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Warraitch A, Killalea M, Murphy J, Barrett E. Creating competent and confident volunteers for inclusive water sports. Ir Med J 2024; 117:943. [PMID: 38682672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
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Murphy J, Schafer L, Mize S. Correction to: Differing field methods and site conditions lead to varying bias in suspended sediment concentrations in the Lower Mississippi and Atchafalaya Rivers. Environ Monit Assess 2023; 196:100. [PMID: 38157072 PMCID: PMC10756883 DOI: 10.1007/s10661-023-12263-w] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- J Murphy
- US Geological Survey, DeKalb, IL, USA.
| | - L Schafer
- US Geological Survey, Catonsville, MD, USA
| | - S Mize
- US Geological Survey, Baton Rouge, LA, USA
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Murphy J, Tharumakunarajah R, Holden KA, King C, Lee AR, Rose K, Hawcutt DB, Sinha IP. Impact of indoor environment on children's pulmonary health. Expert Rev Respir Med 2023; 17:1249-1259. [PMID: 38240133 DOI: 10.1080/17476348.2024.2307561] [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: 10/26/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION A child's living environment has a significant impact on their respiratory health, with exposure to poor indoor air quality (IAQ) contributing to potentially lifelong respiratory morbidity. These effects occur throughout childhood, from the antenatal period through to adolescence. Children are particularly susceptible to the effects of environmental insults, and children living in socioeconomic deprivation globally are more likely to breathe air both indoors and outdoors, which poses an acute and long-term risk to their health. Adult respiratory health is, at least in part, determined by exposures and respiratory system development in childhood, starting in utero. AREAS COVERED This narrative review will discuss, from a global perspective, what contributes to poor IAQ in the child's home and school environment and the impact that indoor air pollution exposure has on respiratory health throughout the different stages of childhood. EXPERT OPINION All children have the right to a living and educational environment without the threat of pollution affecting their health. Action is needed at multiple levels to address this pressing issue to improve lifelong respiratory health. Such action should incorporate a child's rights-based approach, empowering children, and their families, to have access to clean air to breathe in their living environment.
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Affiliation(s)
- Jared Murphy
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | | | - Karl A Holden
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Lab to Life Child Health Data Centre, Alder Hey Children's Hospital, Liverpool, UK
| | - Charlotte King
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Alice R Lee
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Lab to Life Child Health Data Centre, Alder Hey Children's Hospital, Liverpool, UK
| | - Katie Rose
- Department of Respiratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Daniel B Hawcutt
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Ian P Sinha
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Department of Respiratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Munck A, Southern KW, Murphy J, de Winter-de Groot KM, Gartner S, Karadag B, Kashirskaya N, Linnane B, Proesmans M, Sands D, Sommerburg O, Castellani C, Barben J. Cystic Fibrosis Cases Missed by Newborn Bloodspot Screening-Towards a Consistent Definition and Data Acquisition. Int J Neonatal Screen 2023; 9:65. [PMID: 38132824 PMCID: PMC10743499 DOI: 10.3390/ijns9040065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
Repeated European surveys of newborn bloodspot screening (NBS) have shown varied strategies for collecting missed cases, and information on data collection differs among countries/regions, hampering data comparison. The ECFS Neonatal Screening Working Group defined missed cases by NBS as either false negatives, protocol-related, concerning analytical issues, or non-protocol-related, concerning pre- and post-analytical issues. A questionnaire has been designed and sent to all key workers identified in each NBS programme to assess the feasibility of collecting data on missed cases, the stage of the NBS programme when the system failed, and individual patient data on each missed case.
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Affiliation(s)
- Anne Munck
- Hospital Necker Enfants-Malades, AP-HP, CF Centre, University Paris Descartes, 75015 Paris, France;
| | - Kevin W. Southern
- Department of Women’s and Children’s Health, University of Liverpool, Liverpool L69 3BX, UK; (K.W.S.)
| | - Jared Murphy
- Department of Women’s and Children’s Health, University of Liverpool, Liverpool L69 3BX, UK; (K.W.S.)
| | - Karin M. de Winter-de Groot
- Department of Paediatric Pulmonology & Allergology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht University, 3508 AB Utrecht, The Netherlands;
| | - Silvia Gartner
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Bülent Karadag
- Department of Pediatric Pulmonology, Marmara University, 34890 Istanbul, Turkey;
| | - Nataliya Kashirskaya
- Laboratory of Genetic Epidemiology, Research Centre for Medical Genetics, Moscow Regional Research and Clinical Institute, Moscow 115522, Russia;
| | - Barry Linnane
- School of Medicine and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, V94 T9PX Limerick, Ireland;
| | - Marijke Proesmans
- Division of Woman and Child, Department of Pediatrics, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Dorota Sands
- Cystic Fibrosis Department, Institute of Mother and Child, 01-211 Warsaw, Poland;
| | - Olaf Sommerburg
- Paediatric Pulmonology, Allergology & CF Centre, Department of Paediatrics III, University Hospital Heidelberg, 69120 Heidelberg, Germany;
- Translational Lung Research Center, German Lung Research Center, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Carlo Castellani
- Cystic Fibrosis Center, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Jürg Barben
- Paediatric Pulmonology & CF Centre, Children’s Hospital of Eastern Switzerland, 9000 St. Gallen, Switzerland
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Heneghan M, Southern KW, Murphy J, Sinha IP, Nevitt SJ. Corrector therapies (with or without potentiators) for people with cystic fibrosis with class II CFTR gene variants (most commonly F508del). Cochrane Database Syst Rev 2023; 11:CD010966. [PMID: 37983082 PMCID: PMC10659105 DOI: 10.1002/14651858.cd010966.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/21/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is a common life-shortening genetic condition caused by a variant in the cystic fibrosis transmembrane conductance regulator (CFTR) protein. A class II CFTR variant F508del is the commonest CF-causing variant (found in up to 90% of people with CF (pwCF)). The F508del variant lacks meaningful CFTR function - faulty protein is degraded before reaching the cell membrane, where it needs to be to effect transepithelial salt transport. Corrective therapy could benefit many pwCF. This review evaluates single correctors (monotherapy) and any combination of correctors (most commonly lumacaftor, tezacaftor, elexacaftor, VX-659, VX-440 or VX-152) and a potentiator (e.g. ivacaftor) (dual and triple therapies). OBJECTIVES To evaluate the effects of CFTR correctors (with or without potentiators) on clinically important benefits and harms in pwCF of any age with class II CFTR mutations (most commonly F508del). SEARCH METHODS We searched the Cochrane CF Trials Register (28 November 2022), reference lists of relevant articles and online trials registries (3 December 2022). SELECTION CRITERIA Randomised controlled trials (RCTs) (parallel design) comparing CFTR correctors to control in pwCF with class II mutations. DATA COLLECTION AND ANALYSIS Two authors independently extracted data, assessed risk of bias and judged evidence certainty (GRADE); we contacted investigators for additional data. MAIN RESULTS We included 34 RCTs (4781 participants), lasting between 1 day and 48 weeks; an extension of two lumacaftor-ivacaftor studies provided additional 96-week safety data (1029 participants). We assessed eight monotherapy RCTs (344 participants) (4PBA, CPX, lumacaftor, cavosonstat and FDL169), 16 dual-therapy RCTs (2627 participants) (lumacaftor-ivacaftor or tezacaftor-ivacaftor) and 11 triple-therapy RCTs (1804 participants) (elexacaftor-tezacaftor-ivacaftor/deutivacaftor; VX-659-tezacaftor-ivacaftor/deutivacaftor; VX-440-tezacaftor-ivacaftor; VX-152-tezacaftor-ivacaftor). Participants in 21 RCTs had the genotype F508del/F508del, in seven RCTs they had F508del/minimal function (MF), in one RCT F508del/gating genotypes, in one RCT either F508del/F508del genotypes or F508del/residual function genotypes, in one RCT either F508del/gating or F508del/residual function genotypes, and in three RCTs either F508del/F508del genotypes or F508del/MF genotypes. Risk of bias judgements varied across different comparisons. Results from 16 RCTs may not be applicable to all pwCF due to age limits (e.g. adults only) or non-standard designs (converting from monotherapy to combination therapy). Monotherapy Investigators reported no deaths or clinically relevant improvements in quality of life (QoL). There was insufficient evidence to determine effects on lung function. No placebo-controlled monotherapy RCT demonstrated differences in mild, moderate or severe adverse effects (AEs); the clinical relevance of these events is difficult to assess due to their variety and few participants (all F508del/F508del). Dual therapy In a tezacaftor-ivacaftor group there was one death (deemed unrelated to the study drug). QoL scores (respiratory domain) favoured both lumacaftor-ivacaftor and tezacaftor-ivacaftor therapy compared to placebo at all time points (moderate-certainty evidence). At six months, relative change in forced expiratory volume in one second (FEV1) % predicted improved with all dual combination therapies compared to placebo (high- to moderate-certainty evidence). More pwCF reported early transient breathlessness with lumacaftor-ivacaftor (odds ratio (OR) 2.05, 99% confidence interval (CI) 1.10 to 3.83; I2 = 0%; 2 studies, 739 participants; high-certainty evidence). Over 120 weeks (initial study period and follow-up), systolic blood pressure rose by 5.1 mmHg and diastolic blood pressure by 4.1 mmHg with twice-daily 400 mg lumacaftor-ivacaftor (80 participants). The tezacaftor-ivacaftor RCTs did not report these adverse effects. Pulmonary exacerbation rates decreased in pwCF receiving additional therapies to ivacaftor compared to placebo (all moderate-certainty evidence): lumacaftor 600 mg (hazard ratio (HR) 0.70, 95% CI 0.57 to 0.87; I2 = 0%; 2 studies, 739 participants); lumacaftor 400 mg (HR 0.61, 95% CI 0.49 to 0.76; I2 = 0%; 2 studies, 740 participants); and tezacaftor (HR 0.64, 95% CI 0.46 to 0.89; 1 study, 506 participants). Triple therapy No study reported any deaths (high-certainty evidence). All other evidence was low- to moderate-certainty. QoL respiratory domain scores probably improved with triple therapy compared to control at six months (six studies). There was probably a greater relative and absolute change in FEV1 % predicted with triple therapy (four studies each across all combinations). The absolute change in FEV1 % predicted was probably greater for F508del/MF participants taking elexacaftor-tezacaftor-ivacaftor compared to placebo (mean difference 14.30, 95% CI 12.76 to 15.84; 1 study, 403 participants; moderate-certainty evidence), with similar results for other drug combinations and genotypes. There was little or no difference in adverse events between triple therapy and control (10 studies). No study reported time to next pulmonary exacerbation, but fewer F508del/F508del participants experienced a pulmonary exacerbation with elexacaftor-tezacaftor-ivacaftor at four weeks (OR 0.17, 99% CI 0.06 to 0.45; 1 study, 175 participants) and 24 weeks (OR 0.29, 95% CI 0.14 to 0.60; 1 study, 405 participants); similar results were seen across other triple therapy and genotype combinations. AUTHORS' CONCLUSIONS There is insufficient evidence of clinically important effects from corrector monotherapy in pwCF with F508del/F508del. Additional data in this review reduced the evidence for efficacy of dual therapy; these agents can no longer be considered as standard therapy. Their use may be appropriate in exceptional circumstances (e.g. if triple therapy is not tolerated or due to age). Both dual therapies (lumacaftor-ivacaftor, tezacaftor-ivacaftor) result in similar small improvements in QoL and respiratory function with lower pulmonary exacerbation rates. While the effect sizes for QoL and FEV1 still favour treatment, they have reduced compared to our previous findings. Lumacaftor-ivacaftor was associated with an increase in early transient shortness of breath and longer-term increases in blood pressure (not observed for tezacaftor-ivacaftor). Tezacaftor-ivacaftor has a better safety profile, although data are lacking in children under 12 years. In this population, lumacaftor-ivacaftor had an important impact on respiratory function with no apparent immediate safety concerns, but this should be balanced against the blood pressure increase and shortness of breath seen in longer-term adult data when considering lumacaftor-ivacaftor. Data from triple therapy trials demonstrate improvements in several key outcomes, including FEV1 and QoL. There is probably little or no difference in adverse events for triple therapy (elexacaftor-tezacaftor-ivacaftor/deutivacaftor; VX-659-tezacaftor-ivacaftor/deutivacaftor; VX-440-tezacaftor-ivacaftor; VX-152-tezacaftor-ivacaftor) in pwCF with one or two F508del variants aged 12 years or older (moderate-certainty evidence). Further RCTs are required in children under 12 years and those with more severe lung disease.
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Affiliation(s)
- Matthew Heneghan
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Kevin W Southern
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | | | - Ian P Sinha
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Sarah J Nevitt
- Department of Health Data Science, University of Liverpool, Liverpool, UK
- Centre for Reviews and Dissemination, University of York, York, UK
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Al-Qudsi A, Mittal D, Mercuri L, Shah B, Emmerling M, Murphy J. Utilization of extended temporomandibular joint replacements in patients with hemifacial microsomia. Int J Oral Maxillofac Surg 2023; 52:1216-1220. [PMID: 37268548 DOI: 10.1016/j.ijom.2023.05.009] [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: 01/23/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 06/04/2023]
Abstract
Hemifacial microsomia (HFM) patients may benefit from extended temporomandibular joint replacements (eTMJR) to improve function and quality of life. A cross-sectional survey was sent to surgeons who place alloplastic temporomandibular joints regarding their experience with and complications encountered when placing eTMJR in patients with HFM. Fifty-nine responded to the survey. Thirty-six (61.0%) reported treating patients with HFM and 30 (50.8%) of those reported placing an alloplastic temporomandibular joint (TMJ) prosthesis for patients with HFM. Twenty-three of the 30 surgeons (76.7%) placing alloplastic TMJ prostheses reported using an eTMJR in patients with HFM. The average maximum inter-incisal opening (MIO) after an eTMJR in HFM patients was repor ted as> 25 mm by 82.6% of the participants, and between 16 mm and 25 mm by 17.4%. No participants reported MIO < 15 mm. To avoid condylar sag and open bite changes postoperatively, over 70% reported using some form of modification to stabilize the occlusion. Respondents reported good functional outcomes for eTMJR in patients with HFM with relatively few complications. Therefore, eTMJR could be considered a viable option in the management of this patient population.
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Affiliation(s)
- A Al-Qudsi
- Oral and Maxillofacial Surgery, Cook County Health, Chicago, IL, USA.
| | - D Mittal
- College of Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - L Mercuri
- Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - B Shah
- Oral and Maxillofacial Surgery, Cook County Health, Chicago, IL, USA
| | - M Emmerling
- Oral and Maxillofacial Surgery, Cook County Health, Chicago, IL, USA
| | - J Murphy
- Oral and Maxillofacial Surgery, Cook County Health, Chicago, IL, USA; Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
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Murphy J, Schafer L, Mize S. Differing field methods and site conditions lead to varying bias in suspended sediment concentrations in the Lower Mississippi and Atchafalaya Rivers. Environ Monit Assess 2023; 195:1260. [PMID: 37782392 PMCID: PMC10749891 DOI: 10.1007/s10661-023-11836-z] [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] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Abstract
At sites that have been sampled for decades, changes in field and laboratory methods happen over time as instrumentation and protocols improve. Here, we compare the influence of depth- and point-integrated sampling on total, fine (< 0.0625 mm), and coarse (≥ 0.0625 mm) suspended sediment (SS) concentrations in the Lower Mississippi and Atchafalaya Rivers. Using historical field method information, we identified seven sites to test such differences. We found SS samples collected using point-integration tended to have higher concentrations than those collected using depth-integration. However, the presence and magnitude of the bias were inconsistent across sites. Bias was present at the site with less-than-ideal conditions (i.e., non-trapezoidal channel, non-uniform flow) and non-existent at the ideal site location, indicating the bias between sampling methods depends on site sampling conditions. When present, the bias is greater at higher concentrations and at moderate to high flows. At the less-than-ideal site, point-integrated samples can have 16% (total) and 34% (coarse) higher concentrations than depth-integrated samples. When flow effects are removed, this translates to a bias of 19, 9, and 8 mg per liter for total, fine, and coarse SS. When a change in field methods occurs, comparison samples and a rigorous evaluation of those samples are warranted to determine the proper course of action for a particular site. Often, the effect and solution will not be known until several years of comparison samples have been collected under a variety of hydrologic conditions.
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Affiliation(s)
- J Murphy
- US Geological Survey, DeKalb, IL, USA.
| | - L Schafer
- US Geological Survey, Catonsville, MD, USA
| | - S Mize
- US Geological Survey, Baton Rouge, LA, USA
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Agrawal A, Romics L, Thekkinkattil D, Soliman M, Kaushik M, Barmpounakis P, Mortimer C, Courtney CA, Goyal A, Garreffa E, Carmichael A, Lane RA, Rutherford C, Kim B, Achuthan R, Pitsinis V, Goh S, Ray B, Grover K, Vidya R, Murphy J. 'PartBreCon' study. A UK multicentre retrospective cohort study to assess outcomes following PARTial BREast reCONstruction with chest wall perforator flaps. Breast 2023; 71:82-88. [PMID: 37544090 PMCID: PMC10430575 DOI: 10.1016/j.breast.2023.07.007] [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: 02/28/2023] [Revised: 06/27/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Partial breast reconstruction with a pedicled chest wall perforator flap (CWPF) enables breast conservation in a higher tumour: breast volume ratio scenario. Since there is limited evidence, this retrospective cohort study aimed to ascertain immediate (30-days) and medium-term (follow-up duration) surgical outcomes. METHODS STROBE-compliant protocol ascertained CWPF outcomes between March 2011-March 2021. UK centres known to perform CWPF were invited to participate if they performed at least 10 cases. Data were retrospectively collected, including patient demographics, tumour and treatment characteristics, and surgical and oncological outcomes. Statistical analysis (R™) included multivariable logistic regression and sensitivity analysis. RESULTS Across 15 centres, 507 patients with median age (54 years, IQR; 48-62), body mass index (25.4 kg/m2, IQR; 22.5-29), tumour size (26 mm, IQR; 18-35), and specimen weight (62 g, IQR; 40-92) had following flap types: LiCAP (54.1%, n = 273), MiCAP/AiCAP (19.6%, n = 99), LiCAP + LTAP (19.8%, n = 100) and TDAP (2.2%, n = 11). 30-days complication rates were in 12%: haematoma (4.3%, n = 22), wound infection (4.3%, n = 22), delayed wound healing (2.8%, n = 14) and flap loss (0.6%, n = 3; 1 full) leading to readmissions (2.6%, n = 13) and re-operations (2.6%, n = 13). Positive margins (n = 88, 17.7%) led to 15.9% (n = 79) re-excisions, including 7.5% (n = 37) at the planned 2nd of 2-stage surgery and 1.8% (n = 9) mastectomy. At median 23 months (IQR; 11-39) follow-up, there were 1.2% (n = 6) symmetrisations; recurrences: local (1%), regional/nodal (0.6%) and distant (3.2%). CONCLUSIONS This large multicentre cohort study demonstrates acceptable complication and margin re-excision rates. CWPF extends the range of breast conservation techniques. Further studies are required for long-term oncological outcomes.
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Affiliation(s)
- A Agrawal
- Cambridge University Hospitals, Cambridge, UK.
| | - L Romics
- New Victoria Hospital, Glasgow, UK.
| | | | - M Soliman
- Cambridge University Hospitals, Cambridge, UK; Mansoura University, Egypt.
| | - M Kaushik
- University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - P Barmpounakis
- Department of Statistics, Athens University of Economics and Business, Athens, Greece.
| | | | | | - A Goyal
- Royal Derby Hospital, Derby, UK.
| | | | - A Carmichael
- University Hospital of Derby and Burton, Belvedere Road, Burton on Trent, UK.
| | - R A Lane
- Cambridge University Hospitals, Cambridge, UK.
| | | | - B Kim
- St. James's University Hospital, Leeds, UK.
| | - R Achuthan
- St. James's University Hospital, Leeds, UK.
| | | | - S Goh
- Peterborough Hospital, Peterborough, UK.
| | - B Ray
- Harrogate NHS Trust, Harrogate, UK.
| | | | - R Vidya
- Royal Wolverhampton NHS Trust, Wolverhampton, UK.
| | - J Murphy
- Manchester University Hospital, Manchester, UK.
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Clabby C, Valldecabres A, Dillon P, McParland S, Arkins S, O'Sullivan K, Flynn J, Murphy J, Boloña PS. Evaluation of test-day milk somatic cell count to predict intramammary infection in late lactation grazing dairy cows. J Dairy Sci 2023:S0022-0302(23)00292-8. [PMID: 37268571 DOI: 10.3168/jds.2022-22627] [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: 08/05/2022] [Accepted: 02/01/2023] [Indexed: 06/04/2023]
Abstract
Use of selective dry cow antimicrobial therapy requires to precisely differentiate cows with an intramammary infection (IMI) from uninfected cows close to drying-off to enable treatment allocation. Milk somatic cell count (SCC) is an indicator of an inflammatory response in the mammary gland and is usually associated with IMI. However, SCC can also be influenced by cow-level variables such as milk yield, lactation number and stage of lactation. In recent years, predictive algorithms have been developed to differentiate cows with IMI from cows without IMI based on SCC data. The objective of this observational study was to explore the association between SCC and subclinical IMI, taking cognizance of cow-level predictors on Irish seasonal spring calving, pasture-based systems. Additionally, the optimal test-day SCC cut-point (maximized sensitivity and specificity) for IMI diagnosis was determined. A total of 2,074 cows, across 21 spring calving dairy herds with an average monthly milk weighted bulk tank SCC of ≤200,000 cells/mL were enrolled in the study. Quarter-level milk sampling was carried out on all cows in late lactation (interquartile range = 240-261 d in milk) for bacteriological culturing. Bacteriological results were used to define cows with IMI, when ≥1 quarter sample resulted in bacterial growth. Cow-level test-day SCC records were provided by the herd owners. The ability of the average, maximum and last test-day SCC to predict infection were compared using receiver operator curves. Predictive logistic regression models tested included parity (primiparous or multiparous), yield at last test-day and a standardized count of high SCC test-days. In total, 18.7% of cows were classified as having an IMI, with first parity cows having a higher proportion of IMI (29.3%) compared with multiparous cows (16.1%). Staphylococcus aureus accounted for the majority of these infections. The last test-day SCC was the best predictor of infection with the highest area under the curve. The inclusions of parity, yield at last test-day, and a standardized count of high SCC test-days as predictors did not significantly improve the ability of last test-day SCC to predict IMI. The cut-point for last test-day SCC which maximized sensitivity and specificity was 64,975 cells/mL. This study indicates that in Irish seasonal pasture-based dairy herds,with low bulk tank SCC control programs, the last test-day SCC (interquartile range days in milk = 221-240) is the best predictor of IMI in late lactation.
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Affiliation(s)
- C Clabby
- Teagasc, Animal & Grassland Research and Innovation Centre, Moorepark, Fermoy, Co. Cork, P61 C996, Ireland; Faculty of Science and Engineering, University of Limerick, Co. Limerick, V94 C61W, Ireland
| | - A Valldecabres
- Teagasc, Animal & Grassland Research and Innovation Centre, Moorepark, Fermoy, Co. Cork, P61 C996, Ireland
| | - P Dillon
- Teagasc, Animal & Grassland Research and Innovation Centre, Moorepark, Fermoy, Co. Cork, P61 C996, Ireland
| | - S McParland
- Teagasc, Animal & Grassland Research and Innovation Centre, Moorepark, Fermoy, Co. Cork, P61 C996, Ireland
| | - S Arkins
- Faculty of Science and Engineering, University of Limerick, Co. Limerick, V94 C61W, Ireland
| | - K O'Sullivan
- School of Mathematical Sciences, University College Cork, Co. Cork, T12 XF62, Ireland
| | - J Flynn
- Teagasc, Animal & Grassland Research and Innovation Centre, Moorepark, Fermoy, Co. Cork, P61 C996, Ireland
| | - J Murphy
- Kerry Agribusiness, Tralee Road, Castleisland, Co. Kerry, V92 TD68, Ireland
| | - P Silva Boloña
- Teagasc, Animal & Grassland Research and Innovation Centre, Moorepark, Fermoy, Co. Cork, P61 C996, Ireland.
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Doan D, Buchmann R, Murphy J, Joshi S. Autoimmune evaluation of joint pain reveals a surprising diagnosis of Scurvy. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00530-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Wang L, Vaida F, Meagher M, Puri D, Liu F, Dhanji S, Afari J, Hakimi K, Nguyen M, Saitta C, Shah A, Ghassemzadeh S, Nasseri R, Javier-Desloges J, Murphy J, Mckay R, Derweesh I. Proposal for reclassification of T1 and T2A renal cell carcinoma: Analysis of the National Cancer Database. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01308-8] [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: 02/12/2023]
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12
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Tuohy D, Cassidy I, Carey E, Graham M, McCarthy J, Murphy J, Morrissey K, Shanahan J, Tuohy T. 183 DEVELOPING AND FACILITATING ONLINE INTERGENERATIONAL CAFÉS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Many older people throughout their lives will require nursing care, consequentially most nurses will care for older people during their career. It is important that older people and student nurses are provided with shared learning opportunities so that professional caring partnerships can be nurtured and realised for mutual benefit. Intergenerational projects offer opportunities for intergenerational learning. However, few projects explore student nurse-older person dyads and how these can be integrated within undergraduate pre-registration programmes. This paper describes the development and facilitation of online older person-student nurse intergenerational cafés.
Methods
The project was managed by a design team comprising senior administration, lecturers in BSc Nursing programmes and a lecturer in Design for Health and Wellbeing. The ‘world café’ concept along with values of enablement and participation underpinned the design. The initiative was planned to align with a year three community care module. Regular online team meetings were held to agree the aims and outcomes for student nurse-older person cohorts, decide recruitment strategies, agree the process and format of facilitation. Older people were recruited through retirement, church, volunteer, social and sporting organisations, media and also using snowballing methods.
Results
Both student nurse and older person cohorts were offered support on how to access and participate in the café. Participants attended one of three online cafés hosted through Microsoft Teams. Each café followed the same format: 1) Group meeting convened with all participants; 2) Breakout small group ‘table’ discussions with student nurse-older people participants and design team facilitation; 3) The café was reconvened to whole group meeting where feedback was collated to elicit shared learning.
Conclusion
The initiative proved successful and there is merit in embedding intergenerational cafés into professionally accredited health care programmes. Through sharing life experiences and perspectives, intergenerational barriers can be reduced and new insights developed on person-centred gerontological care.
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Affiliation(s)
- D Tuohy
- University of Limerick , Limerick, Ireland
| | - I Cassidy
- University of Limerick , Limerick, Ireland
| | - E Carey
- University of Limerick , Limerick, Ireland
| | - M Graham
- University of Limerick , Limerick, Ireland
| | - J McCarthy
- University of Limerick , Limerick, Ireland
| | - J Murphy
- University of Limerick , Limerick, Ireland
| | | | - J Shanahan
- University of Limerick , Limerick, Ireland
| | - T Tuohy
- University of Limerick , Limerick, Ireland
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13
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Mensch R, Dahab T, Barry P, Murphy J. 169 THE SPECTRUM, ASSESSMENT AND DIAGNOSIS OF NEUROVASCULAR OPHTHALMIC PRESENTATIONS REFERRED TO AN ACUTE MEDICAL UNIT. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Ocular emergencies may require urgent intervention to prevent vision loss. Physicians must be confident in recognizing their presentations. However, literature published in this area is lacking.
Methods
This study assesses the consistency of the assessment of patients with neurovascular ophthalmic conditions in the Acute Medical Unit (AMU) at an Irish tertiary healthcare centre . Conditions of interest include retinal artery and vein occlusions, ischaemic optic neuropathies, and cranial nerve palsies (III, IV, and VI). Research questions to be addressed: 1. The percentage of patients referred from Eye Casualty Services (ECS) to the AMU with neurovascular ophthalmic presentations 2. The investigations performed to diagnose neurovascular ophthalmic conditions 3. How the diagnostic approach used in the AMU compares to that recommended by the literature 4. The accuracy of ECS referral diagnoses. This is an audit of 164 patients attending the AMU during a one-year period who were diagnosed with ophthalmological conditions.
Results
Of patients studied, 58 (35%) were diagnosed with conditions of interest. The most common neurovascular ophthalmic diagnosis was cranial nerve palsy (21, 36%). Among neurovascular patients, routine laboratory investigations were performed in over 90% of cases. Routine imaging was performed in over 80% of cases. Referral diagnoses from the ECS accompanied 13 (22%) of neurovascular patients, all of which were accurate.
Conclusion
Neurovascular ophthalmic conditions represent a significant proportion of ECS referrals to the AMU, and most aren’t diagnosed until after leaving the ECS. Laboratory and imaging investigations may be inappropriately utilized in some cases. More research is needed in this area.
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Affiliation(s)
- R Mensch
- University College Cork , Cork, Ireland
- Cork University Hospital Department of Medicine, , Cork, Ireland
| | - T Dahab
- Cork University Hospital Department of Medicine, , Cork, Ireland
| | - P Barry
- Cork University Hospital Department of Medicine, , Cork, Ireland
| | - J Murphy
- Cork University Hospital Department of Medicine, , Cork, Ireland
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14
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Murphy J, Kelly R, Cathasaigh CN, Murphy D, Cloney T, Hayes K, Arrigan G, O'Sullivan A, Barry P, James K, Healy L. 168 AN EXPLORATION OF ATRIAL FIBRILLATION AND ANTICOAGULATION IN STROKE PATIENTS WHO UNDERGO THROMBECTOMY IN A TERTIARY THROMBECTOMY CENTRE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial Fibrillation is a significant cause of ischaemic stroke. Prevalence of atrial fibrillation in patients requiring thrombectomy is approximately 33%. Embolic thrombi which develop due to Atrial fibrillation may become targets for clot removal by thrombectomy in appropriate patients. Anticoagulation is one of the mainstays of treatment for atrial fibrillation.
Methods
A list of patients who had thrombectomy performed for ischaemic stroke in 2021 was compiled. Charts were reviewed to establish the prevalence of atrial fibrillation and the rates of appropriate dosing of anticoagulant. Of those who were not anticoagulated, we aimed to establish if there was a clear reason for this. This was performed in a tertiary referral centre with 24/7 access to thrombectomy.
Results
97 patients had thrombectomy performed for ischaemic stroke in 2021. 34/97(35%) had atrial fibrillation (21/97 pre-existing , 13/97 newly diagnosed on admission). 15/21 were anticoagulated and 6/21 were not anticoagulated at the time of their stroke. 5/6 had a clear reason documented for stopping anticoagulation. One patient had stopped anticoagulation due to cost. Of those with atrial fibrillation who were anticoagulated at the time of their stroke, 11 were anticoagulated with a Direct-Acting AntiCoagulant (DOAC) and four were anticoagulated with Warfarin. Of the Warfarin group, just one patients’ INR was therapeutic at the time of their stroke. Of the DOAC group, all were on the appropriate dose.
Conclusion
Stroke patients requiring thrombectomy are a group who may suffer the largest strokes. Incidence of atrial fibrillation was similar to previous studies. It was encouraging that there was a documented reason for all patients who were not anticoagulated, and that the DOAC dose was appropriate. Issues with therapeutic levels of Warfarin are further highlighted here. This study concludes that we may not be as bad at anticoagulation as we may think.
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Affiliation(s)
- J Murphy
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - R Kelly
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - CN Cathasaigh
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - D Murphy
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - T Cloney
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - K Hayes
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - G Arrigan
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - A O'Sullivan
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - P Barry
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - K James
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
| | - L Healy
- Cork University Hospital Department of Geriatrics and Stroke Medicine, , Cork, Ireland
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15
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Murphy J, Webster C. 285 DEVELOPING A FRAILTY CARE PATHWAY IN A REHABILITATION HOSPITAL: A PILOT STUDY. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Frailty is a common condition in older adults. The Clinical Frailty Scale (CFS) is a widely used frailty screening-tool within the Irish healthcare system due to its time-efficiency and transferability between settings. The Edmonton Frailty Scale (EFS) is heralded as an effective tool capturing multi-dimensional aspects of frailty. Due to the lack of blanket referral system for some Multi-Disciplinary Team (MDT) members in our Irish rehabilitation hospital, early identification of frailty is key to ensure timely input from all disciplines. To optimise MDT intervention, the EFS was piloted alongside the CFS comparing user-experience and sensitivity.
Methods
Education sessions were held by frailty-group members to familiarise staff with frailty concepts and frailty-tool administration. The EFS and CFS were administered with all patients over 65 years within 72 hours of admission onto two wards of our hospital over a three-month period. Frailty scale completion was co-ordinated by the physiotherapists and occupational therapists who operate a blanket referral system. Detection of frailty triggered an urgent referral to dietician, medical social work and speech and language therapy colleagues who don’t operate a blanket referral system. The target time for MDT input was two days for the severely frail cohort and one week for mild or moderately frail patients.
Results
The EFS was administered for 83 patients (mean age: 84 years). Of those, 6% were severely frail, 23% were moderately frail and 28% were mildly frail. The CFS was found to detect a higher frailty level in 47% of patients screened when compared to the EFS and took an average of ten minutes less to administer.
Conclusion
The CFS will continue to be administered with patients due to its higher sensitivity to frailty and time efficiency for completion. Referrals will continue to be generated to all MDT members to expedite input with frail patients.
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Affiliation(s)
- J Murphy
- Clontarf Hospital , Dublin, Ireland
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16
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Pattwell M, Eldridge L, Milton M, Jethwa J, Murphy J, Slavova-Boneva V, Kiely G, Cowan-Dickie S, Pessoa Silva M, Tomlins E, Crimmin J, McWhirter A, Roe J, Ashforth K, Grayer J, Henderson B, Stanley P, Mann L, Halsted A, Kano Y, McGinn M, Droney J, Mooney J, Bateman E, Wood J, Kipps E, Johnston S, Ashurst I, Ring A, Battisti N. Nutritional needs in older adults receiving systemic treatment for breast cancer: The Royal Marsden Senior Adult Oncology Programme experience. J Geriatr Oncol 2022. [DOI: 10.1016/s1879-4068(22)00350-2] [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: 11/07/2022]
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17
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Sahid S, Daurka J, Gibbs R, Murphy J. O094 Novel technique and cohort study: Stoppa approach to sciatic notch clearance in locally advanced / recurrent pelvic cancer pelvic cancer. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Introduction
Locally advanced / recurrent pelvic cancers (LARC) extending into the greater sciatic notch represent a significant clinical challenge. Conventional surgical resection is associated with high rates of R1/2 resection, while locoregional oncological treatments often fail to control the disease. In this study we present the first report of a modified Stoppa approach that facilitates en bloc excision of pelvic sidewall structures with LARC.
Methods
This is a retrospective review of patients who underwent surgery for LARC with the novel Stoppa approach between 2016 and 2020 in our centre.
Result
7 patients (6 female and 1 male) were identified from the institutional database with Median age of 66 (37–74). Three separate tumour types were included in the cohort: rectal adenocarcinoma - 4 (57%), anal squamous cell carcinoma - 2 (29%), and prostate adenocarcinoma - 1 (14%). 3 (42%) patients developed Clavien Dindo Class III complications (2 returned to theatre for minor flap revisions; 1 pre-sacral collection required radiological drainage). All patients lost active ipsilateral foot dorsiflexion due to planned nerve root transection. Median hospital stay was 46 days (17–114). All resections were R0.
Conclusion
This is the first report of a novel Stoppa approach for en bloc pelvic sidewall excision. The presented pathological resection results are promising; however, this procedure is associated with significant morbidity. Future studies will be necessary to confirm the presented oncological results and determine if the associated morbidity can be decreased.
Take-home message
Modified Stoppa technique is feasible to achieve Sciatic Notch tumour clearance in primary or recurrent locally advanced pelvic cancer. Further research needed to assess long term oncological outcome and reduce post operative morbidity.
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Affiliation(s)
- S Sahid
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust
| | - J Daurka
- Department of Orthopaedics, Imperial College Healthcare NHS Trust
| | - R Gibbs
- Division of Vascular Medicine and Vascular Surgery, Imperial College Healthcare NHS
| | - J Murphy
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust
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18
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Mondellini G, Shih H, Ning Y, Ladanyi A, Antler K, Murphy J, Feldman V, Leahy N, Kim A, Naka Y, Sayer G, Uriel N, Kurlansky P, Takeda K, Yuzefpolskaya M, Colombo P. Impact of Race and Ethnicity on Readmissions After HeartMate 3 (HM3) Implantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1444] [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] Open
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19
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Gujjuri R, Kawka M, Murphy J. 31 Quality or Quantity? An Analysis of the Colorectal Cancer Resection Volume-Outcome Relationship From the 2019 National Bowel Cancer Audit Data. Br J Surg 2022. [DOI: 10.1093/bjs/znac041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
Despite increasing evidence supporting cancer services centralisation, no consensus exists in the association between high-hospital or high-surgeon volume and mortality following colorectal cancer surgery. This study aimed to identify and characterise a volume-outcome relationship in colorectal cancer.
Method
National Bowel Cancer Audit (NBOCA) dataset was combined with the Association of Coloproctology of Great Britain and Ireland (ACPGBI) Clinical Outcomes Publication (COP) 2019 report. Adjusted 90-day and 2-year mortality were derived from patients included in the 2018 and 2016 datasets, respectively. The impact of centre volume, surgeon volume and ACPGBI membership rates on outcomes was assessed. Cumulative sum (CUSUM) analysis was performed to identify the centre and surgeon volume threshold.
Results
144 hospitals were included, with 17,235 and 17,703 patients from the 2018 and 2016 datasets, respectively. 781 surgeons were identified, with 478 holding ACPGBI memberships. No significant difference was found between centre or surgeon volumes for adjusted 90-day and 2-year mortality. High ACPGBI membership rates were significantly associated with a reduced 90-day (p=0.006), but not 2-year mortality (p=0.198). CUSUM analysis found 36 per year as threshold centre volume (p=0.003) and 15 surgeries per year as the threshold surgeon volume (p=0.241).
Conclusions
The high degree of existing centralisation for cancer services in the UK limits the number of true low-volume centres compared to other countries. Surgeon volume may be a better predictor of colorectal cancer surgery outcomes than centre volume. More granular data is needed to improve the current understanding of the association between surgeon volume, ACPGBI membership and outcomes in colorectal surgery.
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Affiliation(s)
- R. Gujjuri
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - M. Kawka
- Department of Medicine, Imperial College London, South Kensington Campus, London, United Kingdom
| | - J. Murphy
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
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20
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Clabby C, McParland S, Dillon P, Arkins S, Flynn J, Murphy J, Boloña PS. Internal teat sealants alone or in combination with antibiotics at dry-off – the effect on udder health in dairy cows in five commercial herds. Animal 2022; 16:100449. [DOI: 10.1016/j.animal.2021.100449] [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] [Received: 07/13/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022] Open
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21
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Bradley DT, Murphy S, McWilliams P, Arnold S, Lavery S, Murphy J, de Lusignan S, Hobbs R, Tsang RSM, Akbari A, Torabi F, Beggs J, Chuter A, Shi T, Vasileiou E, Robertson C, Sheikh A, Reid H, O'Reilly D. Investigating the association between COVID-19 vaccination and care home outbreak frequency and duration. Public Health 2022; 203:110-115. [PMID: 35038629 PMCID: PMC8683272 DOI: 10.1016/j.puhe.2021.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES At the end of 2020, many countries commenced a vaccination programme against SARS-CoV-2. Public health authorities aim to prevent and interrupt outbreaks of infectious disease in social care settings. We aimed to investigate the association between the introduction of the vaccination programme and the frequency and duration of COVID-19 outbreaks in Northern Ireland (NI). STUDY DESIGN We undertook an ecological study using routinely available national data. METHODS We used Poisson regression to measure the relationship between the number of RT-PCR confirmed COVID-19 outbreaks in care homes, and as a measure of community COVID-19 prevalence, the Office for National Statistics COVID-19 Infection Survey estimated the number of people testing positive for COVID-19 in NI. We estimated the change in this relationship and estimated the expected number of care home outbreaks in the absence of the vaccination programme. A Cox proportional hazards model estimated the hazard ratio of a confirmed COVID-19 care home outbreak closure. RESULTS Care home outbreaks reduced by two-thirds compared to expected following the introduction of the vaccination programme, from a projected 1625 COVID-19 outbreaks (95% prediction interval 1553-1694) between 7 December 2020 and 28 October 2021 to an observed 501. We estimated an adjusted hazard ratio of 2.53 of the outbreak closure assuming a 21-day lag for immunity. CONCLUSIONS These findings describe the association of the vaccination with a reduction in outbreak frequency and duration across NI care homes. This indicates probable reduced harm and disruption from COVID-19 in social care settings following vaccination. Future research using individual level data from care home residents will be needed to investigate the effectiveness of the vaccines and the duration of their effects.
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Affiliation(s)
- D T Bradley
- Public Health Agency, Belfast, UK; Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - S Murphy
- Centre for Public Health, Queen's University Belfast, Belfast, UK.
| | | | - S Arnold
- Public Health Agency, Belfast, UK
| | - S Lavery
- Public Health Agency, Belfast, UK
| | - J Murphy
- Public Health Agency, Belfast, UK
| | - S de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R Hobbs
- Nuffield Department of Health Care Sciences, University of Oxford, Oxford, UK
| | - R S M Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - A Akbari
- Population Data Science and Health Data Research UK, Swansea University, Swansea, UK
| | - F Torabi
- Population Data Science, Swansea University Medical School, UK
| | - J Beggs
- BREATHE- The Health Data Research Hub For Respiratory Health, UK
| | - A Chuter
- BREATHE- The Health Data Research Hub For Respiratory Health, UK
| | - T Shi
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E Vasileiou
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - C Robertson
- Public Health Scotland, UK; University of Strathclyde, Glasgow, UK
| | - A Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK; BREATHE- The Health Data Research Hub For Respiratory Health, UK
| | - H Reid
- Public Health Agency, Belfast, UK
| | - D O'Reilly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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22
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Colvin MK, Forchelli GA, Reese KL, Capawana MR, Beery CS, Murphy J, Doyle AE, O'Keefe SM, Braaten EB. Neuropsychology consultation to identify learning disorders in children and adolescents: a proposal based on lessons learned during the COVID-19 pandemic. Child Neuropsychol 2022; 28:671-688. [PMID: 35073818 DOI: 10.1080/09297049.2021.2005010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Learning disorders are common neurodevelopmental conditions, occurring both idiopathically and in the context of other medical conditions. They are frequently comorbid with other neurodevelopmental and psychiatric conditions. Delayed identification and treatment have been associated with significant negative psychosocial consequences. The need for pediatric neuropsychologists to efficiently screen for learning disorders is likely to increase in the months and years following the COVID-19 pandemic, which has severely disrupted access to educational services, especially for children who also face racial and economic disparities. In this paper, we describe a consultation model that can be used to screen for learning disorders and can be completed using both in-person and telemedicine visits. Implementation may result in earlier intervention for struggling children, increase access to neuropsychological services without increasing wait times for comprehensive evaluations, and provide opportunities for collaborations with other health professionals (e.g., pediatricians, therapists, psychiatrists, and neurologists).
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Affiliation(s)
- M K Colvin
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - G A Forchelli
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - K L Reese
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - M R Capawana
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - C S Beery
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - J Murphy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - A E Doyle
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - S M O'Keefe
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - E B Braaten
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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23
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O'Riordan F, Murphy J, Egan G, Ahern E. 46 MEASURING THE IMPACT OF COVID-19 RESTRICTIONS ON MOBILITY IN OLDER ADULTS WITH FRAGILITY FRACTURES USING THE NEW MOBILITY SCORE. Age Ageing 2021. [PMCID: PMC8690020 DOI: 10.1093/ageing/afab219.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Methods Results Conclusion References
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Affiliation(s)
- F O'Riordan
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - J Murphy
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - G Egan
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - E Ahern
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
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24
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O'Riordan F, Murphy J, Egan G, Murphy C, Ahern E. 47 DOSING OF DIRECT ORAL ANTICOAGULANTS IN OLDER ADULTS. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Direct oral anticoagulants (DOACs) are approved for a variety of uses including prevention of stroke in non-valvular atrial fibrillation and treatment and prevention of deep vein thrombosis and pulmonary embolism. Adjustment to DOAC dosing may be required for age, weight and renal impairment. Incorrect lower dosing puts patients at risk of thromboembolic events whereas inappropriate higher dosing increases the risk of bleeding. We compared current DOAC dosing for patients admitted to our hospital and compare this against HSE best practice to determine if patients were receiving the correct dose [1].
Methods
A prospective single-centre study. Patients admitted to our hospital following a fracture and reviewed by the Orthogeriatric team between August–October 2020 were eligible for inclusion. We recorded admission DOAC dose, age, weight and renal function. We also obtained data including sex and Clinical Frailty Scale (CFS).
Results
Thirty-one patients were included. Mean age was 86 years [range 66–99] and 21(68%) were female. Apixaban was the most commonly used DOAC; 25(81%). Stroke prevention in non-valvular atrial fibrillation was the most common DOAC indication; 29(93%). Twelve patients (39%) had an inappropriate DOAC dose prescribed. Eight patients (67%) had an inappropriately low dose and 4 patients (33%) had an inappropriately high dose. The mean CFS was 5 [Range 2–7] classifying our cohort as mildly frail.
Conclusion
Our study has shown that over one-third of our patients were on an inappropriate DOAC dose on admission with the majority (67%) due to under-dosing. Many factors may have influenced dosing choices by clinicians but our findings highlight the challenges in dosing, monitoring and the overall management of DOAC therapy in older people. Further studies and research are required to establish the most accurate and effective dosing strategies for DOACs in older adults.
Reference
1. Health Service Executive [Internet]. Ireland ‘Anticoagulation Prescribing Tips’ https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/noac-prescribing-tips-for-noacs.pdf.
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Affiliation(s)
- F O'Riordan
- Department of Geriatric Medicine, Cork University Hospital , Cork, Ireland
| | - J Murphy
- Department of Geriatric Medicine, Cork University Hospital , Cork, Ireland
| | - G Egan
- Department of Geriatric Medicine, Cork University Hospital , Cork, Ireland
| | - C Murphy
- Department of Geriatric Medicine, Cork University Hospital , Cork, Ireland
| | - E Ahern
- Department of Geriatric Medicine, Cork University Hospital , Cork, Ireland
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Murphy J, Yeap B, Dagogo-Jack I. FP09.04 Impact of Brain Metastasis Status on Adverse Events (AEs) Requiring Dose Reduction Among Patients Receiving Lorlatinib. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Salgado A, Murphy J, Barrett E. The Benefits Experience by Families Participating in the Watersports Inclusion Games. Ir Med J 2021; 114:436. [PMID: 35969219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Aims The Watersports Inclusion Games (Inclusion Games) is a free event for children and families with disability to participate in water-based activities. Family participation in physical activity can improve mental health and confidence in children with disability. This study aims to gain an insight into the benefits and barriers of participation, perceived by parents and carers. Methods After an initial literature review, an online pre-event and post-event survey was constructed via SurveyMonkey. Both surveys were circulated three times to attendees. Statistical and thematic analysis was carried out to compare changes in responses both before and after the event. Results 49% of participants were primarily hoping to experience a new sport in a controlled environment and meet others with similar challenges. The surveys also highlighted an increase in reported family bonding [P=0.14] due to the event. A thematic analysis revealed event organisation and planning is vital for effective participation of children with disability. Conclusion Creating an equal opportunity for young people with disabilities and their families to partake in watersports led to increased confidence and a higher likelihood of future participation. Effective organisation and extra help were key enabling factors facilitating these benefits.
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Affiliation(s)
- A Salgado
- UCD School of Child and Adolescent Psychiatry, School of Medicine, University College Dublin, Belfield, Dublin 4
| | | | - E Barrett
- Child and Adolescent Liaison Psychiatry, Children's University Hospital, Temple Street, Dublin 1
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O’Connor C, Lyons L, Murphy J, Hennessey D. Fabrication of artificial kidney stones of different physical properties for ex vivo experimentation. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00198-1] [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: 11/29/2022] Open
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Plans D, Ponzo S, Morelli D, Cairo M, Ring C, Keating CT, Cunningham AC, Catmur C, Murphy J, Bird G. Measuring interoception: The phase adjustment task. Biol Psychol 2021; 165:108171. [PMID: 34411620 DOI: 10.1016/j.biopsycho.2021.108171] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 02/03/2023]
Abstract
Interoception, perception of one's bodily state, has been associated with mental health and socio-emotional processes. However, several interoception tasks are of questionable validity, meaning associations between interoception and other variables require confirmation with new measures. Here we describe the novel, smartphone-based Phase Adjustment Task (PAT). Tones are presented at the participant's heart rate, but out of phase with heartbeats. Participants adjust the phase relationship between tones and heartbeats until they are synchronous. Data from 124 participants indicates variance in performance across participants which is not affected by physiological or strategic confounds. Associations between interoception and anxiety, depression and stress were not significant. Weak associations between interoception and mental health variables may be a consequence of testing a non-clinical sample. A second study revealed PAT performance to be moderately stable over one week, consistent with state effects on interoception.
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Affiliation(s)
- D Plans
- INDEX Group, Department of Science, Innovation, Technology, and Entrepreneurship, University of Exeter, United Kingdom; Huma Therapeutics Ltd, London, United Kingdom; Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.
| | - S Ponzo
- Huma Therapeutics Ltd, London, United Kingdom.
| | - D Morelli
- Huma Therapeutics Ltd, London, United Kingdom; Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - M Cairo
- Huma Therapeutics Ltd, London, United Kingdom
| | - C Ring
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - C T Keating
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | | | - C Catmur
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - J Murphy
- Department of Psychology, Royal Holloway University of London, London, United Kingdom
| | - G Bird
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom; Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
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Murphy J, Gandhi A. Does Mastectomy Reduce Overall Survival in Early Stage Breast Cancer? Clin Oncol (R Coll Radiol) 2021; 33:440-447. [DOI: 10.1016/j.clon.2021.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/22/2020] [Accepted: 03/05/2021] [Indexed: 01/12/2023]
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Gandhi A, Duxbury P, Murphy J, Foden P, Lalloo F, Clancy T, Wisely J, Kirwan CC, Howell A, Evans DG. Patient reported outcome measures in a cohort of patients at high risk of breast cancer treated by bilateral risk reducing mastectomy and breast reconstruction. J Plast Reconstr Aesthet Surg 2021; 75:69-76. [PMID: 34219040 DOI: 10.1016/j.bjps.2021.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 09/02/2020] [Revised: 02/12/2021] [Accepted: 06/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many women with increased lifetime risk of developing breast cancer, due to pathogenic gene variants or family history, choose to undergo bilateral risk reducing mastectomies (BRRM). Patient reported outcome measures (PROMS) are an increasingly important part of informed consent but are little studied in women undergoing BRRM. METHODS We used a validated PROMS tool for breast reconstruction (BREAST-Q) in 297 women who had BRRM and breast reconstruction, 81% of whom had no malignancy (Benign Group, BG) and 19% in whom a perioperative breast cancer was diagnosed (Cancer Group, CG). 128 women also completed a Hospital Anxiety & Depression Score (HADS) questionnaire to test if preoperative HADS score could predict PROMS outcomes. RESULTS Women in the CG had lower PROMS scores for satisfaction with their breasts, nipple reconstruction and sexual wellbeing. Both groups reported equal satisfaction with BRRM outcome and psychosocial well-being. Physical well-being PROMS of the abdomen and chest were high in women in both groups as were scores for satisfaction with the care they received. The CG group reported suboptimal quality of patient information. A higher presurgical HADS anxiety score predicted less favourable postoperative psychosocial well-being despite similar levels of satisfaction with aesthetic outcome. CONCLUSION We show a high degree of patient reported satisfaction by woman undergoing BRRM and reconstruction. There was a negative association with a cancer diagnosis on quality of life PROMS and higher preoperative anxiety levels negatively affected postoperative psychosocial well-being. These important findings should be part of the informed consent process during preoperative counselling.
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Affiliation(s)
- A Gandhi
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - P Duxbury
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - J Murphy
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - P Foden
- Department of Medical Statistics, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - F Lalloo
- Department of Clinical Genetics, Manchester Centre for Genomic Medicine, St Marys Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - T Clancy
- Department of Clinical Genetics, Manchester Centre for Genomic Medicine, St Marys Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - J Wisely
- Department of Clinical Psychology, Laureate House, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - C C Kirwan
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - A Howell
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - D G Evans
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Gardner L, Ibeh B, Murphy J, Allain J, Yeung S, Chenard C. Hydrogen recombination scaling experiments at CNL’s hydrogen safety test facility. Nuclear Engineering and Design 2021. [DOI: 10.1016/j.nucengdes.2021.111152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Southern KW, Murphy J, Sinha IP, Nevitt SJ. A systematic cochrane review of corrector therapies (with or without potentiators) for people with cystic fibrosis with class II gene variants (most commonly F508DEL). Paediatr Respir Rev 2021; 38:33-36. [PMID: 33875358 DOI: 10.1016/j.prrv.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Affiliation(s)
- K W Southern
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - J Murphy
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - I P Sinha
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - S J Nevitt
- Department of Health Data Science, University of Liverpool, Liverpool, UK
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Gilmour A, Cutress R, Gandhi A, Harcourt D, Little K, Mansell J, Murphy J, Pennery E, Tillett R, Vidya R, Martin L. Oncoplastic breast surgery: A guide to good practice. Eur J Surg Oncol 2021; 47:2272-2285. [PMID: 34001384 DOI: 10.1016/j.ejso.2021.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 04/08/2021] [Revised: 04/18/2021] [Accepted: 05/05/2021] [Indexed: 02/08/2023] Open
Abstract
Oncoplastic Breast Surgery has become standard of care in the management of Breast Cancer patients. These guidelines written by an Expert Advisory Group; convened by the Association of Breast Surgery (ABS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), are designed to provide all members of the breast cancer multidisciplinary team (MDT) with guidance on the best breast surgical oncoplastic and reconstructive practice at each stage of a patient's journey, based on current evidence. It is hoped they will also be of benefit to the wide range of professionals and service commissioners who are involved in this area of clinical practice.
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Affiliation(s)
- A Gilmour
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, United Kingdom
| | - R Cutress
- University of Southampton and University Hospital Southampton, United Kingdom
| | - A Gandhi
- Manchester Academic Health Sciences Centre & Manchester University Hospitals NHS Trust, Manchester, United Kingdom
| | - D Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - K Little
- Liverpool Breast Unit, Liverpool University Foundation Trust, United Kingdom
| | - J Mansell
- Gartnavel General Hospital, Glasgow, United Kingdom
| | - J Murphy
- Manchester University Hospitals NHS Trust, United Kingdom
| | | | - R Tillett
- Royal Devon and Exeter NHS Trust, Exeter, United Kingdom
| | - R Vidya
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - L Martin
- Liverpool Breast Unit, Liverpool University Foundation Trust, United Kingdom.
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Ibrahim H, Walsh J, Casey D, Murphy J, Plant BJ, O'Leary P, Murphy DM. Recurrent asthma exacerbations: co-existing asthma and common variable immunodeficiency. J Asthma 2021; 59:1177-1180. [PMID: 33902374 DOI: 10.1080/02770903.2021.1922913] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Common variable immunodeficiency is characterized by impaired B-cell differentiation and defective immunoglobulin production manifesting as recurrent respiratory tract infections. While the condition can masquerade as asthma, late diagnosis of CVID in known asthmatic is rarely reported. We present the case of a 43-year-old lady with recurrent episodes of wheeze, cough, sinusitis and multiple lower respiratory tract infections. Transiently responsive to antibiotics and steroids. These episodes had been occurring for many years and she had a longstanding clinical diagnosis of asthma. As part of her work up for recurrent respiratory tract infections a CT thorax was performed and demonstrated bronchiectasis. Further tests including Immunoglobulin levels revealed critically low IgG, IgM, and IgA levels. Immunoglobulin replacement therapy was commenced with a reduction in exacerbation frequency and severity, and objective improvement of asthma control. Subsequent lung function tests demonstrated reversible airflow limitation (obstructive lung function with 13% reversibility in FEV1 post-bronchodilator) consistent with asthma. Our case illustrates the importance of searching for alternate and co-existent diagnoses in patients diagnosed with asthma who are unresponsive to conventional therapy. We believe that serum immunoglobulin measurement should form a component of such a workup.
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Affiliation(s)
- H Ibrahim
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - J Walsh
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - D Casey
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - J Murphy
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - B J Plant
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,The HRB funded Clinical Research Facility, University College Cork, Cork, Ireland
| | - P O'Leary
- The Department of Medicine, School of Medicine, University College Cork, Cork, Ireland
| | - D M Murphy
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,The HRB funded Clinical Research Facility, University College Cork, Cork, Ireland
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Murphy J. Re: Two-week rule: suspected head and neck cancer referrals from a general medical practice perspective. Br J Oral Maxillofac Surg 2021; 59:611. [PMID: 33863591 DOI: 10.1016/j.bjoms.2020.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/26/2020] [Indexed: 11/18/2022]
Affiliation(s)
- J Murphy
- University of Leeds, Leeds LS2 9JT.
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Lumish H, Chaudhary E, Cagliostro B, Javaid A, Mondellini G, Braghieri L, Sweat A, Murphy J, Pinsino A, Takeda K, Naka Y, Sayer G, Uriel N, Aaron J, Colombo P, Yuzefpolskaya M. Pseudomonas aeruginosa Infection Predicts Need for Surgical Incision and Drainage in LVAD Patients with Driveline Infection. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1935] [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] Open
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Abstract
Pediatric feeding problems occur in 25-40% of all children and disproportionately affect children with health and/or developmental concerns. Children with autism spectrum disorder (ASD) are at particularly high risk for feeding difficulties, though the connection between ASD and feeding problems is not well understood. As issues related to problematic feeding behavior frequently present to outpatient pediatric clinics, there is a need to understand the common factors that contribute to the development of both adaptive and maladaptive feeding behaviors. The current study examined predictors of problematic feeding behavior in children with and without ASD. Parents of children with ASD reported significantly greater child disruptive behavior, parenting stress, child feeding difficulties, and problematic parental feelings and strategies regarding feeding. Child disruptive behavior and parenting stress contributed the most variance in the prediction of child feeding difficulties and the relation between child disruptive behavior and feeding difficulties was partially mediated by parental strategies and feelings.
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Affiliation(s)
- J Murphy
- Department of Psychology, University of South Alabama, 75 S University Blvd, UCOM 1000, Mobile, AL, 36688, USA
| | - K Zlomke
- Department of Psychology, University of South Alabama, 75 S University Blvd, UCOM 1000, Mobile, AL, 36688, USA.
| | - J VanOrmer
- Department of Psychology, University of South Alabama, 75 S University Blvd, UCOM 1000, Mobile, AL, 36688, USA
| | - H Swingle
- Department of Pediatrics, University of South Alabama, Mobile, USA
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O’Flynn A, Murphy J, Barrett E. The watersports inclusion games - what are the benefits for volunteers? Eur Psychiatry 2021. [PMCID: PMC9475715 DOI: 10.1192/j.eurpsy.2021.1235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The Watersports Inclusion Games is an annual event organised by Irish Sailing and partners that provides an opportunity for individuals of all abilities across the physical, sensory, intellectual and learning spectrums and those experiencing barriers accessing mainstream sport to partake in a range of watersports. 79 volunteers from the 2019 cohort responded to a pilot survey to assess the benefits for volunteers at the event. Objectives This project aims to assess this data in the context of current knowledge about the benefits for volunteers in inclusive sport. Methods Literature review used the PEO keyword framework in medical and psychological databases, as well as grey literature. Data was collected using SurveyMonkey, quantitative data was analysed using Survey Monkey and SPSS, and qualitative themes were analysed using SurveyMonkey and Excel. Results Only one article exploring the benefits for volunteers in inclusive watersports was identified during literature review. This pilot survey analysis is the first on this topic in Ireland, and the largest sample of volunteers in inclusive watersport that we are aware of internationally. Thematic analysis finds that volunteers at this event are primarily motivated by altruistic motives, while the benefits they perceive include both personal enjoyment and growth, and seeing the enjoyment of other participants. Conclusions This project demonstrates that inclusive watersports can have many benefits for volunteers. The findings of this study can contribute to the evidence base on the benefits of inclusive sport for all those involved, while also identifying an opportunity for further study on volunteerism in inclusive sport, particularly adaptive watersports. Conflict of interest Ms O’Flynn reports a scholarship from the Health Research Board for this project, Dr Barrett has nothing to disclose, Ms Murphy reports to be the Inclusion Games Office, and thus responsible for the organisation of the Watersports Inclusion Games.
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Esponda GM, Ryan GK, Estrin GL, Usmani S, Lee L, Murphy J, Qureshi O, Endale T, Regan M, Eaton J, De Silva M. Lessons from a theory of change-driven evaluation of a global mental health funding portfolio. Int J Ment Health Syst 2021; 15:18. [PMID: 33640004 PMCID: PMC7913430 DOI: 10.1186/s13033-021-00442-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/15/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Given the underinvestment in global mental health to-date, it is important to consider how best to maximize the impact of existing investments. Theory of Change (ToC) is increasingly attracting the interest of funders seeking to evaluate their own impact. This is one of four papers investigating Grand Challenges Canada's (GCC's) first global mental health research funding portfolio (2012-2016) using a ToC-driven approach. METHODS A portfolio-level ToC map was developed through a collaborative process involving GCC grantees and other key stakeholders. Proposed ToC indicators were harmonised with GCC's pre-existing Results-based Management and Accountability Framework to produce a "Core Metrics Framework" of 23 indicators linked to 17 outcomes of the ToC map. For each indicator relevant to their project, the grantee was asked to set a target prior to the start of implementation, then report results at six-month intervals. We used the latest available dataset from all 56 projects in GCC's global mental health funding portfolio to produce a descriptive analysis of projects' characteristics and outcomes related to delivery. RESULTS 12,999 people were trained to provide services, the majority of whom were lay or other non-specialist health workers. Most projects exceeded their training targets for capacity-building, except for those training lay health workers. Of the 321,933 people screened by GCC-funded projects, 162,915 received treatment. Most projects focused on more than one disorder and exceeded all their targets for screening, diagnosis and treatment. Fewer people than intended were screened for common mental disorders and epilepsy (60% and 54%, respectively), but many more were diagnosed and treated than originally proposed (148% and 174%, respectively). In contrast, the three projects that focused on perinatal depression exceeded screening and diagnosis targets, but only treated 43% of their intended target. CONCLUSIONS Under- or over-achievement of targets may reflect operational challenges such as high staff turnover, or challenges in setting appropriate targets, for example due to insufficient epidemiological evidence. Differences in delivery outcomes when disaggregated by disorder suggest that these challenges are not universal. We caution implementers, funders and evaluators from taking a one-size-fits all approach and make several recommendations for how to facilitate more in-depth, multi-method evaluation of impact using portfolio-level ToC.
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Affiliation(s)
- G Miguel Esponda
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Camberwell, London, SE5 8AB, UK.
- ESRC Centre for Society and Mental Health, King's College London, London, UK.
| | - G K Ryan
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - G Lockwood Estrin
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck College, University of London, London, UK
| | - S Usmani
- Independent Researcher, Minneapolis, MN, USA
| | - L Lee
- Independent Researcher, London, UK
| | - J Murphy
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - O Qureshi
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - T Endale
- Department of Counselling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - M Regan
- Health Improvement Directorate, Public Health England, London, UK
| | - J Eaton
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- CBM Global, Cambridge, UK
| | - M De Silva
- Department of Population Health, Wellcome Trust, London, UK
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McBride O, Heslop P, Glover G, Taggart T, Hanna-Trainor L, Shevlin M, Murphy J. Prevalence estimation of intellectual disability using national administrative and household survey data: The importance of survey question specificity. Int J Popul Data Sci 2021; 6:1342. [PMID: 34164584 PMCID: PMC8188522 DOI: 10.23889/ijpds.v6i1.1342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Variability in prevalence estimation of intellectual disability has been attributed to heterogeneity in study settings, methodologies, and intellectual disability case definitions. Among studies based on national household survey data specifically, variability in prevalence estimation has partly been attributed to the level of specificity of the survey questions employed to determine the presence of intellectual disability. Specific aims & method Using standardised difference scoring, and ‘intellectual disability’ survey data from the 2007 Northern Ireland Survey on Activity Limitation and Disability (NISALD) (N=23,689) and the 2011 Northern Ireland Census (N=1,770,217) the following study had two aims. First, we aimed to demonstrate the effects of survey question specificity on intellectual disability prevalence estimation. Second, we aimed to produce reliable estimates of the geographic variation of intellectual disability within private households in Northern Ireland while also assessing the socio-demographic, health-related and disability characteristics of this population. Findings Prevalence estimates generated using the more crudely classified intellectual disability Census data indicated a prevalence of 2% for the overall population, 3.8% for children aged between 0 and 15 years, and 1.5% for citizens aged 16 years or older. Intellectual disability prevalence estimates generated using the more explicitly defined 2007 NISALD data indicated a population prevalence of 0.5% for the overall population, 1.3% for children aged between 0 and 15 years, and 0.3% for citizens aged 16 years or older. The NISALD estimates were consistent with most recent international meta-analysis prevalence estimates. According to the NISALD data, the majority of those with an intellectual disability were male, lived outside Belfast, and experienced severe intellectual disability, with multiple comorbid health conditions. Discussion The current findings highlight the importance of survey question specificity in the estimation of intellectual disability prevalence and provide reliable prevalence estimates of intellectual disability in Northern Ireland. The findings also demonstrate the utility of administrative data for detecting and understanding intellectual disability, and inform recommendations on how to maximise use of future intellectual disability Census data
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Affiliation(s)
- O McBride
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - P Heslop
- School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - G Glover
- Learning Disability Observatory, Public Health England, London, United Kingdom
| | - T Taggart
- School of Nursing, Ulster University, Derry, Northern Ireland
| | - L Hanna-Trainor
- School of Nursing, Ulster University, Derry, Northern Ireland
| | - M Shevlin
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - J Murphy
- School of Psychology, Ulster University, Coleraine, Northern Ireland
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Baksaas-Aasen K, Gall LS, Stensballe J, Juffermans NP, Curry N, Maegele M, Brooks A, Rourke C, Gillespie S, Murphy J, Maroni R, Vulliamy P, Henriksen HH, Pedersen KH, Kolstadbraaten KM, Wirtz MR, Kleinveld DJB, Schäfer N, Chinna S, Davenport RA, Naess PA, Goslings JC, Eaglestone S, Stanworth S, Johansson PI, Gaarder C, Brohi K. Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial. Intensive Care Med 2021; 47:49-59. [PMID: 33048195 PMCID: PMC7550843 DOI: 10.1007/s00134-020-06266-1] [Citation(s) in RCA: 133] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 09/20/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Contemporary trauma resuscitation prioritizes control of bleeding and uses major haemorrhage protocols (MHPs) to prevent and treat coagulopathy. We aimed to determine whether augmenting MHPs with Viscoelastic Haemostatic Assays (VHA) would improve outcomes compared to Conventional Coagulation Tests (CCTs). METHODS This was a multi-centre, randomized controlled trial comparing outcomes in trauma patients who received empiric MHPs, augmented by either VHA or CCT-guided interventions. Primary outcome was the proportion of subjects who, at 24 h after injury, were alive and free of massive transfusion (10 or more red cell transfusions). Secondary outcomes included 28-day mortality. Pre-specified subgroups included patients with severe traumatic brain injury (TBI). RESULTS Of 396 patients in the intention to treat analysis, 201 were allocated to VHA and 195 to CCT-guided therapy. At 24 h, there was no difference in the proportion of patients who were alive and free of massive transfusion (VHA: 67%, CCT: 64%, OR 1.15, 95% CI 0.76-1.73). 28-day mortality was not different overall (VHA: 25%, CCT: 28%, OR 0.84, 95% CI 0.54-1.31), nor were there differences in other secondary outcomes or serious adverse events. In pre-specified subgroups, there were no differences in primary outcomes. In the pre-specified subgroup of 74 patients with TBI, 64% were alive and free of massive transfusion at 24 h compared to 46% in the CCT arm (OR 2.12, 95% CI 0.84-5.34). CONCLUSION There was no difference in overall outcomes between VHA- and CCT-augmented-major haemorrhage protocols.
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Affiliation(s)
| | - L S Gall
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - J Stensballe
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - N P Juffermans
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - N Curry
- Oxford University Hospital NHS Trust, Oxford, UK
| | - M Maegele
- Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany
| | - A Brooks
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C Rourke
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - S Gillespie
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - J Murphy
- Queen Mary University of London, London, UK
| | - R Maroni
- Queen Mary University of London, London, UK
| | - P Vulliamy
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - H H Henriksen
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K Holst Pedersen
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - M R Wirtz
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - D J B Kleinveld
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - N Schäfer
- Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany
| | - S Chinna
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R A Davenport
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - P A Naess
- Oslo University Hospital & University of Oslo, Oslo, Norway
| | - J C Goslings
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - S Eaglestone
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - S Stanworth
- Oxford University Hospital NHS Trust, Oxford, UK.,NHS Blood and Transplant, Bristol, UK
| | - P I Johansson
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - C Gaarder
- Oslo University Hospital & University of Oslo, Oslo, Norway
| | - K Brohi
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK.
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Southern KW, Murphy J, Sinha IP, Nevitt SJ. Corrector therapies (with or without potentiators) for people with cystic fibrosis with class II CFTR gene variants (most commonly F508del). Cochrane Database Syst Rev 2020; 12:CD010966. [PMID: 33331662 PMCID: PMC8094390 DOI: 10.1002/14651858.cd010966.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a common life-shortening genetic condition caused by a variant in the cystic fibrosis transmembrane conductance regulator (CFTR) protein. A class II CFTR variant F508del (found in up to 90% of people with CF (pwCF)) is the commonest CF-causing variant. The faulty protein is degraded before reaching the cell membrane, where it needs to be to effect transepithelial salt transport. The F508del variant lacks meaningful CFTR function and corrective therapy could benefit many pwCF. Therapies in this review include single correctors and any combination of correctors and potentiators. OBJECTIVES To evaluate the effects of CFTR correctors (with or without potentiators) on clinically important benefits and harms in pwCF of any age with class II CFTR mutations (most commonly F508del). SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Cystic Fibrosis Trials Register, reference lists of relevant articles and online trials registries. Most recent search: 14 October 2020. SELECTION CRITERIA Randomised controlled trials (RCTs) (parallel design) comparing CFTR correctors to control in pwCF with class II mutations. DATA COLLECTION AND ANALYSIS Two authors independently extracted data, assessed risk of bias and evidence quality (GRADE); we contacted investigators for additional data. MAIN RESULTS We included 19 RCTs (2959 participants), lasting between 1 day and 24 weeks; an extension of two lumacaftor-ivacaftor studies provided additional 96-week safety data (1029 participants). We assessed eight monotherapy RCTs (344 participants) (4PBA, CPX, lumacaftor, cavosonstat and FDL169), six dual-therapy RCTs (1840 participants) (lumacaftor-ivacaftor or tezacaftor-ivacaftor) and five triple-therapy RCTs (775 participants) (elexacaftor-tezacaftor-ivacaftor or VX-659-tezacaftor-ivacaftor); below we report only the data from elexacaftor-tezacaftor-ivacaftor combination which proceeded to Phase 3 trials. In 14 RCTs participants had F508del/F508del genotypes, in three RCTs F508del/minimal function (MF) genotypes and in two RCTs both genotypes. Risk of bias judgements varied across different comparisons. Results from 11 RCTs may not be applicable to all pwCF due to age limits (e.g. adults only) or non-standard design (converting from monotherapy to combination therapy). Monotherapy Investigators reported no deaths or clinically-relevant improvements in quality of life (QoL). There was insufficient evidence to determine any important effects on lung function. No placebo-controlled monotherapy RCT demonstrated differences in mild, moderate or severe adverse effects (AEs); the clinical relevance of these events is difficult to assess with their variety and small number of participants (all F508del/F508del). Dual therapy Investigators reported no deaths (moderate- to high-quality evidence). QoL scores (respiratory domain) favoured both lumacaftor-ivacaftor and tezacaftor-ivacaftor therapy compared to placebo at all time points. At six months lumacaftor 600 mg or 400 mg (both once daily) plus ivacaftor improved Cystic Fibrosis Questionnaire (CFQ) scores slightly compared with placebo (mean difference (MD) 2.62 points (95% confidence interval (CI) 0.64 to 4.59); 1061 participants; high-quality evidence). A similar effect was observed for twice-daily lumacaftor (200 mg) plus ivacaftor (250 mg), but with low-quality evidence (MD 2.50 points (95% CI 0.10 to 5.10)). The mean increase in CFQ scores with twice-daily tezacaftor (100 mg) and ivacaftor (150 mg) was approximately five points (95% CI 3.20 to 7.00; 504 participants; moderate-quality evidence). At six months, the relative change in forced expiratory volume in one second (FEV1) % predicted improved with combination therapies compared to placebo by: 5.21% with once-daily lumacaftor-ivacaftor (95% CI 3.61% to 6.80%; 504 participants; high-quality evidence); 2.40% with twice-daily lumacaftor-ivacaftor (95% CI 0.40% to 4.40%; 204 participants; low-quality evidence); and 6.80% with tezacaftor-ivacaftor (95% CI 5.30 to 8.30%; 520 participants; moderate-quality evidence). More pwCF reported early transient breathlessness with lumacaftor-ivacaftor, odds ratio 2.05 (99% CI 1.10 to 3.83; 739 participants; high-quality evidence). Over 120 weeks (initial study period and follow-up) systolic blood pressure rose by 5.1 mmHg and diastolic blood pressure by 4.1 mmHg with twice-daily 400 mg lumacaftor-ivacaftor (80 participants; high-quality evidence). The tezacaftor-ivacaftor RCTs did not report these adverse effects. Pulmonary exacerbation rates decreased in pwCF receiving additional therapies to ivacaftor compared to placebo: lumacaftor 600 mg hazard ratio (HR) 0.70 (95% CI 0.57 to 0.87; 739 participants); lumacaftor 400 mg, HR 0.61 (95% CI 0.49 to 0.76; 740 participants); and tezacaftor, HR 0.64 (95% CI, 0.46 to 0.89; 506 participants) (moderate-quality evidence). Triple therapy Three RCTs of elexacaftor to tezacaftor-ivacaftor in pwCF (aged 12 years and older with either one or two F508del variants) reported no deaths (high-quality evidence). All other evidence was graded as moderate quality. In 403 participants with F508del/minimal function (MF) elexacaftor-tezacaftor-ivacaftor improved QoL respiratory scores (MD 20.2 points (95% CI 16.2 to 24.2)) and absolute change in FEV1 (MD 14.3% predicted (95% CI 12.7 to 15.8)) compared to placebo at 24 weeks. At four weeks in 107 F508del/F508del participants, elexacaftor-tezacaftor-ivacaftor improved QoL respiratory scores (17.4 points (95% CI 11.9 to 22.9)) and absolute change in FEV1 (MD 10.0% predicted (95% CI 7.5 to 12.5)) compared to tezacaftor-ivacaftor. There was probably little or no difference in the number or severity of AEs between elexacaftor-tezacaftor-ivacaftor and placebo or control (moderate-quality evidence). In 403 F508del/F508del participants, there was a longer time to protocol-defined pulmonary exacerbation with elexacaftor-tezacaftor-ivacaftor over 24 weeks (moderate-quality evidence). AUTHORS' CONCLUSIONS There is insufficient evidence that corrector monotherapy has clinically important effects in pwCF with F508del/F508del. Both dual therapies (lumacaftor-ivacaftor, tezacaftor-ivacaftor) result in similar improvements in QoL and respiratory function with lower pulmonary exacerbation rates. Lumacaftor-ivacaftor was associated with an increase in early transient shortness of breath and longer-term increases in blood pressure (not observed for tezacaftor-ivacaftor). Tezacaftor-ivacaftor has a better safety profile, although data are lacking in children under 12 years. In this population, lumacaftor-ivacaftor had an important impact on respiratory function with no apparent immediate safety concerns; but this should be balanced against the blood pressure increase and shortness of breath seen in longer-term adult data when considering lumacaftor-ivacaftor. There is high-quality evidence of clinical efficacy with probably little or no difference in AEs for triple (elexacaftor-tezacaftor-ivacaftor) therapy in pwCF with one or two F508del variants aged 12 years or older. Further RCTs are required in children (under 12 years) and those with more severe respiratory function.
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Affiliation(s)
- Kevin W Southern
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Jared Murphy
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Ian P Sinha
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Sarah J Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, UK
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Leo CA, Leeuwenburgh M, Orlando A, Corr A, Scott SM, Murphy J, Knowles CH, Vaizey CJ, Giordano P. Initial experience with SphinKeeper™ intersphincteric implants for faecal incontinence in the UK: a two-centre retrospective clinical audit. Colorectal Dis 2020; 22:2161-2169. [PMID: 32686233 DOI: 10.1111/codi.15277] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/30/2020] [Indexed: 02/08/2023]
Abstract
AIM The SphinKeeper™ artificial bowel sphincter implant is a relatively new surgical technique for the treatment of refractory faecal incontinence. This study presents the first experience in two UK tertiary centres. METHOD This is a retrospective audit of prospectively collected clinical data in relation to technique, safety, feasibility and short-term effectiveness from patients undergoing surgery from January 2016 to April 2019. Baseline data, intra-operative and postoperative complications, symptoms [using St Mark's incontinence score (SMIS)] and radiological outcomes were analysed. RESULTS Twenty-seven patients [18 women, median age 57 years (range 27-87)] underwent SphinKeeper. In 30% of the patients, the firing device jammed and not all prostheses were delivered. There were no intra-operative complications and all patients were discharged the same or the following day. SMIS significantly improved from baseline [median -6 points (range -12 to +3); P < 0.00016] with 14/27 (51.9%) patients achieving a 50% reduction in the SMIS score. On postoperative imaging, a median of seven prostheses (range 0-10) were identified with a median of five (range 0-10) optimally placed. There was no relationship between number of well-sited prostheses on postoperative imaging and categorical success based on 50% reduction in SMIS (χ2 test, P = 0.79). CONCLUSION SphinKeeper appears to be a safe procedure for faecal incontinence. Overall, about 50% patients achieved a meaningful improvement in symptoms. However, clinical benefit was unrelated to the rate of misplaced/migrated implants. This has implications for confidence in proof of mechanism and also the need for technical refinement.
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Affiliation(s)
- C A Leo
- Imperial College London, London, UK.,Sir Alan Park's Physiology Unit, St Mark's Hospital Academic Institute, Harrow, UK
| | | | - A Orlando
- Imperial College London, London, UK.,Sir Alan Park's Physiology Unit, St Mark's Hospital Academic Institute, Harrow, UK
| | - A Corr
- Sir Alan Park's Physiology Unit, St Mark's Hospital Academic Institute, Harrow, UK
| | - S M Scott
- National Bowel Research Centre and GI Physiology Unit, Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Queen Mary University of London, London, UK.,Royal London Hospital, London, UK
| | - J Murphy
- Imperial College London, London, UK
| | - C H Knowles
- National Bowel Research Centre and GI Physiology Unit, Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Queen Mary University of London, London, UK.,Royal London Hospital, London, UK
| | - C J Vaizey
- Sir Alan Park's Physiology Unit, St Mark's Hospital Academic Institute, Harrow, UK
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Murphy J, Etti M, Duret A, Papineni P. Ocular tuberculosis: A case series from a London hospital. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1215] [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: 11/17/2022] Open
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Leo CA, Thomas GP, Bradshaw E, Karki S, Hodgkinson JD, Murphy J, Vaizey CJ. Long-term outcome of sacral nerve stimulation for faecal incontinence. Colorectal Dis 2020; 22:2191-2198. [PMID: 32954658 DOI: 10.1111/codi.15369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/06/2020] [Indexed: 12/11/2022]
Abstract
AIM Sacral nerve stimulation (SNS) is a minimally invasive treatment for faecal incontinence (FI). We report our experience of patients who have undergone SNS for FI with a minimum of 5 years' follow-up. This is a single centre prospective observational study with the aim to assess the long-term function of SNS. METHOD All patients implanted with SNS were identified from our prospective database. The date of implantation, first and last clinic follow-up, surgical complications and St Mark's incontinence scores were abstracted and analysed. RESULTS From 1996 to 2014, 381 patients were considered for SNS. Of these, 256 patients met the study inclusion criteria. Median age at implantation was 52 years (range 18-81). The ratio of women to men was 205:51. Indications were urge FI (25%), passive FI (17.9%) and mixed FI (57%). The median of the incontinence score at baseline was 19/24 and this improved to 7/24 at the 6-month follow-up. Of the total cohort, 235 patients received a medium-term follow-up (median 110 months, range 12-270) with a median continence score of 10/24 which was also confirmed at the telephone long-term follow-up on 185 patients (132 months, range 60-276). CONCLUSION This study demonstrates that SNS is an effective treatment in the long term. SNS results in an improvement of validated scores for approximately 60% of patients; however, there is a significant reduction of efficacy over time due to underlying causes.
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Affiliation(s)
- C A Leo
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Northwest London University NHS Trust, Harrow, UK.,Imperial College London, London, UK.,Northwick Park Hospital, London North West NHS Trust, Harrow, UK
| | - G P Thomas
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Northwest London University NHS Trust, Harrow, UK
| | - E Bradshaw
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Northwest London University NHS Trust, Harrow, UK
| | - S Karki
- Northwick Park Hospital, London North West NHS Trust, Harrow, UK
| | - J D Hodgkinson
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Northwest London University NHS Trust, Harrow, UK.,Imperial College London, London, UK
| | - J Murphy
- Imperial College London, London, UK
| | - C J Vaizey
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Northwest London University NHS Trust, Harrow, UK.,Imperial College London, London, UK
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Paniccia M, Ippolito C, McFarland S, Murphy J, Reed N. Health-Related Quality of Life in Non-Concussed Children: A Normative Study to Inform Concussion Management. Dev Neurorehabil 2020; 23:534-541. [PMID: 32156189 DOI: 10.1080/17518423.2020.1736683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: There has been a shift to consider pediatric concussion recovery beyond symptom management by considering how health-related quality of life (HRQoL) affects recovery. This study investigated normative ranges of HRQoL in children and explored its relationship with common pediatric concussion variables. Methods: A cross-sectional study of 1,722 non-concussed children 8-12 years old (M = 10.52 ± 1.23 years; 1,335 males, 387 females) was conducted by secondary analysis of clinical baseline concussion data. Demographic information, concussion-like symptoms (PCSI-C), and HRQoL (KIDSCREEN-10 Index) were self-reported. Results: The most reported concussion-like symptoms were common stress symptoms and were significantly negatively correlated with HRQoL. Premorbid histories of attention deficit hyperactivity disorder, mental health challenges, headaches/migraines, and concussion significantly lowered HRQoL. The number of diagnosed concussions and PCSI-C scores were significantly negatively correlated with HRQoL. Conclusions: The normative ranges and model can indicate HRQoL levels to inform clinicians how children may respond to concussion and streamline care beyond traditional assessment models.
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Affiliation(s)
- M Paniccia
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - C Ippolito
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - S McFarland
- Early Concussion Care Program, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - J Murphy
- Early Concussion Care Program, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - N Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto , Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto , Toronto, Canada
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Osborne MS, Bentley E, Farrow A, Chan J, Murphy J. Impact of coronavirus disease 2019 on urgent referrals to secondary care otolaryngology: a prospective case series. J Laryngol Otol 2020; 134:1-4. [PMID: 32981533 PMCID: PMC7684200 DOI: 10.1017/s0022215120002091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE As the novel coronavirus disease 2019 changed patient presentation, this study aimed to prospectively identify these changes in a single ENT centre. DESIGN A seven-week prospective case series was conducted of urgently referred patients from primary care and accident and emergency department. RESULTS There was a total of 133 referrals. Referral rates fell by 93 per cent over seven weeks, from a mean of 5.4 to 0.4 per day. Reductions were seen in referrals from both primary care (89 per cent) and the accident and emergency department (93 per cent). Presentations of otitis externa and epistaxis fell by 83 per cent, and presentations of glandular fever, tonsillitis and peritonsillar abscess fell by 67 per cent. CONCLUSION Coronavirus disease 2019 has greatly reduced the number of referrals into secondary care ENT. The cause for this reduction is likely to be due to patients' increased perceived risk of the virus presence in a medical setting. The impact of this reduction is yet to be ascertained, but will likely result in a substantial increase in emergency pressures once the lockdown is lifted and the general public's perception of the coronavirus disease 2019 risk reduces.
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Affiliation(s)
- M S Osborne
- Department of ENT, New Cross Hospital, Wolverhampton, UK
| | - E Bentley
- Department of ENT, New Cross Hospital, Wolverhampton, UK
| | - A Farrow
- Department of ENT, New Cross Hospital, Wolverhampton, UK
| | - J Chan
- Department of ENT, Princess Royal Hospital, Telford, UK
| | - J Murphy
- Department of ENT, New Cross Hospital, Wolverhampton, UK
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Paniccia M, Ippolito C, McFarland S, Murphy J, Reed N. Self-efficacy in non-concussed youth: a normative study. Brain Inj 2020; 34:1532-1540. [PMID: 32910683 DOI: 10.1080/02699052.2020.1792983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In pediatric concussion, there has been a shift to consider how pre-injury profiles, such as self-efficacy, affect the recovery trajectory. The aim of this study was to investigate normal ranges of self-efficacy (overall, academic, social, emotional) in youth and to explore its relationship with the effects of daily stressors, operationalized as concussion-like symptoms, demographic factors, pre-injury/learning related factors, and concussion history. METHODS A cross-sectional study of 1300 uninjured youth 13-18 years old (1111 males, 189 females) was conducted by secondary analysis of clinical pre-injury/baseline concussion data. Demographic information, concussion-like symptoms (Post-concussion Symptom Inventory), and self-efficacy (Self-efficacy Questionnaire for Children) were self-reported. RESULTS The most reported concussion-like symptoms were common stress symptoms and there was a strong negative relationship with self-efficacy. Males reported higher self-efficacy than females, but no age effects were observed. Pre-injury factors including learning disability, ADHD, special education, IEP, mental health challenges, history of headaches/migraines, and concussion history were associated with significantly lower overall self-efficacy. CONCLUSIONS These normative ranges and predictive model can be used to provide a benchmark of self-efficacy to indicate how youth may respond to a concussion, and to inform clinical care during recovery.
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Affiliation(s)
- M Paniccia
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - C Ippolito
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - S McFarland
- Concussion Centre, Early Concussion Care Program, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - J Murphy
- Concussion Centre, Early Concussion Care Program, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - N Reed
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto , Toronto, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto , Toronto, Canada
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Hyland P, Shevlin M, McBride O, Murphy J, Karatzias T, Bentall RP, Martinez A, Vallières F. Anxiety and depression in the Republic of Ireland during the COVID-19 pandemic. Acta Psychiatr Scand 2020; 142:249-256. [PMID: 32716520 DOI: 10.1111/acps.13219] [Citation(s) in RCA: 283] [Impact Index Per Article: 70.8] [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: 07/20/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The COVID-19 pandemic in Ireland resulted in a nationwide quarantine on March 27, 2020. This study represents the first assessment of rates of anxiety and depression in the general population of Ireland during the pandemic. AIMS Our first aim was to estimate the probable prevalence rates of generalized anxiety disorder (GAD) and depression and to identify sociodemographic risk factors associated with screening positive for GAD or depression. Our second aim was to determine if COVID-19 related anxiety was highest amongst those in society at greatest risk of morality from COVID-19. METHOD Self-report data were collected from a nationally representative Irish sample (N = 1041) online between March 31 and April 5; the first week of the nationwide quarantine measures. Recognized cut-off scores on the GAD-7 and PHQ-9 were used to estimate rates of GAD and depression. Correlates of screening positive for GAD or depression were assessed using logistic regression analysis. RESULTS GAD (20.0%), depression (22.8%) and GAD or depression (27.7%) was common. Screening positive for GAD or depression was associated with younger age, female sex, loss of income due to COVID-19, COVID-19 infection and higher perceived risk of COVID-19 infection. Citizens aged 65 and older had significantly higher levels of COVID-19 related anxiety than adults aged 18-34. CONCLUSIONS Initial results from this multi-wave study monitoring changes in population anxiety and depression throughout the pandemic indicate that GAD and depression were common experiences in the population during the initial phase of the COVID-19 pandemic.
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Affiliation(s)
- P Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland.,Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - M Shevlin
- School of Psychology, Ulster University, Ulster, UK
| | - O McBride
- School of Psychology, Ulster University, Ulster, UK
| | - J Murphy
- School of Psychology, Ulster University, Ulster, UK
| | - T Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | | | | | - F Vallières
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
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Leo CA, Cavazzoni E, Leeuwenburgh MMN, Thomas GP, Dennis A, Bassett P, Hodgkinson JD, Warusavitarne J, Murphy J, Vaizey CJ. Comparison between high-resolution water-perfused anorectal manometry and THD ® Anopress anal manometry: a prospective observational study. Colorectal Dis 2020; 22:923-930. [PMID: 31994307 PMCID: PMC7496679 DOI: 10.1111/codi.14992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/22/2020] [Indexed: 12/13/2022]
Abstract
AIM Anorectal physiology tests provide a functional assessment of the anal canal. The aim of this study was to compare the results generated by standard high-resolution water-perfused manometry (WPM) with the newer THD® Anopress manometry system. METHOD This was a prospective observational study. Conventional manometry was carried out using a water-perfused catheter with high-resolution manometry and compared with the Anopress system with air-filled catheters. All patients underwent the two procedures successively in a randomized order. Time to arrive at the resting pressure plateau, resting, squeeze, straining pressure and visual analogue scale (VAS) scores for pain were recorded. A qualitative analysis of the two devices was performed. RESULTS Between 2016 and 2017, 60 patients were recruited. The time from insertion of the catheter to arriving at the resting pressure plateau was significantly lower with the Anopress compared with WPM: 12 s [interquartile range (IQR) 10-17 s] versus 100 s (IQR 67-121 s) (P < 0.001). A strong correlation between the manometric values of WPM and the Anopress was observed. Both procedures were well tolerated, although the VAS score for insertion of the WPM catheter was significantly higher. The Anopress was easier to use and more time-efficient than the WPM. CONCLUSION The pressure values obtained with Anopress correlated well with those of conventional manometry. The Anopress has the advantage of being less time-consuming, user-friendly and better tolerated by patients.
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Affiliation(s)
- C. A. Leo
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK,Imperial College of LondonLondonUK,The Royal London HospitalLondonUK
| | - E. Cavazzoni
- Santa Maria della Misericordia HospitalUniversità degli Studi di PerugiaPerugiaItaly
| | | | - G. P. Thomas
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
| | - A. Dennis
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
| | | | - J. D. Hodgkinson
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK,Imperial College of LondonLondonUK
| | - J. Warusavitarne
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
| | | | - C. J. Vaizey
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
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