, El-Dahr J, Mvula MM, Sterling Y, Martin WJ, Stephens KU, Lichtveld M. Indoor environmental exposures for children with asthma enrolled in the HEAL study, post-Katrina New Orleans. Environ Health Perspect 2012; 120:1600-6. [PMID: 22894816 PMCID: PMC3556612 DOI: 10.1289/ehp.1104840] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 08/09/2012] [Indexed: 05/14/2023]
Abstract
BACKGROUND Rain and flooding from Hurricane Katrina resulted in widespread growth of mold and bacteria and production of allergens in New Orleans, Louisiana, which may have led to increased exposures and morbidity in children with asthma. OBJECTIVES The goal of the Head-off Environmental Asthma in Louisiana (HEAL) study was to characterize post-Katrina exposures to mold and allergens in children with asthma. METHODS The homes of 182 children with asthma in New Orleans and surrounding parishes were evaluated by visual inspection, temperature and moisture measurements, and air and dust sampling. Air was collected using vacuum-pump spore traps and analyzed for > 30 mold taxa using bright field microscopy. Dust was collected from the children's beds and bedroom floors and analyzed for mouse (Mus m 1), dust mite (Der p 1), cockroach (Bla g 1), and mold (Alternaria mix) allergens using ELISA. RESULTS More than half (62%) of the children were living in homes that had been damaged by rain, flooding, or both. Geometric mean indoor and outdoor airborne mold levels were 501 and 3,958 spores/m3, respectively. Alternaria antigen was detected in dust from 98% of homes, with 58% having concentrations > 10 µg/g. Mus m 1, Der p 1, and Bla g 1 were detected in 60%, 35%, and 20% of homes, respectively, at low mean concentrations. CONCLUSIONS Except for Alternaria antigen in dust, concentrations of airborne mold (ratio of indoor to outdoor mold) and dust allergens in the homes of HEAL children were lower than measurements found in other studies, possibly because of extensive post-Katrina mold remediation and renovations, or because children moved into cleaner homes upon returning to New Orleans.
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Affiliation(s)
- L Faye Grimsley
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA.
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Mitchell H, Cohn RD, Wildfire J, Thornton E, Kennedy S, El-Dahr JM, Chulada PC, Mvula MM, Grimsley LF, Lichtveld MY, White LE, Sterling YM, Stephens KU, Martin WJ. Implementation of evidence-based asthma interventions in post-Katrina New Orleans: the Head-off Environmental Asthma in Louisiana (HEAL) study. Environ Health Perspect 2012; 120:1607-12. [PMID: 22894795 PMCID: PMC3556603 DOI: 10.1289/ehp.1104242] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 08/09/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Childhood asthma morbidity and mortality in New Orleans, Louisiana, is among the highest in the nation. In August 2005, Hurricane Katrina created an environmental disaster that led to high levels of mold and other allergens and disrupted health care for children with asthma. OBJECTIVES We implemented a unique hybrid asthma counselor and environmental intervention based on successful National Institutes of Health asthma interventions from the National Cooperative Inner City Asthma (NCICAS) and Inner-City Asthma (ICAS) Studies with the goal of reducing asthma symptoms in New Orleans children after Hurricane Katrina. METHODS Children (4-12 years old) with moderate-to-severe asthma (n = 182) received asthma counseling and environmental intervention for approximately 1 year. HEAL was evaluated employing several analytical approaches including a pre-post evaluation of symptom changes over the entire year, an analysis of symptoms according to the timing of asthma counselor contact, and a comparison to previous evidence-based interventions. RESULTS Asthma symptoms during the previous 2 weeks decreased from 6.5 days at enrollment to 3.6 days at the 12-month symptom assessment (a 45% reduction, p < 0.001), consistent with changes observed after NCICAS and ICAS interventions (35% and 62% reductions in symptom days, respectively). Children whose families had contact with a HEAL asthma counselor by 6 months showed a 4.09-day decrease [95% confidence interval (CI): 3.25 to 4.94-day decrease] in symptom days, compared with a 1.79-day decrease (95% CI: 0.90, 2.67) among those who had not yet seen an asthma counselor (p < 0.001). CONCLUSIONS The novel combination of evidence-based asthma interventions was associated with improved asthma symptoms among children in post-Katrina New Orleans. Post-intervention changes in symptoms were consistent with previous randomized trials of NCICAS and ICAS interventions.
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Affiliation(s)
- Herman Mitchell
- Rho Federal Systems Division, Inc., Chapel Hill, North Carolina 27517, USA.
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