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MacDonald J, Hertzke C, Gaffney K, Fleming K, Lockhart AC, Gentles CA, Arenth J, Sample L, Ozark S, Hudspeth M, Goodrich G. BPI24-020: Institutional Policy Implementation for Allocating Chemotherapy During a Shortage. J Natl Compr Canc Netw 2024; 22:BPI24-020. [PMID: 38580277 DOI: 10.6004/jnccn.2023.7185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
| | | | - Kelly Gaffney
- 1Medical University of South Carolina, Charleston, SC
| | | | | | | | - Joshua Arenth
- 1Medical University of South Carolina, Charleston, SC
| | - Laura Sample
- 1Medical University of South Carolina, Charleston, SC
| | - Shelly Ozark
- 1Medical University of South Carolina, Charleston, SC
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Bergus KC, Patterson K, Castellanos S, Bourgeois T, MacDonald J, Mallampalli G, Fabia R, Thakkar R, Schwartz D. Characterizing Delirium and Associated Risk Factors Using the Cornell Assessment of Pediatric Delirium Score in Pediatric Burn Patients. J Burn Care Res 2024; 45:8-16. [PMID: 37930874 PMCID: PMC11023097 DOI: 10.1093/jbcr/irad170] [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: 02/27/2023] [Indexed: 11/08/2023]
Abstract
Delirium is a syndrome of acute brain dysfunction with disturbance in consciousness and cognition that is increasingly recognized in critically ill pediatric patients. The Cornell Assessment of Pediatric Delirium (CAPD) tool is used to detect delirium in children of all ages and developmental stages in various hospital settings. To date, the incidence of delirium in the pediatric burn population has been poorly defined. In order to describe the incidence as well as risk factors for delirium in this patient population, we retrospectively reviewed patients <18 years of age admitted to our American Burn Association-verified pediatric burn center from March 2018 to May 2021 who underwent delirium screening using the CAPD tool. Patient demographics, burn characteristics, hospitalization details, and date of first positive delirium screening were collected, and χ2, Fisher's exact test, univariate, and multivariate analyses were performed. Delirium was identified in 42 (10.8%) of 389 patients meeting inclusion criteria. Patients screening positive for delirium were older (4 years [IQR: 2, 11] vs 2 years [IQR: 1, 6], P < .0005) and had larger TBSA burns (21.63% [IQR: 9, 42] vs 3.5% [IQR: 1.75, 6], P < .0001) than delirium-negative patients. Delirium-positive patients required a longer duration of mechanical ventilation (OR 4.23; 95% CI [1.16-15.39], P = .0289) and had higher TBSA burns (OR 1.12; 95% CI [1.06-1.17], P < .0001). Delirium-positive patients had 1.6 day longer length-of-stay adjusted for TBSA burned (95% CI [0.81-2.41], P < .0001). Compared to delirium-negative patients, delirium-positive patients had a 5.4-day longer PICU admission (95% CI [2.93-10.3]; P < .0001). Screening pediatric burn patients with risk factors known to be associated with delirium by using the CAPD score could improve delirium prevention and allow for early intervention.
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Affiliation(s)
- Katherine C Bergus
- Nationwide Children's Hospital, Columbus, OH 43205, USA
- Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA
| | - Kelli Patterson
- Nationwide Children's Hospital, Columbus, OH 43205, USA
- Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA
| | - Sydney Castellanos
- Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA
| | | | | | - Grace Mallampalli
- Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA
| | - Renata Fabia
- Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Rajan Thakkar
- Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Dana Schwartz
- Nationwide Children's Hospital, Columbus, OH 43205, USA
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MacDonald J, Estcourt CS, Flowers P, Nandwani R, Frankis J, Young I, Clutterbuck D, Dalrymple J, McDaid L, Steedman N, Saunders J. Improving HIV pre-exposure prophylaxis (PrEP) adherence and retention in care: Process evaluation and recommendation development from a nationally implemented PrEP programme. PLoS One 2023; 18:e0292289. [PMID: 37812636 PMCID: PMC10561843 DOI: 10.1371/journal.pone.0292289] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/15/2023] [Indexed: 10/11/2023] Open
Abstract
INTRODUCTION HIV pre-exposure prophylaxis (PrEP), in which people take HIV medication to prevent HIV acquisition, underpins global HIV transmission elimination strategies. Effective prevention needs people to adhere to PrEP and remain in care during periods of risk, but this is difficult to achieve. We undertook a process evaluation of Scotland's PrEP programme to explore barriers and facilitators to PrEP adherence and retention in care and to systematically develop evidence-based, theoretically-informed recommendations to address them. METHODS We conducted semi-structured interviews and focus groups (09/2018-07/2019) with patients who identified as gay or bisexual men and were either using PrEP, had declined the offer of PrEP, had stopped PrEP, or had been assessed as ineligible for PrEP (n = 39 of whom n = 5 (13%) identified as trans, median age 31 years and interquartile range 14 years), healthcare professionals involved in PrEP provision (n = 54 including specialist sexual health doctors and nurses of various grades, PrEP prescribing general practitioners, health promotion officers, midwifes, and a PrEP clinical secretary), and clients (n = 9) and staff (n = 15) of non-governmental organisations with an HIV prevention remit across Scotland. We used thematic analysis to map key barriers and facilitators to priority areas that could enhance adherence and retention in care. We used implementation science analytic tools (Theoretical Domains Framework, Intervention Functions, Behaviour Change Technique Taxonomy, APEASE criteria) and expert opinion to systematically generate recommendations. RESULTS Barriers included perceived complexity of on-demand dosing, tendency for users to stop PrEP before seeking professional support, troublesome side-effects, limited flexibility in the settings/timings/nature of review appointments, PrEP-related stigma and emerging stigmas around not using PrEP. Facilitators included flexible appointment scheduling, reminders, and processes to follow up non-attenders. Examples of the 25 recommendations include: emphasising benefits of PrEP reviews and providing appointments flexibly within individualised PrEP care; using clinic systems to remind/recall PrEP users; supporting PrEP conversations among sexual partners; clear on-demand dosing guidance; encouraging good PrEP citizenship; detailed discussion on managing side-effects and care/coping planning activities. CONCLUSIONS PrEP adherence and retention in care is challenging, reducing the effectiveness of PrEP at individual and population levels. We identify and provide solutions to where and how collaborative interventions across public health, clinical, and community practice could address these challenges.
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Affiliation(s)
- Jennifer MacDonald
- Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
| | - Claudia S. Estcourt
- Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
- Sandyford Sexual Health Services, NHS Greater Glasgow and Clyde, Glasgow, Scotland, United Kingdom
| | - Paul Flowers
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, United Kingdom
| | - Rak Nandwani
- Sandyford Sexual Health Services, NHS Greater Glasgow and Clyde, Glasgow, Scotland, United Kingdom
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jamie Frankis
- Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
| | - Ingrid Young
- Centre for Biomedicine, Self & Society, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Dan Clutterbuck
- Chalmers Sexual Health Centre, NHS Lothian, Edinburgh, Scotland, United Kingdom
| | - Jenny Dalrymple
- Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
| | - Lisa McDaid
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - Nicola Steedman
- Chief Medical Officer Directorate, Scottish Government, Edinburgh, Scotland, United Kingdom
| | - John Saunders
- Institute for Global Health, University College London, London, England, United Kingdom
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Estcourt CS, MacDonald J, Saunders J, Nandwani R, Young I, Frankis J, Clutterbuck D, Steedman N, McDaid L, Dalrymple J, Flowers P. Improving HIV pre-exposure prophylaxis (PrEP) uptake and initiation: process evaluation and recommendation development from a national PrEP program<a href="#FN1"> †</a>. Sex Health 2023; 20:282-295. [PMID: 37603534 DOI: 10.1071/sh22170] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/19/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND HIV pre-exposure prophylaxis (PrEP) is key to HIV transmission elimination but implementation is challenging and under-researched. We undertook a process evaluation of the first 2years of a national PrEP program to explore barriers and facilitators to implementation and to develop recommendations to improve implementation, focusing on PrEP uptake and initiation. METHODS Stage 1 involved semi-structured telephone interviews and focus groups (September 2018-July 2019) with geographically and demographically diverse patients seeking/using/declining/stopping PrEP (n =39), sexual healthcare professionals (n =54), community-based organisation service users (n =9) and staff (n =15) across Scotland. We used deductive thematic analysis, to derive and then map key barriers and facilitators to priority areas that experts agreed would enhance uptake and initiation. In Stage 2, we used analytic tools from implementation science to systematically generate evidence-based, theoretically-informed recommendations to enhance uptake and initiation of PrEP. RESULTS Barriers and facilitators were multi-levelled and interdependent. Barriers included the rapid pace of implementation without additional resource, and a lack of familiarity with PrEP prescribing. Facilitators included opportunities for acquisition of practice-based knowledge and normalisation of initiation activities. We refined our 68 'long-list' recommendations to 41 using expert input and the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) criteria. Examples include: provision of PrEP in diverse settings to reach all in need; co-produced, culturally sensitive training resources for healthcare professionals, with focused content on non-daily dosing; meaningful collaborative working across all stakeholders. CONCLUSIONS These evidence-based, theory informed recommendations provide a robust framework for optimising PrEP uptake and initiation in diverse settings to ensure PrEP reaches all who may benefit.
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Affiliation(s)
- Claudia S Estcourt
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK; and Sandyford Sexual Health Services, NHS Greater Glasgow & Clyde, 6 Sandyford Place, Glasgow G3 7NB, UK
| | - Jennifer MacDonald
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - John Saunders
- Institute for Global Health, University College London, Mortimer Market Centre, London WC1E 6JB, UK; and HPA Health Protection Services, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Rak Nandwani
- Sandyford Sexual Health Services, NHS Greater Glasgow & Clyde, 6 Sandyford Place, Glasgow G3 7NB, UK; and College of Medical, Veterinary & Life Sciences, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - Ingrid Young
- Centre for Biomedicine, Self & Society, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Jamie Frankis
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Dan Clutterbuck
- Chalmers Sexual Health Centre, NHS Lothian, 2A Chalmers Street, Edinburgh EH3 9ES, UK
| | - Nicola Steedman
- Chief Medical Officer Directorate, Scottish Government, St Andrew's House, Regent Road, Edinburgh, EH1 3DG, UK
| | - Lisa McDaid
- Institute for Social Science Research, The University of Queensland, Brisbane, St Lucia, Qld 4072, Australia
| | - Jenny Dalrymple
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Paul Flowers
- School of Psychological Sciences & Health, University of Strathclyde, 16 Richmond Street, Glasgow G1 1XQ, UK
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Rimel BJ, Crane EK, Hou J, Nakayama J, MacDonald J, Lutz K, Makker V, O'Cearbhaill RE. Tyrosine kinase inhibitor toxicities: A society of gynecologic oncology review and recommendations. Gynecol Oncol 2023; 174:148-156. [PMID: 37207499 DOI: 10.1016/j.ygyno.2023.05.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Oral tyrosine kinase inhibitors (TKIs) have new indications for treatment in gynecologic malignancies. These targeted drugs have both unique and overlapping toxicities, which require careful attention and management. New combination therapies with immune-oncology agents have demonstrated promise in endometrial cancer. This review examines common adverse events associated with TKIs and provides readers with an evidence-based review on current uses and strategies for the management of these medications. METHODS A comprehensive review of the medical literature on TKI use in gynecologic cancer was undertaken by a committee approach. Details of each drug, its molecular target, and relevant data on both clinical efficacy and side effects were compiled and organized for clinical use. Information on drug-related secondary effects and management strategies for specific toxicities, including dose reduction and concomitant medications, were gathered. RESULTS TKIs can potentially offer improved response rates and durable responses for a group of patients who were previously without an effective standard second-line therapy. The combination of lenvatinib and pembrolizumab represents a more targeted approach to the drivers of endometrial cancer; however, there remains significant drug-related toxicity, and thus dose reduction and dose delay are frequently required. Toxicity management requires frequent check-ins and management strategies to help patients find the highest tolerable dose. TKIs are expensive and patient financial toxicity is as critical a measure of a drug's utility as any drug side effect. Many of these drugs have patient assistance programs, which should be fully utilized to minimize cost. CONCLUSIONS Future studies are needed to expand the role of TKIs into new molecularly driven groups. Attention to cost, durability of response, and long-term toxicity management is needed to ensure all eligible patients have access to treatment.
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Affiliation(s)
- Bobbie J Rimel
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Erin K Crane
- Levine Cancer Institute, Charlotte, NC, United States of America
| | - June Hou
- Columbia University Irvings Medical Center, New York, NY, United States of America
| | - John Nakayama
- Allegheny Health Network, Pittsburgh, PA, United States of America
| | - Jennifer MacDonald
- Medical University of South Carolina, Charleston, SC, United States of America
| | - Kathleen Lutz
- New York University Langone Health Perlmutter Cancer Center, New York, NY, United States of America
| | - Vicky Makker
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, United States of America
| | - Roisin E O'Cearbhaill
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, United States of America
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Bacsu JD, Kortzman A, Fraser S, Chasteen AL, MacDonald J, O'Connell ME. Understanding Intersectional Ageism and Stigma of Dementia: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e46093. [PMID: 37040178 PMCID: PMC10131922 DOI: 10.2196/46093] [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] [Received: 01/30/2023] [Revised: 03/16/2023] [Accepted: 03/23/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Ageism and stigma reduce the quality of life of older adults living with dementia. However, there is a paucity of literature addressing the intersection and combined effects of ageism and stigma of dementia. This intersectionality, rooted in the social determinants of health (ie, social support and access to health care), compounds health disparities and is, therefore, an important area of inquiry. OBJECTIVE This scoping review protocol outlines a methodology that will be used to examine ageism and stigma confronting older adults living with dementia. The aim of this scoping review will be to identify the definitional components, indicators, and measures used to track and evaluate the impact of ageism and stigma of dementia. More specifically, this review will focus on examining the commonalities and differences in definitions and measures to develop a better understanding of intersectional ageism and stigma of dementia as well as the current state of the literature. METHODS Guided by Arksey and O'Malley's 5-stage framework, our scoping review will be conducted by searching 6 electronic databases (PsycINFO, MEDLINE, Web of Science, CINAHL, Scopus, and Embase) and a web-based search engine (ie, Google Scholar). Reference lists of relevant journal articles will be hand-searched to identify additional articles. The results from our scoping review will be presented using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews) checklist. RESULTS This scoping review protocol was registered with the Open Science Framework on January 17, 2023. Data collection and analysis and manuscript writing will occur from March to September 2023. The target date for manuscript submission will be October 2023. Findings from our scoping review will be disseminated through various means, such as journal articles, webinars, national networks, and conference presentations. CONCLUSIONS Our scoping review will summarize and compare the core definitions and measures used to understand ageism and stigma toward older adults with dementia. This is significant because there is limited research addressing the intersectionality of ageism and stigma of dementia. Accordingly, findings from our study may provide critical knowledge and insight to help inform future research, programs, and policies to address intersectional ageism and stigma of dementia. TRIAL REGISTRATION Open Science Framework; https://osf.io/yt49k. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46093.
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Affiliation(s)
| | - August Kortzman
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sarah Fraser
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Alison L Chasteen
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | | | - Megan E O'Connell
- Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
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Lovett ME, Daniel M, Keesari R, MacDonald J, Rodriguez V, Muszynski J, Sribnick EA, O'Brien NF, Ayad O. Catheter-associated deep vein thrombosis in children with severe traumatic brain injury: A single-center experience. Pediatr Blood Cancer 2023; 70:e30044. [PMID: 36250988 DOI: 10.1002/pbc.30044] [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: 05/18/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND This study was performed to describe the single-center experience of deep vein thrombosis (DVT) in children with severe traumatic brain injury (sTBI) who were mechanically ventilated with a central line, and to identify potentially modifiable risk factors. It was hypothesized that children with DVT would have a longer duration of central venous line (CVL) and a higher use of hypertonic saline (HTS) compared to those without DVT. PROCEDURE/METHODS This was a retrospective study of children (0-18 years) with sTBI, who were intubated, had a CVL, and a minimum intensive care unit (ICU) stay of 3 days. Children were analyzed by the presence or absence of DVT. HTS use was evaluated using milliliter per kilogram (ml/kg) of 3% equivalents. Univariable and multivariable logistic regression models were used to determine which factors were associated with DVT. RESULTS Seventy-seven children met inclusion criteria, 23 (29.9%) had a DVT detected in an extremity. On univariable analysis, children with DVT identified in an extremity had prolonged CVL use (14 vs. 8.5 days, p = .021) and longer duration of mechanical ventilation (15 vs. 10 days, p = .013). HTS 3% equivalent ml/kg was not different between groups. On multivariable analysis, mechanical ventilation duration was associated with DVT detection in an extremity, whereas neither CVL duration nor HTS use had an association. CONCLUSIONS There was a high incidence of extremity DVT detected in children with sTBI who received invasive mechanical ventilation and had a CVL. HTS administration was not associated with DVT detection in an extremity.
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Affiliation(s)
- Marlina E Lovett
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio, USA
| | - Megan Daniel
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio, USA
| | - Rohali Keesari
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer MacDonald
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio, USA
| | - Vilmarie Rodriguez
- Department of Pediatrics, Division of Hematology and Oncology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer Muszynski
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio, USA.,Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Eric A Sribnick
- Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Surgery, Division of Neurosurgery, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio, USA
| | - Nicole F O'Brien
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio, USA
| | - Onsy Ayad
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio, USA
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MacDonald J, Demiris G, Shevin M, Thadaney-Israni S, Jay Carney T, Cupito A. Health Technology for All: An Equity-Based Paradigm Shift Opportunity. NAM Perspect 2022; 2022:202212a. [PMID: 36713773 PMCID: PMC9875852 DOI: 10.31478/202212a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | | | | | | | - Timothy Jay Carney
- Global Health Equity Intelligence Collaborative, LLC and University of North Carolina, Chapel Hill
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Hudson D, Lakhani R, MacDonald J, Chande N, McDonald JW. A177 METHOTREXATE FOR THE INDUCTION OF REMISSION IN ULCERATIVE COLITIS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.175] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Obtaining steroid-free remission in Ulcerative Colitis (UC) is a clinically important parameter that can mitigate the development of disease-related complications and lead to improved quality of life.
Aims
A systematic review to assess the effects and safety of methotrexate for induction in patients with UC.
Methods
MEDLINE, EMBASE, CENTRAL were searched from inception to August 20, 2020. Randomized controlled trials (RCTs) comparing methotrexate with placebo or an active comparator in patients with active ulcerative colitis were considered for inclusion. The primary outcome measure was the proportion of patients who achieved clinical remission and withdrawal from steroids as defined by the studies and expressed as a percentage of the total number of patients randomized (intention-to-treat analysis). The overall quality of the evidence supporting the primary outcome was assessed using the GRADE criteria.
Results
Three studies (n=212) were included in the review. Two studies were randomized controlled trials comparing methotrexate to placebo for induction of remission of active ulcerative colitis. The first study (n = 67) compared oral methotrexate (12.5 mg/week) to placebo. Forty-seven percent (14/30) of methotrexate patients achieved clinical remission and complete withdrawal from steroids during the study period compared to 49% (18/37) of placebo patients (RR 0.96, 95% CI 0.58 to 1.59). A GRADE analysis indicated that the overall quality of the evidence supporting this outcome was low due to very sparse data. The second study (n=111) compared subcutaneous/intramuscular methotrexate 25 mg/week to placebo. The primary outcome, steroid-free remission at week 16, was present in 32% (19/60) of patients on methotrexate in comparison to 20%(10/51) of patients in the placebo arm (RR 1.62; 95% CI 0.83 to 3.15; P-value of 0.15). A GRADE analysis indicated downgrading of the evidence to low given very sparse data (29 events). An additional head-to-head randomised controlled study (n = 34) compared oral methotrexate (15 mg/week) to 6-mercaptopurine (1.5 mg/kg/day) and 5-aminosalicylic acid (3 g/day). This final study was judged to be at high risk of bias due to an open-label design. At 30 weeks, 58% (7/12) of methotrexate patients achieved clinical remission and withdrawal from steroids compared to 79% (11/14) of 6-mercaptopurine patients (RR 0.74, 95% CI 0.43 to 1.29) and 25% (2/8) of 5-aminosalicylic acid patients (RR 2.33, 95% CI 0.64 to 8.49). GRADE analyses indicated that the overall quality of the evidence was very low due to very sparse data and high risk of bias.
Conclusions
Methotrexate demonstrated no benefit over placebo or active comparators for the induction of steroid-free remission. Future research is ongoing to explore the utility of combination therapy with monoclonal antibody biologic therapy for the treatment of active ulcerative colitis.
Funding Agencies
None
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Affiliation(s)
- D Hudson
- The University of Western Ontario, London, ON, Canada
| | - R Lakhani
- The University of Western Ontario, London, ON, Canada
| | | | - N Chande
- The University of Western Ontario, London, ON, Canada
| | - J W McDonald
- The University of Western Ontario, London, ON, Canada
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Thiex NJ, Anderson S, Gildemeister B, Adcock W, Boedigheimer J, Bogren E, Coffin R, Conway K, DeBaker A, Frankenius E, Gramse M, Hogan P, Knese T, MacDonald J, M�ller J, Royle R, Russell M, Shafiee F, Shreve B, Sieh J, Spann M, Töpler E, Watts M. Crude Fat, Diethyl Ether Extraction, in Feed, Cereal Grain, and Forage (Randall/Soxtec/Submersion Method): Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.5.888] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
A method for determining crude fat in animal feed, cereal grain, and forage (plant tissue) was collaboratively studied. Crude fat was extracted from the animal feed, cereal grain, or forage material with diethyl ether by the Randall method, also called the Soxtec method or the submersion method. The proposed submersion method considerably decreases the extraction time required to complete a batch of samples. The increase in throughput is very desirable in the quest for faster turnaround times and the greater efficiency in the use of labor. In addition, this method provides for reclamation of the solvent as a step of the method. The submersion method for fat extraction was previously studied for meat and meat products and was accepted as AOAC Official Method 991.36. Fourteen blind samples were sent to 12 collaborators in the United States, Sweden, Canada, and Germany. The within-laboratory relative standard deviation (repeatability) ranged from 1.09 to 9.26% for crude fat. Among-laboratory (including within) relative standard deviation (reproducibility) ranged from 1.0 to 21.0%. The method is recommended for Official First Action.
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Affiliation(s)
- Nancy J Thiex
- South Dakota State University, Oscar E. Olson Biochemistry Laboratories, Box 2170, ASC 151, Brookings, SD 57007
| | | | - Bryan Gildemeister
- South Dakota State University, Oscar E. Olson Biochemistry Laboratories, Box 2170, ASC 151, Brookings, SD 57007
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Thiex NJ, Anderson S, Gildemeister B, Adcock W, Boedigheimer J, Bogren E, Coffin R, Conway K, DeBaker A, Frankenius E, Gramse M, Hogan P, Knese T, MacDonald J, M�ller J, Royle R, Russell M, Shafiee F, Shreve B, Sieh J, Spann M, Töpler E, Watts M. Crude Fat, Hexanes Extraction, in Feed, Cereal Grain, and Forage (Randall/Soxtec/Submersion Method): Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.5.899] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
A method for determining crude fat in animal feed, cereal grain, and forage (plant tissue) was collaboratively studied. Crude fat was extracted from the animal feed, cereal grain, or forage material with hexanes by the Randall method, also called the Soxtec method or the submersion method. The use of hexanes provides for an alternative to diethyl ether for fat extractions. The proposed submersion method considerably decreases the extraction time required to complete a batch of samples compared to Soxhlet. The increase in throughput is very desirable in the quest for faster turnaround times and the greater efficiency in the use of labor. In addition, this method provides for reclamation of the solvent as a step of the method. The submersion method for fat extraction was previously studied for meat and meat products and was accepted as AOAC Official Method 991.36. Fourteen blind samples were sent to 14 collaborators in the United States, Sweden, Canada, and Germany. The within-laboratory relative standard deviation (repeatability) ranged from 1.23 to 5.80% for crude fat. Among-laboratory (including within) relative standard deviation (reproducibility) ranged from 1.88 to 14.1%. The method is recommended for Official First Action.
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Affiliation(s)
- Nancy J Thiex
- South Dakota State University, Oscar E. Olson Biochemistry Laboratories, Box 2170, ASC 151, Brookings, SD 57007
| | | | - Bryan Gildemeister
- South Dakota State University, Oscar E. Olson Biochemistry Laboratories, Box 2170, ASC 151, Brookings, SD 57007
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12
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Sharma P, Gakhar N, MacDonald J, Abidi MZ, Benamu E, Bajrovic V, Purev E, Haverkos BM, Tobin J, Kaiser J, Chase S, Miller M, Weinberg A, Gutman JA. Letermovir prophylaxis through day 100 post transplant is safe and effective compared with alternative CMV prophylaxis strategies following adult cord blood and haploidentical cord blood transplantation. Bone Marrow Transplant 2019; 55:780-786. [PMID: 31664185 DOI: 10.1038/s41409-019-0730-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/09/2019] [Accepted: 10/16/2019] [Indexed: 01/07/2023]
Abstract
We compared CMV outcomes of three prophylactic approaches used for CBT and haploidentical cord transplants from December 2009 through 2018: letermovir (n = 32) through day 100 post transplant, "valacyclovir day 100" (valacyclovir 2 g orally three times daily through day 100) (n = 60), and "valacyclovir hospital discharge" (valacyclovir 2 g orally three times daily through hospital discharge then acyclovir 800 mg twice daily) (n = 41). Through day 100, none in the letermovir group, six (10%) in the "valacyclovir day 100," and nine (22%) in the "valacyclovir hospital discharge" group required CMV directed treatment (p = 0.005 and 0.06 comparing letermovir to "valacyclovir hospital discharge" and "valacyclovir day 100"). Fewer patients in the letermovir group (n = 7, 22%) had any CMV reactivation versus the "valacyclovir day 100" group (n = 20, 33%) versus the "valacyclovir hospital discharge" group (n = 23, 57%) (p = 0.003 and 0.21 comparing letermovir to "valacyclovir hospital discharge" and "valacyclovir day 100"). Among patients not reactivating CMV before 100 days, reactivation rates between day 100 and 180 were higher in the letermovir and "valacyclovir day 100" groups than the "valacyclovir hospital discharge" group. Letermovir is safe and effective compared with alternative prophylaxis approaches following CBT through day 100. Reactivation and monitoring after day 100 remain potential concerns.
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Affiliation(s)
- Prashant Sharma
- Department of Medicine, University of Colorado, Denver, CO, USA
| | - Neel Gakhar
- Department of Medicine, University of Colorado, Denver, CO, USA
| | | | - Maheen Z Abidi
- Department of Medicine, University of Colorado, Denver, CO, USA.,Division of Infectious Disease, University of Colorado, Denver, CO, USA.,Division of Hematology, University of Colorado, Denver, CO, USA
| | - Esther Benamu
- Department of Medicine, University of Colorado, Denver, CO, USA.,Division of Infectious Disease, University of Colorado, Denver, CO, USA.,Division of Hematology, University of Colorado, Denver, CO, USA
| | - Valida Bajrovic
- Department of Medicine, University of Colorado, Denver, CO, USA.,Division of Infectious Disease, University of Colorado, Denver, CO, USA.,Division of Hematology, University of Colorado, Denver, CO, USA
| | - Enkhtsetseg Purev
- Department of Medicine, University of Colorado, Denver, CO, USA.,Division of Pharmacy, University of Colorado, Denver, CO, USA
| | - Bradley M Haverkos
- Department of Medicine, University of Colorado, Denver, CO, USA.,Division of Hematology, University of Colorado, Denver, CO, USA
| | - Jennifer Tobin
- Division of Pharmacy, University of Colorado, Denver, CO, USA
| | - Jeff Kaiser
- Division of Pharmacy, University of Colorado, Denver, CO, USA
| | - Stephanie Chase
- Division of Pharmacy, University of Colorado, Denver, CO, USA
| | - Matthew Miller
- Division of Pharmacy, University of Colorado, Denver, CO, USA
| | - Adriana Weinberg
- Department of Medicine, University of Colorado, Denver, CO, USA.,Division of Infectious Disease, University of Colorado, Denver, CO, USA.,Division of Hematology, University of Colorado, Denver, CO, USA
| | - Jonathan A Gutman
- Department of Medicine, University of Colorado, Denver, CO, USA. .,Division of Pharmacy, University of Colorado, Denver, CO, USA.
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13
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Price L, Gozdzielewska L, Young M, Smith F, MacDonald J, McParland J, Williams L, Langdridge D, Davis M, Flowers P. Effectiveness of interventions to improve the public's antimicrobial resistance awareness and behaviours associated with prudent use of antimicrobials: a systematic review. J Antimicrob Chemother 2019; 73:1464-1478. [PMID: 29554263 DOI: 10.1093/jac/dky076] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/07/2018] [Indexed: 11/14/2022] Open
Abstract
Background A global antimicrobial resistance (AMR) awareness intervention targeting the general public has been prioritized. Objectives To evaluate the effectiveness of interventions that aim to change AMR awareness and subsequent stewardship behaviours amongst the public. Methods Five databases were searched between 2000 and 2016 for interventions to change the public's AMR awareness and/or antimicrobial stewardship behaviours. Study designs meeting the Cochrane Effective Practice and Organization of Care (EPOC) criteria, non-controlled before-and-after studies and prospective cohort studies were considered eligible. Participants recruited from healthcare settings and studies measuring stewardship behaviours of healthcare professionals were excluded. Quality of studies was assessed using EPOC risk of bias criteria. Data were extracted and synthesized narratively. Registration: PROSPERO international prospective register of systematic reviews (PROSPERO 2016: CRD42016050343). Results Twenty studies were included in the review with nine meeting the EPOC criteria. The overall risk of bias was high. Nineteen studies were conducted in high-income countries. Mass media interventions were most common (n = 7), followed by school-based (n = 6) and printed material interventions (n = 6). Seventeen studies demonstrated a significant effect on changing knowledge, attitudes or the public's antimicrobial stewardship behaviours. Analysis showed that interventions targeting schoolchildren and parents have notable potential, but for the general public the picture is less clear. Conclusions Our work provides an in-depth examination of the effectiveness of AMR interventions for the public. However, the studies were heterogeneous and the quality of evidence was poor. Well-designed, experimental studies on behavioural outcomes of such interventions are required.
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Affiliation(s)
- Lesley Price
- Safeguarding Health through Infection Prevention Research Group, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Lucyna Gozdzielewska
- Safeguarding Health through Infection Prevention Research Group, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Mairi Young
- Safeguarding Health through Infection Prevention Research Group, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Fraser Smith
- Safeguarding Health through Infection Prevention Research Group, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Jennifer MacDonald
- Safeguarding Health through Infection Prevention Research Group, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Joanna McParland
- Safeguarding Health through Infection Prevention Research Group, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Lynn Williams
- School of Psychological Sciences and Health, University of Strathclyde, 40 George Street, Glasgow G1 1QE, UK
| | - Darren Langdridge
- Faculty of Arts & Social Sciences, Open University, Walton Hall, Milton Keynes MK7 6AA, UK
| | - Mark Davis
- School of Social Sciences, Monash University, Chancellors Walk, Melbourne, Victoria, 3800, Australia
| | - Paul Flowers
- Safeguarding Health through Infection Prevention Research Group, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
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14
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MacDonald A, Pinto A, Evans S, Ashmore C, MacDonald J, Daly A. Home delivery service of low protein foods in inherited metabolic disorders: Does it help? Mol Genet Metab Rep 2019; 19:100466. [PMID: 30963029 PMCID: PMC6434332 DOI: 10.1016/j.ymgmr.2019.100466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/16/2019] [Accepted: 03/16/2019] [Indexed: 11/27/2022] Open
Abstract
Background In the UK, the customary method of obtaining special low protein (LP) foods was by dispensing through a pharmacist (until 2010) for patients with inherited metabolic disorders (IMD) requiring LP diets. Recently, different home delivery services have been introduced to support patient access of low protein foods, but the effectiveness of these services is unclear. Aim A prospective, longitudinal, observational study to examine the effectiveness and safety of patient home delivery services for LP foods over 12 months in IMD patients requiring a LP diet. Methods IMD patients/caregivers had the choice of 2 home delivery services (Homeward® and Vitaflo at Home®) as well as access to primary care pharmacy services. Both home delivery services provided a limited range of LP foods. Over a 12-month period, a member of the IMD dietetic team conducted 4 home visits to IMD patients on LP diets using home delivery services for low protein foods. At each visit, caregivers completed a questionnaire consisting of 20 multiple choice and open questions about their prescription experience with special LP foods. The researchers also completed stock checks, assessed 'use by dates' and adequacy of home storage for LP foods. Results In total, 58 patients participated in this study. Over 12 months, 95% (n = 55/58) of caregivers used their local pharmacy, 93% (n = 54/58) Homeward® and 78% (n = 45/58) Vitaflo at Home® to access LP foods. Two home delivery services were used by 41 (71%) caregivers and the remaining 17 (29%) only used one of the home delivery service companies. Each patient only stored a median of 6 (range 0-22) different LP foods at home. Overall, 45% (n = 26/58) of caregivers reported problems with their GP prescriptions. 30% (n = 16/53) of caregivers received at least one incorrect prescription when using their pharmacy (e.g. gluten-free foods instead of LP, incorrect product or incorrect product amount), 6% errors (n = 3/53) with Homeward® and 2% (n = 1/48) with Vitaflo at Home®. 49% (n = 26/53) of caregivers said they experienced delayed receipt of LP foods from their pharmacy, compared with 11% (n = 6/55) from Homeward® and 8% (n = 4/48) Vitaflo at Home®. Conclusions Although home delivery services for special LP foods are associated with less errors and delay compared with pharmacies, inaccuracies and inefficiencies still occur and the overall system is complex. We suggest a new, simpler, less fragmented system whereby metabolic dietitians prescribe LP foods. This is likely to result in less burden on NHS resources and ensure a better treatment delivered to IMD patients.
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Affiliation(s)
- A MacDonald
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - A Pinto
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - S Evans
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - C Ashmore
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - J MacDonald
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - A Daly
- Birmingham Women's and Children's Hospital, Birmingham, UK
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15
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MacDonald J, Heisler C, Otley A, Currie B, Phalen-Kelly K, Jones J. A206 INVESTIGATING IBD TRANSITION READINESS AND FAMILY DYNAMICS: THE ADOLESCENT AND PRIMARY CAREGIVER PERSPECTIVE. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - C Heisler
- Gastroenterology, Research Services, QEII Health Sciences Centre, Halifax, NS, Canada
| | - A Otley
- Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - B Currie
- QEII Health Sciences Centre, Halifax, NS, Canada
| | - K Phalen-Kelly
- Gastroenterology, Research Services, QEII Health Sciences Centre, Halifax, NS, Canada
| | - J Jones
- Medicine, Dalhousie University, Halifax, NS, Canada
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16
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Muddiman E, Bullock AD, Hampton JM, Allery L, MacDonald J, Webb KL, Pugsley L. Disciplinary boundaries and integrating care: using Q-methodology to understand trainee views on being a good doctor. BMC Med Educ 2019; 19:59. [PMID: 30770777 PMCID: PMC6377780 DOI: 10.1186/s12909-019-1493-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/12/2019] [Indexed: 05/10/2023]
Abstract
BACKGROUND Rising numbers of patients with multiple-conditions and complex care needs mean that it is increasingly important for doctors from different specialty areas to work together, alongside other members of the multi-disciplinary team, to provide patient centred care. However, intra-professional boundaries and silos within the medical profession may challenge holistic approaches to patient care. METHODS We used Q methodology to examine how postgraduate trainees (n = 38) on a range of different specialty programmes in England and Wales could be grouped based on their rankings of 40 statements about 'being a good doctor'. Themes covered in the Q-set include: generalism (breadth) and specialism (depth), interdisciplinarity and multidisciplinary team working, patient-centredness, and managing complex care needs. RESULTS A by-person factor analysis enabled us to map distinct perspectives within our participant group (P-set). Despite high levels of overall commonality, three groups of trainees emerged, each with a clear perspective on being a good doctor. We describe the first group as 'generalists': team-players with a collegial and patient-centred approach to their role. The second group of 'general specialists' aspired to be specialists but with a generalist and patient-centred approach to care within their specialty area. Both these two groups can be contrasted to those in the third 'specialist' group, who had a more singular focus on how their specialty can help the patient. CONCLUSIONS Whilst distinct, the priorities and values of trainees in this study share some important aspects. The results of our Q-sort analysis suggest that it may be helpful to understand the relationship between generalism and specialism as less of a dichotomy and more of a continuum that transcends primary and secondary care settings. A nuanced understanding of trainee views on being a good doctor, across different specialties, may help us to bridge gaps and foster interdisciplinary working.
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Affiliation(s)
- E Muddiman
- Cardiff University School of Social Sciences, Cardiff, UK.
| | - A D Bullock
- Cardiff University School of Social Sciences, Cardiff, UK
| | - J M Hampton
- Cardiff University School of Social Sciences, Cardiff, UK
| | - L Allery
- Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK
| | - J MacDonald
- Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK
| | - K L Webb
- Cardiff University School of Social Sciences, Cardiff, UK
| | - L Pugsley
- Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK
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17
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McLean K, Glasbey J, Borakati A, Brooks T, Chang H, Choi S, Goodson R, Nielsen M, Pronin S, Salloum N, Sewart E, Vanniasegaram D, Drake T, Gillies M, Harrison E, Chapman S, Khatri C, Kong C, Claireaux H, Bath M, Mohan M, McNamee L, Kelly M, Mitchell H, Fitzgerald J, Bhangu A, Nepogodiev D, Antoniou I, Dean R, Davies N, Trecarten S, Henderson I, Holmes C, Wylie J, Shuttleworth R, Jindal A, Hughes F, Gouda P, Fleck R, Hanrahan M, Karunakaran P, Chen J, Sykes M, Sethi R, Suresh S, Patel P, Patel M, Varma R, Mushtaq J, Gundogan B, Bolton W, Khan T, Burke J, Morley R, Favero N, Adams R, Thirumal V, Kennedy E, Ong K, Tan Y, Gabriel J, Bakhsh A, Low J, Yener A, Paraoan V, Preece R, Tilston T, Cumber E, Dean S, Ross T, McCance E, Amin H, Satterthwaite L, Clement K, Gratton R, Mills E, Chiu S, Hung G, Rafiq N, Hayes J, Robertson K, Dynes K, Huang H, Assadullah S, Duncumb J, Moon R, Poo S, Mehta J, Joshi K, Callan R, Norris J, Chilvers N, Keevil H, Jull P, Mallick S, Elf D, Carr L, Player C, Barton E, Martin A, Ratu S, Roberts E, Phan P, Dyal A, Rogers J, Henson A, Reid N, Burke D, Culleton G, Lynne S, Mansoor S, Brennan C, Blessed R, Holloway C, Hill A, Goldsmith T, Mackin S, Kim S, Woin E, Brent G, Coffin J, Ziff O, Momoh Z, Debenham R, Ahmed M, Yong C, Wan J, Copley H, Raut P, Chaudhry F, Nixon G, Dorman C, Tan R, Kanabar S, Canning N, Dolaghan M, Bell N, McMenamin M, Chhabra A, Duke K, Turner L, Patel T, Chew L, Mirza M, Lunawat S, Oremule B, Ward N, Khan M, Tan E, Maclennan D, McGregor R, Chisholm E, Griffin E, Bell L, Hughes B, Davies J, Haq H, Ahmed H, Ungcharoen N, Whacha C, Thethi R, Markham R, Lee A, Batt E, Bullock N, Francescon C, Davies J, Shafiq N, Zhao J, Vivekanantham S, Barai I, Allen J, Marshall D, McIntyre C, Wilson H, Ashton A, Lek C, Behar N, Davis-Hall M, Seneviratne N, Esteve L, Sirakaya M, Ali S, Pope S, Ahn J, Craig-McQuaide A, Gatfield W, Leong S, Demetri A, Kerr A, Rees C, Loveday J, Liu S, Wijesekera M, Maru D, Attalla M, Smith N, Brown D, Sritharan P, Shah A, Charavanamuttu V, Heppenstall-Harris G, Ng K, Raghvani T, Rajan N, Hulley K, Moody N, Williams M, Cotton A, Sharifpour M, Lwin K, Bright M, Chitnis A, Abdelhadi M, Semana A, Morgan F, Reid R, Dickson J, Anderson L, McMullan R, Ahern N, Asmadi A, Anderson L, Boon Xuan JL, Crozier L, McAleer S, Lees D, Adebayo A, Das M, Amphlett A, Al-Robeye A, Valli A, Khangura J, Winarski A, Ali A, Woodward H, Gouldthrope C, Turner M, Sasapu K, Tonkins M, Wild J, Robinson M, Hardie J, Heminway R, Narramore R, Ramjeeawon N, Hibberd A, Winslow F, Ho W, Chong B, Lim K, Ho S, Crewdson J, Singagireson S, Kalra N, Koumpa F, Jhala H, Soon W, Karia M, Rasiah M, Xylas D, Gilbert H, Sundar-Singh M, Wills J, Akhtar S, Patel S, Hu L, Brathwaite-Shirley C, Nayee H, Amin O, Rangan T, Turner E, McCrann C, Shepherd R, Patel N, Prest-Smith J, Auyoung E, Murtaza A, Coates A, Prys-Jones O, King M, Gaffney S, Dewdney C, Nehikhare I, Lavery J, Bassett J, Davies K, Ahmad K, Collins A, Acres M, Egerton C, Cheng K, Chen X, Chan N, Sheldon A, Khan S, Empey J, Ingram E, Malik A, Johnstone M, Goodier R, Shah J, Giles J, Sanders J, McLure S, Pal S, Rangedara A, Baker A, Asbjoernsen C, Girling C, Gray L, Gauntlett L, Joyner C, Qureshi S, Mogan Y, Ng J, Kumar A, Park J, Tan D, Choo K, Raman K, Buakuma P, Xiao C, Govinden S, Thompson O, Charalambos M, Brown E, Karsan R, Dogra T, Bullman L, Dawson P, Frank A, Abid H, Tung L, Qureshi U, Tahmina A, Matthews B, Harris R, O'Connor A, Mazan K, Iqbal S, Stanger S, Thompson J, Sullivan J, Uppal E, MacAskill A, Bamgbose F, Neophytou C, Carroll A, Rookes C, Datta U, Dhutia A, Rashid S, Ahmed N, Lo T, Bhanderi S, Blore C, Ahmed S, Shaheen H, Abburu S, Majid S, Abbas Z, Talukdar S, Burney L, Patel J, Al-Obaedi O, Roberts A, Mahboob S, Singh B, Sheth S, Karia P, Prabhudesai A, Kow K, Koysombat K, Wang S, Morrison P, Maheswaran Y, Keane P, Copley P, Brewster O, Xu G, Harries P, Wall C, Al-Mousawi A, Bonsu S, Cunha P, Ward T, Paul J, Nadanakumaran K, Tayeh S, Holyoak H, Remedios J, Theodoropoulou K, Luhishi A, Jacob L, Long F, Atayi A, Sarwar S, Parker O, Harvey J, Ross H, Rampal R, Thomas G, Vanmali P, McGowan C, Stein J, Robertson V, Carthew L, Teng V, Fong J, Street A, Thakker C, O'Reilly D, Bravo M, Pizzolato A, Khokhar H, Ryan M, Cheskes L, Carr R, Salih A, Bassiony S, Yuen R, Chrastek D, Rosen O'Sullivan H, Amajuoyi A, Wang A, Sitta O, Wye J, Qamar M, Major C, Kaushal A, Morgan C, Petrarca M, Allot R, Verma K, Dutt S, Chilima C, Peroos S, Kosasih S, Chin H, Ashken L, Pearse R, O'Loughlin R, Menon A, Singh K, Norton J, Sagar R, Jathanna N, Rothwell L, Watson N, Harding F, Dube P, Khalid H, Punjabi N, Sagmeister M, Gill P, Shahid S, Hudson-Phillips S, George D, Ashwood J, Lewis T, Dhar M, Sangal P, Rhema I, Kotecha D, Afzal Z, Syeed J, Prakash E, Jalota P, Herron J, Kimani L, Delport A, Shukla A, Agarwal V, Parthiban S, Thakur H, Cymes W, Rinkoff S, Turnbull J, Hayat M, Darr S, Khan U, Lim J, Higgins A, Lakshmipathy G, Forte B, Canning E, Jaitley A, Lamont J, Toner E, Ghaffar A, McDowell M, Salmon D, O'Carroll O, Khan A, Kelly M, Clesham K, Palmer C, Lyons R, Bell A, Chin R, Waldron R, Trimble A, Cox S, Ashfaq U, Campbell J, Holliday R, McCabe G, Morris F, Priestland R, Vernon O, Ledsam A, Vaughan R, Lim D, Bakewell Z, Hughes R, Koshy R, Jackson H, Narayan P, Cardwell A, Jubainville C, Arif T, Elliott L, Gupta V, Bhaskaran G, Odeleye A, Ahmed F, Shah R, Pickard J, Suleman Y, North A, McClymont L, Hussain N, Ibrahim I, Ng G, Wong V, Lim A, Harris L, Tharmachandirar T, Mittapalli D, Patel V, Lakhani M, Bazeer H, Narwani V, Sandhu K, Wingfield L, Gentry S, Adjei H, Bhatti M, Braganza L, Barnes J, Mistry S, Chillarge G, Stokes S, Cleere J, Wadanamby S, Bucko A, Meek J, Boxall N, Heywood E, Wiltshire J, Toh C, Ward A, Shurovi B, Horth D, Patel B, Ali B, Spencer T, Axelson T, Kretzmer L, Chhina C, Anandarajah C, Fautz T, Horst C, Thevathasan A, Ng J, Hirst F, Brewer C, Logan A, Lockey J, Forrest P, Keelty N, Wood A, Springford L, Avery P, Schulz T, Bemand T, Howells L, Collier H, Khajuria A, Tharakan R, Parsons S, Buchan A, McGalliard R, Mason J, Cundy O, Li N, Redgrave N, Watson R, Pezas T, Dennis Y, Segall E, Hameed M, Lynch A, Chamberlain M, Peck F, Neo Y, Russell G, Elseedawy M, Lee S, Foster N, Soo Y, Puan L, Dennis R, Goradia H, Qureshi A, Osman S, Reeves T, Dinsmore L, Marsden M, Lu Q, Pitts-Tucker T, Dunn C, Walford R, Heathcote E, Martin R, Pericleous A, Brzyska K, Reid K, Williams M, Wetherall N, McAleer E, Thomas D, Kiff R, Milne S, Holmes M, Bartlett J, Lucas de Carvalho J, Bloomfield T, Tongo F, Bremner R, Yong N, Atraszkiewicz B, Mehdi A, Tahir M, Sherliker G, Tear A, Pandey A, Broyd A, Omer H, Raphael M, Chaudhry W, Shahidi S, Jawad A, Gill C, Fisher IH, Adeleja I, Clark I, Aidoo-Micah G, Stather P, Salam G, Glover T, Deas G, Sim N, Obute R, Wynell-Mayow W, Sait M, Mitha N, de Bernier G, Siddiqui M, Shaunak R, Wali A, Cuthbert G, Bhudia R, Webb E, Shah S, Ansari N, Perera M, Kelly N, McAllister R, Stanley G, Keane C, Shatkar V, Maxwell-Armstrong C, Henderson L, Maple N, Manson R, Adams R, Semple E, Mills M, Daoub A, Marsh A, Ramnarine A, Hartley J, Malaj M, Jewell P, Whatling E, Hitchen N, Chen M, Goh B, Fern J, Rogers S, Derbyshire L, Robertson D, Abuhussein N, Deekonda P, Abid A, Harrison P, Aildasani L, Turley H, Sherif M, Pandey G, Filby J, Johnston A, Burke E, Mohamud M, Gohil K, Tsui A, Singh R, Lim S, O'Sullivan K, McKelvey L, O'Neill S, Roberts H, Brown F, Cao Y, Buckle R, Liew Y, Sii S, Ventre C, Graham C, Filipescu T, Yousif A, Dawar R, Wright A, Peters M, Varley R, Owczarek S, Hartley S, Khattak M, Iqbal A, Ali M, Durrani B, Narang Y, Bethell G, Horne L, Pinto R, Nicholls K, Kisyov I, Torrance H, English W, Lakhani S, Ashraf S, Venn M, Elangovan V, Kazmi Z, Brecher J, Sukumar S, Mastan A, Mortimer A, Parker J, Boyle J, Elkawafi M, Beckett J, Mohite A, Narain A, Mazumdar E, Sreh A, Hague A, Weinberg D, Fletcher L, Steel M, Shufflebotham H, Masood M, Sinha Y, Jenvey C, Kitt H, Slade R, Craig A, Deall C, Reakes T, Chervenkoff J, Strange E, O'Bryan M, Murkin C, Joshi D, Bergara T, Naqib S, Wylam D, Scotcher S, Hewitt C, Stoddart M, Kerai A, Trist A, Cole S, Knight C, Stevens S, Cooper G, Ingham R, Dobson J, O'Kane A, Moradzadeh J, Duffy A, Henderson C, Ashraf S, McLaughin C, Hoskins T, Reehal R, Bookless L, McLean R, Stone E, Wright E, Abdikadir H, Roberts C, Spence O, Srikantharajah M, Ruiz E, Matthews J, Gardner E, Hester E, Naran P, Simpson R, Minhas M, Cornish E, Semnani S, Rojoa D, Radotra A, Eraifej J, Eparh K, Smith D, Mistry B, Hickling S, Din W, Liu C, Mithrakumar P, Mirdavoudi V, Rashid M, Mcgenity C, Hussain O, Kadicheeni M, Gardner H, Anim-Addo N, Pearce J, Aslanyan A, Ntala C, Sorah T, Parkin J, Alizadeh M, White A, Edozie F, Johnston J, Kahar A, Navayogaarajah V, Patel B, Carter D, Khonsari P, Burgess A, Kong C, Ponweera A, Cody A, Tan Y, Ng A, Croall A, Allan C, Ng S, Raghuvir V, Telfer R, Greenhalgh A, McKerr C, Edison M, Patel B, Dear K, Hardy M, Williams P, Hassan S, Sajjad U, O'Neill E, Lopes S, Healy L, Jamal N, Tan S, Lazenby D, Husnoo S, Beecroft S, Sarvanandan T, Weston C, Bassam N, Rabinthiran S, Hayat U, Ng L, Varma D, Sukkari M, Mian A, Omar A, Kim J, Sellathurai J, Mahmood J, O'Connell C, Bose R, Heneghan H, Lalor P, Matheson J, Doherty C, Cullen C, Cooper D, Angelov S, Drislane C, Smith A, Kreibich A, Palkhi E, Durr A, Lotfallah A, Gold D, Mckean E, Dhanji A, Anilkumar A, Thacoor A, Siddiqui Z, Lim S, Piquet A, Anderson S, McCormack D, Gulati J, Ibrahim A, Murray S, Walsh S, McGrath A, Ziprin P, Chua E, Lou C, Bloomer J, Paine H, Osei-Kuffour D, White C, Szczap A, Gokani S, Patel K, Malys M, Reed A, Torlot G, Cumber E, Charania A, Ahmad S, Varma N, Cheema H, Austreng L, Petra H, Chaudhary M, Zegeye M, Cheung F, Coffey D, Heer R, Singh S, Seager E, Cumming S, Suresh R, Verma S, Ptacek I, Gwozdz A, Yang T, Khetarpal A, Shumon S, Fung T, Leung W, Kwang P, Chew L, Loke W, Curran A, Chan C, McGarrigle C, Mohan K, Cullen S, Wong E, Toale C, Collins D, Keane N, Traynor B, Shanahan D, Yan A, Jafree D, Topham C, Mitrasinovic S, Omara S, Bingham G, Lykoudis P, Miranda B, Whitehurst K, Kumaran G, Devabalan Y, Aziz H, Shoa M, Dindyal S, Yates J, Bernstein I, Rattan G, Coulson R, Stezaker S, Isaac A, Salem M, McBride A, McFarlane H, Yow L, MacDonald J, Bartlett R, Turaga S, White U, Liew W, Yim N, Ang A, Simpson A, McAuley D, Craig E, Murphy L, Shepherd P, Kee J, Abdulmajid A, Chung A, Warwick H, Livesey A, Holton P, Theodoreson M, Jenkin S, Turner J, Entwisle J, Marchal S, O'Connor S, Blege H, Aithie J, Sabine L, Stewart G, Jackson S, Kishore A, Lankage C, Acquaah F, Joyce H, McKevitt K, Coffey C, Fawaz A, Dolbec K, O'Sullivan D, Geraghty J, Lim E, Bolton L, FitzPatrick D, Robinson C, Ramtoola T, Collinson S, Grundy L, McEnhill P, Harbhajan Singh G, Loughran D, Golding D, Keeling R, Williams R, Whitham R, Yoganathan S, Nachiappan R, Egan R, Owasil R, Kwan M, He A, Goh R, Bhome R, Wilson H, Teoh P, Raji K, Jayakody N, Matthams J, Chong J, Luk C, Greig R, Trail M, Charalambous G, Rocke A, Gardiner N, Bulley F, Warren N, Brennan E, Fergurson P, Wilson R, Whittingham H, Brown E, Khanijau R, Gandhi K, Morris S, Boulton A, Chandan N, Barthorpe A, Maamari R, Sandhu S, McCann M, Higgs L, Balian V, Reeder C, Diaper C, Sale T, Ali H, Archer C, Clarke A, Heskin J, Hurst P, Farmer J, O'Flynn L, Doan L, Shuker B, Stott G, Vithanage N, Hoban K, Nesargikar P, Kennedy H, Grossart C, Tan E, Roy C, Sim P, Leslie K, Sim D, Abul M, Cody N, Tay A, Woon E, Sng S, Mah J, Robson J, Shakweh E, Wing V, Mills H, Li M, Barrow T, Balaji S, Jordan H, Phillips C, Naveed H, Hirani S, Tai A, Ratnakumaran R, Sahathevan A, Shafi A, Seedat M, Weaver R, Batho A, Punj R, Selvachandran H, Bhatt N, Botchey S, Khonat Z, Brennan K, Morrison C, Devlin E, Linton A, Galloway E, McGarvie S, Ramsay N, McRobbie H, Whewell H, Dean W, Nelaj S, Eragat M, Mishra A, Kane T, Zuhair M, Wells M, Wilkinson D, Woodcock N, Sun E, Aziz N, Ghaffar MKA. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. Br J Anaesth 2019; 122:42-50. [PMID: 30579405 DOI: 10.1016/j.bja.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. METHODS This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. RESULTS Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. CONCLUSIONS After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
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MacDonald J, Drewnoski M, Carlson Z. 276 Systems approaches to beef cattle production: maximizing use of alternative forages to optimize agricultural ecosystems. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J MacDonald
- University of Nebraska - Lincoln,Lincoln, NE, United States
| | - M Drewnoski
- University of Nebraska - Lincoln,Lincoln, NE, United States
| | - Z Carlson
- University of Nebraska - Lincoln,Lincoln, NE, United States
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Currie K, King C, McAloney-Kocaman K, Roberts NJ, MacDonald J, Dickson A, Cairns S, Khanna N, Flowers P, Reilly J, Price L. The acceptability of screening for Carbapenemase Producing Enterobacteriaceae (CPE): cross-sectional survey of nursing staff and the general publics' perceptions. Antimicrob Resist Infect Control 2018; 7:144. [PMID: 30534365 PMCID: PMC6260859 DOI: 10.1186/s13756-018-0434-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/08/2018] [Indexed: 12/29/2022] Open
Abstract
Background Carbapenemase Producing Enterobacteriaceae (CPE) has spread rapidly and presents a growing challenge in antimicrobial resistance (AMR) management internationally. Screening for CPE may involve a rectal swab, there are limited treatment options for affected patients, and colonised patients are cared for in isolation to protect others. These measures are sound infection prevention precautions; however, the acceptability of CPE screening and its consequences are currently unknown. The aim of this study was ‘To determine factors influencing acceptability of CPE screening from the perspectives of nursing staff and the general public.’ Methods National cross-sectional surveys of nursing staff (n = 450) and the general public (n = 261). The Theoretical Domains Framework (TDF) guided data collection and analysis. Regression modelling was used to identify factors that predicted acceptability of CPE screening. Results For nursing staff, the following predictor variables were significant: intention to conduct CPE screening (OR 14.19, CI 5.14–39.22); belief in the severity of the consequences of CPE (OR 7.13, CI 3.26–15.60); knowledge of hospital policy for screening (OR 3.04, CI 1.45–6.34); preference to ask patients to take their own rectal swab (OR 2.89, CI 1.39–6.0); awareness that CPE is an organism of growing concern (OR 2.44, CI 1.22–4.88). The following predictor variables were significant for the general public: lack of knowledge of AMR (β − .11, p = .01); social influences (β .14,p = .032); social norms (β .21p = .00); acceptability of being isolated if colonised (β .22, p = .000), beliefs about the acceptability of rectal swabbing (β .15, p = .00), beliefs about the impact of careful explanation about CPE screening from a health professional (β .32, p = .00). Integrating results from staff and public perspectives points to the importance of knowledge of AMR, environmental resources, and social influences in shaping acceptability. Conclusions This is the first study to systematically examine the acceptability of CPE screening across nursing staff and the public. The use of TDF enabled identification of the mechanisms of action, or theoretical constructs, likely to be important in understanding and changing CPE related behaviour amongst professionals and public alike. Electronic supplementary material The online version of this article (10.1186/s13756-018-0434-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kay Currie
- 1School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland G4 0BA UK
| | - Caroline King
- 1School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland G4 0BA UK
| | - Kareena McAloney-Kocaman
- 1School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland G4 0BA UK
| | - Nicola J Roberts
- 1School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland G4 0BA UK
| | - Jennifer MacDonald
- 1School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland G4 0BA UK
| | - Adele Dickson
- 1School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland G4 0BA UK
| | | | | | - Paul Flowers
- 1School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland G4 0BA UK
| | - Jacqui Reilly
- 1School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland G4 0BA UK.,2NHS Health Protection Scotland, Glasgow, UK
| | - Lesley Price
- 1School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland G4 0BA UK
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Melone L, Price L, Ness V, Simpson L, MacDonald J, Reilly J. The effect of fake tan on hand hygiene practice. J Infect Prev 2018; 19:266-269. [PMID: 38617878 PMCID: PMC11009565 DOI: 10.1177/1757177418769380] [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: 11/03/2017] [Accepted: 03/13/2018] [Indexed: 04/16/2024] Open
Abstract
Hand hygiene is the single most important measure in reducing the spread of infection. The aim of this study was to assess the uptake of fake tan in nursing students and evaluate the impact of wearing fake tan on hand hygiene training lotion removal during handwashing with soap and water. Of the 217 participants recruited, 21% wore fake tan. Statistical analysis revealed no significant difference between fake tan and non-fake tan wearers. Consequentially, no guidelines regarding the wearing of fake tan in clinical practice are currently required.
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Affiliation(s)
- Lynn Melone
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Lesley Price
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Valerie Ness
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Liz Simpson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Jennifer MacDonald
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Jacqueline Reilly
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
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Langdridge D, Davis M, Gozdzielewska L, McParland J, Williams L, Young M, Smith F, MacDonald J, Price L, Flowers P. A visual affective analysis of mass media interventions to increase antimicrobial stewardship amongst the public. Br J Health Psychol 2018; 24:66-87. [PMID: 30221433 PMCID: PMC6585774 DOI: 10.1111/bjhp.12339] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Received: 05/14/2018] [Revised: 08/08/2018] [Indexed: 11/26/2022]
Abstract
Objectives In an innovative approach to improve the contribution of health psychology to public health we have analysed the presence and nature of affect within the visual materials deployed in antimicrobial stewardship interventions targeting the public identified through systematic review. Design A qualitative analysis focused on the affective content of visual materials garnered from a systematic review of antibiotic stewardship (k = 20). Methods A novel method was devised drawing on concepts from semiotics to analyse the affective elements within intervention materials. Results Whilst all studies examined tacitly rely on affect, only one sought to explicitly deploy affect. Three thematic categories of affect are identified within the materials in which specific ideological machinery is deployed: (1) monsters, bugs, and superheroes; (2) responsibility, threat, and the misuse/abuse of antibiotics; (3) the figure of the child. Conclusions The study demonstrates how affect is a present but tacit communication strategy of antimicrobial stewardship interventions but has not – to date – been adequately theorized or explicitly considered in the intervention design process. Certain affective features were explored in relation to the effectiveness of antimicrobial resistance interventions and warrant further investigation. We argue that further research is needed to systematically illuminate and capitalize upon the use of affect to effect behaviour change concerning antimicrobial stewardship. Statement of contribution What is already known on this subject? The (mis)use of antibiotics and consequent risk of antimicrobial resistance is a critical public health problem. If sufficient action is not taken, global society will face the ‘post‐antibiotic’ era, in which common infections will lead to death for many millions. Key desirable behavioural changes are decreased patient demands for antibiotics, use of them for targeted purposes alone, and compliance with prescribed dosing. There is a growth of interest in the role of affect in mass media interventions designed to engage publics and produce health‐related behavioural change.
What does this study add? This article presents a novel analytic approach to understanding and intervening within behaviour change in public health that may complement other types of analysis. We present findings specifically from an ‘affective’ analysis based on semiotics in which we critically interrogated the visual imagery being deployed in mass media public health interventions concerning antimicrobial stewardship. Three thematic categories of affect are identified within the materials in which specific ideological machinery is deployed and that demonstrate some association with intervention effectiveness worthy of further investigation and testing.
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Affiliation(s)
- Darren Langdridge
- Faculty of Arts & Social Sciences, Open University, Milton Keynes, UK
| | - Mark Davis
- School of Social Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lucyna Gozdzielewska
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Joanna McParland
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Lynn Williams
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Mairi Young
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Fraser Smith
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Jennifer MacDonald
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Lesley Price
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Paul Flowers
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
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Currie K, King C, McAloney-Kocaman K, Roberts NJ, MacDonald J, Dickson A, Cairns S, Khanna N, Flowers P, Reilly J, Price L. Barriers and enablers to meticillin-resistant Staphylococcus aureus admission screening in hospitals: a mixed-methods study. J Hosp Infect 2018; 101:100-108. [PMID: 30098382 DOI: 10.1016/j.jhin.2018.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND To reduce the risk of transmission of meticillin-resistant Staphylococcus aureus (MRSA), international guidelines recommend admission screening to identify hospital patients at risk of colonization. However, routine monitoring indicates that optimum screening compliance levels are not always achieved. In order to enhance compliance, we must better understand those factors which influence staff screening behaviours. AIM To identify factors which influence staff compliance with hospital MRSA screening policies. METHODS A sequential two-stage mixed-methods design applied constructs from normalization process theory and the theoretical domains framework to guide data collection and analysis. Initial qualitative findings informed subsequent development of a national cross-sectional survey of nursing staff (N = 450). Multiple regression modelling identified which barriers and enablers best predict staff compliance. FINDINGS Three factors were significant in predicting optimum (>90%) compliance with MRSA screening: having MRSA screening routinized within the admission process; category of clinical area; feedback of MRSA screening compliance within the clinical area. Integration of data-sets indicated that organizational systems which 'make doing the right thing easy' influence compliance, as does local ward culture. Embedded values and beliefs regarding the relative (de)prioritization of MRSA screening are important. CONCLUSION To our knowledge, this is the first study to provide original evidence of barriers and enablers to MRSA screening, applying both sociological and psychological theory. As antimicrobial resistance is a global health concern, these findings have international relevance for screening programmes. Future policy recommendations or behaviour change interventions, based on the insights presented here, could have significant impact upon improving screening compliance.
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Affiliation(s)
- K Currie
- Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK.
| | - C King
- Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK
| | - K McAloney-Kocaman
- Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK
| | - N J Roberts
- Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK
| | - J MacDonald
- Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK
| | - A Dickson
- Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK
| | - S Cairns
- NHS Health Protection Scotland, Glasgow, UK
| | - N Khanna
- NHS Greater Glasgow & Clyde, Glasgow, UK
| | - P Flowers
- Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK
| | - J Reilly
- Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK; NHS Health Protection Scotland, Glasgow, UK
| | - L Price
- Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK
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Xie J, Nettel-Aguirre A, Lee BE, Chui L, Pang XL, Zhuo R, Parsons B, Vanderkooi OG, Tarr PI, Ali S, Dickinson JA, Hagen E, Svenson LW, MacDonald SE, Drews SJ, Tellier R, Graham T, Lavoie M, MacDonald J, Freedman SB. Relationship between enteric pathogens and acute gastroenteritis disease severity: a prospective cohort study. Clin Microbiol Infect 2018; 25:454-461. [PMID: 29964235 DOI: 10.1016/j.cmi.2018.06.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 03/07/2018] [Revised: 05/28/2018] [Accepted: 06/09/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the relationship between individual bacterial and viral pathogens and disease severity. METHODS Children <18 years with three or more episodes of vomiting and/or diarrhoea were enrolled in two Canadian paediatric emergency departments between December 2014 and August 2016. Specimens were analysed employing molecular panels, and outcome data were collected 14 days after enrolment. The primary outcome was severe disease over the entire illness (symptom onset until 14-day follow-up), quantified employing the Modified Vesikari Scale (MVS) score. The score was additionally analysed in two other time periods: index (symptom onset until enrolment) and follow-up (enrolment until 14-day follow-up). RESULTS Median participant age was 20.7 (IQR: 11.3, 44.2) months; 47.4% (518/1093) and 73.4% (802/1093) of participants had index and total MVS scores ≥11, respectively. The most commonly identified pathogens were rotavirus (289/1093; 26.4%) and norovirus (258/1093; 23.6%). In multivariable analysis, severe disease over the entire illness was associated with rotavirus (OR = 9.60; 95%CI: 5.69, 16.19), Salmonella (OR = 6.61; 95%CI: 1.50, 29.17), adenovirus (OR = 2.53; 95%CI: 1.62, 3.97), and norovirus (OR = 1.43; 95%CI: 1.01, 2.01). Pathogens associated with severe disease at the index visit were: rotavirus only (OR = 6.13; 95%CI: 4.29, 8.75), Salmonella (OR = 4.59; 95%CI: 1.71, 12.29), adenovirus only (OR = 2.06; 95%CI: 1.41, 3.00), rotavirus plus adenovirus (OR = 3.15; 95%CI: 1.35, 7.37), and norovirus (OR = 0.68; 95%CI: 0.49, 0.94). During the follow-up period, rotavirus (OR = 2.21; 95%CI: 1.50, 3.25) and adenovirus (OR = 2.10; 95%CI: 1.39, 3.18) were associated with severe disease. CONCLUSIONS In children presenting for emergency department care with acute gastroenteritis, pathogens identified were predominantly viruses, and several of which were associated with severe disease. Salmonella was the sole bacterium independently associated with severe disease.
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Affiliation(s)
- J Xie
- Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - A Nettel-Aguirre
- Departments of Pediatrics and of Community Health Sciences, Cumming School of Medicine, Faculty of Kinesiology, Alberta Children's Hospital Research Institute, O'Brien Population Health Institute, University of Calgary, Calgary, Alberta, Canada
| | - B E Lee
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - L Chui
- Provincial Laboratory for Public Health, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - X L Pang
- Provincial Laboratory for Public Health, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - R Zhuo
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - B Parsons
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - O G Vanderkooi
- Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine and Community Health Sciences and the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - P I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - S Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - J A Dickinson
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - E Hagen
- Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - L W Svenson
- Analytics and Performance Reporting, Alberta Health Division of Preventive Medicine, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - S E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Canada; School of Public Health, University of Alberta, Edmonton, Canada; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - S J Drews
- Provincial Laboratory for Public Health, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - R Tellier
- Provincial Laboratory for Public Health, Alberta, Canada; Departments of Pathology and Laboratory Medicine and Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - T Graham
- Alberta Health Services, Edmonton Zone, Alberta, Canada; Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - M Lavoie
- Population and Public Health, Fraser Health, Surrey, British Columbia, Canada
| | - J MacDonald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - S B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Marjanovic Z, Bajkov L, MacDonald J. The Conscientious Responders Scale Helps Researchers Verify the Integrity of Personality Questionnaire Data. Psychol Rep 2018; 122:1529-1549. [PMID: 29914343 DOI: 10.1177/0033294118783917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Conscientious Responders Scale is a five-item embeddable validity scale that differentiates between conscientious and indiscriminate responding in personality-questionnaire data (CR & IR). This investigation presents further evidence of its validity and generalizability across two experiments. Study 1 tests its sensitivity to questionnaire length, a known cause of IR, and tries to provoke IR by manipulating psychological reactance. As expected, short questionnaires produced higher Conscientious Responders Scale scores than long questionnaires, and Conscientious Responders Scale scores were unaffected by reactance manipulations. Study 2 tests concerns that the Conscientious Responders Scale's unusual item content could potentially irritate and baffle responders, ironically increasing rates of IR. We administered two nearly identical questionnaires: one with an embedded Conscientious Responders Scale and one without the Conscientious Responders Scale. Psychometric comparisons revealed no differences across questionnaires' means, variances, interitem response consistencies, and Cronbach's alphas. In sum, the Conscientious Responders Scale is highly sensitive to questionnaire length-a known correlate of IR-and can be embedded harmlessly in questionnaires without provoking IR or changing the psychometrics of other measures.
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McParland JL, Williams L, Gozdzielewska L, Young M, Smith F, MacDonald J, Langdridge D, Davis M, Price L, Flowers P. What are the 'active ingredients' of interventions targeting the public's engagement with antimicrobial resistance and how might they work? Br J Health Psychol 2018; 23:804-819. [PMID: 29804314 PMCID: PMC6175406 DOI: 10.1111/bjhp.12317] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/25/2018] [Indexed: 12/23/2022]
Abstract
Objectives Changing public awareness of antimicrobial resistance (AMR) represents a global public health priority. A systematic review of interventions that targeted public AMR awareness and associated behaviour was previously conducted. Here, we focus on identifying the active content of these interventions and explore potential mechanisms of action. Methods The project took a novel approach to intervention mapping utilizing the following steps: (1) an exploration of explicit and tacit theory and theoretical constructs within the interventions using the Theoretical Domains Framework (TDFv2), (2) retrospective coding of behaviour change techniques (BCTs) using the BCT Taxonomy v1, and (3) an investigation of coherent links between the TDF domains and BCTs across the interventions. Results Of 20 studies included, only four reported an explicit theoretical basis to their intervention. However, TDF analysis revealed that nine of the 14 TDF domains were utilized, most commonly ‘Knowledge’ and ‘Environmental context and resources’. The BCT analysis showed that all interventions contained at least one BCT, and 14 of 93 (15%) BCTs were coded, most commonly ‘Information about health consequences’, ‘Credible source’, and ‘Instruction on how to perform the behaviour’. Conclusions We identified nine relevant TDF domains and 14 BCTs used in these interventions. Only 15% of BCTs have been applied in AMR interventions thus providing a clear opportunity for the development of novel interventions in this context. This methodological approach provides a useful way of retrospectively mapping theoretical constructs and BCTs when reviewing studies that provide limited information on theory and intervention content. Statement of contribution What is already known on this subject? Evidence of the effectiveness of interventions that target the public to engage them with AMR is mixed; the public continue to show poor knowledge and misperceptions of AMR. Little is known about the common, active ingredients of AMR interventions targeting the public and information on explicit theoretical content is sparse. Information on the components of AMR public health interventions is urgently needed to enable the design of effective interventions to engage the public with AMR stewardship behaviour.
What does this study add? The analysis shows very few studies reported any explicit theoretical basis to the interventions they described. Many interventions share common components, including core mechanisms of action and behaviour change techniques. The analysis suggests components of future interventions to engage the public with AMR.
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Affiliation(s)
| | - Lynn Williams
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | | | - Mairi Young
- Institute for Applied Health, Glasgow Caledonian University, UK
| | - Fraser Smith
- Institute for Applied Health, Glasgow Caledonian University, UK
| | | | - Darren Langdridge
- Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK
| | - Mark Davis
- School of Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lesley Price
- Institute for Applied Health, Glasgow Caledonian University, UK
| | - Paul Flowers
- Institute for Applied Health, Glasgow Caledonian University, UK
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Deol N, Nguyen T, Parker CE, Khanna R, MacDonald J, Feagan BG, Jairath V. A111 INFLIXIMAB FOR INDUCTION OF REMISSION IN CROHN’S DISEASE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Deol
- Gastroenterology, Western University, London, ON, Canada
| | - T Nguyen
- Robarts Clinical Trials, London, ON, Canada
| | | | - R Khanna
- Department of Medicine, London, ON, Canada
| | | | - B G Feagan
- Department of Medicine, London, ON, Canada
| | - V Jairath
- Department of Medicine, London, ON, Canada
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Flowers P, Wu O, Lorimer K, Ahmed B, Hesselgreaves H, MacDonald J, Cayless S, Hutchinson S, Elliott L, Sullivan A, Clutterbuck D, Rayment M, McDaid L. The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development. Health Technol Assess 2018; 21:1-164. [PMID: 28145220 DOI: 10.3310/hta21050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited. OBJECTIVES To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention. DATA SOURCES All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014. REVIEW METHODS A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation. RESULTS Overall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from 'goals and planning' and 'identity' groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation. LIMITATIONS There was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity. CONCLUSIONS Evidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention. FUTURE WORK There is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity. STUDY REGISTRATION The study is registered as PROSPERO CRD42014009500. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Paul Flowers
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment and National Institute for Health Research Complex Reviews Support Unit, University of Glasgow, Glasgow, UK
| | - Karen Lorimer
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Bipasha Ahmed
- GCU London, Glasgow Caledonian University, London, UK
| | - Hannah Hesselgreaves
- Health Economics and Health Technology Assessment and National Institute for Health Research Complex Reviews Support Unit, University of Glasgow, Glasgow, UK
| | - Jennifer MacDonald
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Sandi Cayless
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Sharon Hutchinson
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lawrie Elliott
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lisa McDaid
- Chief Scientist Office/Medical Research Council Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Evans S, Daly A, MacDonald J, Pinto A, MacDonald A. Fifteen years of using a second stage protein substitute for weaning in phenylketonuria: a retrospective study. J Hum Nutr Diet 2017; 31:349-356. [PMID: 28940742 DOI: 10.1111/jhn.12510] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In phenylketonuria (PKU), during weaning, it is necessary to introduce a second stage phenylalanine (Phe)-free protein substitute (PS) to help meet non-Phe protein requirements. Semi-solid weaning Phe-free PS have been available for >15 years, although no long-term studies have reported their efficacy. METHODS Retrospective data from 31 children with PKU who commenced a weaning PS were collected from clinical records from age of weaning to 2 years, on: gender; birth order; weaning age; anthropometry; blood Phe levels; age commenced and dosage of weaning PS and Phe-free infant L-amino acid formula; natural protein intake; and issues with administration of PS or food. RESULTS Median commencement age for weaning was 17 weeks (range 12-25 weeks) and, for weaning PS, 20 weeks (range 13-37 weeks). Median natural protein was 4 g day-1 (range 3-11 g day-1 ) and total protein intake was >2 g kg-1 day-1 from weaning to 2 years of age. Children started on 2-4 g day-1 protein equivalent (5-10 g day-1 of powder) from weaning PS, increasing by 0.2 g kg-1 day-1 (2 g day-1 ) monthly to 12 months of age. Teething and illness adversely affected the administration of weaning PS and the acceptance of solid foods. Altogether, 32% of children had delayed introduction of more textured foods, associated with birth order (firstborn 80% versus 38%; P = 0.05) and food refusal when teething (80% versus 29%; P = 0.02). CONCLUSIONS Timing of introduction of solid foods and weaning PS, progression onto more textured foods and consistent feeding routines were important in aiding their acceptance. Any negative behaviour with weaning PS was mainly associated with food refusal, teething and illness. Parental approach influenced the acceptance of weaning PS.
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Affiliation(s)
- S Evans
- Dietetic Department, Birmingham Children's Hospital, Birmingham, UK
| | - A Daly
- Dietetic Department, Birmingham Children's Hospital, Birmingham, UK
| | - J MacDonald
- Dietetic Department, Birmingham Children's Hospital, Birmingham, UK
| | - A Pinto
- Dietetic Department, Birmingham Children's Hospital, Birmingham, UK
| | - A MacDonald
- Dietetic Department, Birmingham Children's Hospital, Birmingham, UK
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Muddiman E, Bullock AD, MacDonald J, Allery L, Webb KL, Pugsley L. 'It's surprising how differently they treat you': a qualitative analysis of trainee reflections on a new programme for generalist doctors. BMJ Open 2016; 6:e011239. [PMID: 27601487 PMCID: PMC5020751 DOI: 10.1136/bmjopen-2016-011239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES An increase in patients with long-term conditions and complex care needs presents new challenges to healthcare providers around the developed world. In response, more broad-based training programmes have developed to better prepare trainees for the changing landscape of healthcare delivery. This paper focuses on qualitative elements of a longitudinal, mixed-methods evaluation of the postgraduate, post-Foundation Broad-Based Training (BBT) programme in England. It aims to provide a qualitative analysis of trainees' evaluations of whether the programme meets its intentions to develop practitioners adept at managing complex cases, patient focused care, specialty integration and conviction in career choice. We also identify unintended consequences. SETTING 9 focus groups of BBT trainees were held over a 12-month period. Discussions were audio-recorded and subjected to directed content analysis. Data were collected from trainees across all 7 participating regions: East Midlands; West Midlands; Severn; Northern; North Western; Yorkshire and Humber; Kent, Surry and Sussex. PARTICIPANTS Focus group participants (61 in total) from the first and second cohorts of BBT. RESULTS Evidence from trainees indicated that the programme was meeting its aims: trainees valued the extra time to decide on their onward career specialty, having a wider experience and developing a more integrated perspective. They thought of themselves as different and perceived that others they worked alongside also saw them as different. Being different meant benefitting from novel training experiences and opportunities for self-development. However, unintended consequences were feelings of isolation, and uncertainty about professional identity. CONCLUSIONS By spanning boundaries between specialties, trainee generalists have the potential to improve experiences and outcomes for patients with complex health needs. However, the sense of isolation will inhibit this potential. We employ the concept of 'belongingness' to identify challenges related to the implementation of generalist training programmes within existing structures of healthcare provision.
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Affiliation(s)
- E Muddiman
- Cardiff Unit for Research and Evaluation into Medical and Dental Education (CUREMeDE), Cardiff University School of Social Sciences, Cardiff, UK
| | - A D Bullock
- Cardiff Unit for Research and Evaluation into Medical and Dental Education (CUREMeDE), Cardiff University School of Social Sciences, Cardiff, UK
| | - J MacDonald
- Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK
| | - L Allery
- Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK
| | - K L Webb
- Cardiff Unit for Research and Evaluation into Medical and Dental Education (CUREMeDE), Cardiff University School of Social Sciences, Cardiff, UK
| | - L Pugsley
- Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK
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Abstract
A PBI and thyroxine iodine manual method (Oxford Laboratories) have been compared with a serum thyroxine method based on competitive protein-binding. The thyroxine iodine technique appeared to be more reliable and practicable than the PBI method, except that the latter has the advantage that it can be automated. The close correlation between results from the serum thyroxineiodine and thyroxine methods makes the former a useful addition to the range of tests employed in the investigation of thyroid function.
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Affiliation(s)
- J. MacDonald
- Sub-department of Endocrine Pathology, Liverpool Clinic, Liverpool L7 7DE
| | - L. J. Hipkin
- Sub-department of Endocrine Pathology, Liverpool Clinic, Liverpool L7 7DE
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MacDonald J, Lorimer K, Knussen C, Flowers P. Interventions to increase condom use among middle-aged and older adults: A systematic review of theoretical bases, behaviour change techniques, modes of delivery and treatment fidelity. J Health Psychol 2016; 21:2477-2492. [PMID: 25921479 DOI: 10.1177/1359105315580462] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This systematic review collates, examines and syntheses condom use interventions for middle-aged and older adults. Associations between effectiveness and theoretical basis, behaviour change techniques, mode of delivery and treatment fidelity were explored. Five interventions were included; one was effective. Compared to interventions with non-significant findings, the effective telephone-administered intervention used theory to a greater extent, had a higher number of behaviour change techniques and employed more treatment fidelity strategies. There is a need to develop theory-based interventions targeting condom use among this population and evaluate these in randomised controlled trials that are rigorously designed and reported. Health psychologists have a key role in this endeavour.
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Abstract
This study aimed to assess the value of periodic review by an occupational therapist (OT) of elderly patients with rheumatoid arthritis (RA). Twenty-four patients aged over 65 years who had longstanding RA and had had at least one previous contact with an OT completed a modified health assessment questionnaire (HAQ)1.2 to give an assessment of their self perceived functional ability then had a formal OT assessment. Two months later the patients completed a second HAQ to assess the effect of the OT assessment and assistance. Only three of the 24 patients were felt by the OT to have no need of intervention by her; 17 of the patients felt that the OT contact had been useful. Possible intervention to improve quality of life was not predicted by the patient's perception of limitations nor by the HAQ score. There were no significant changes in HAQ scores despite OT assessment and intervention. Other assessments of disability or wellbeing merit investigation in the context of OT intervention but the need for OT review of elderly patients with RA is clear.
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Affiliation(s)
- CH McAlpine
- Department of Rheumatology, Gathavel General Hospital
| | - E. Woodhouse
- Department of Occupational Therapy, Gatrtnavel General Hospital
| | - J. MacDonald
- Department of Geriatric Medicine, Gartnavel General Hospital
| | - J. Hunter
- Department of Rheumatology, Gartnavel General Hospital, Glasgow
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Cleveland B, Bower C, Jones T, MacDonald J, Sullivan G. Effect of feeding distillers grains and supplementing antioxidants on lipid oxidation of ground beef. Meat Sci 2016. [DOI: 10.1016/j.meatsci.2015.08.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pannucci C, Swistun L, MacDonald J, Brooke B, Henke P. The 2005 Caprini Score Predicts Both Baseline Venous Thromboembolism Risk and Effectiveness of Chemoprophylaxis: A Meta-Analysis of 13,412 Surgical Patien. J Vasc Surg Venous Lymphat Disord 2016. [DOI: 10.1016/j.jvsv.2015.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Evans S, Daly A, Chahal S, MacDonald J, MacDonald A. Food acceptance and neophobia in children with phenylketonuria: a prospective controlled study. J Hum Nutr Diet 2015; 29:427-33. [DOI: 10.1111/jhn.12346] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- S. Evans
- Dietetic Department, Birmingham Children's Hospital; Birmingham UK
| | - A. Daly
- Dietetic Department, Birmingham Children's Hospital; Birmingham UK
| | - S. Chahal
- Dietetic Department, Birmingham Children's Hospital; Birmingham UK
| | - J. MacDonald
- Dietetic Department, Birmingham Children's Hospital; Birmingham UK
| | - A. MacDonald
- Dietetic Department, Birmingham Children's Hospital; Birmingham UK
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Ponce CH, Brown MS, Osterstock JB, Cole NA, Lawrence TE, Soto-Navarro S, MacDonald J, Lambert BD, Maxwell C. Effects of wet corn distillers grains with solubles on visceral organ mass, trace mineral status, and polioencephalomalacia biomarkers of individually-fed cattle. J Anim Sci 2014; 92:4034-46. [PMID: 25023807 DOI: 10.2527/jas.2014-7695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/13/2022] Open
Abstract
Twenty-four steers (initial BW = 385 ± 1.1 kg) were blocked by BW and randomly assigned to 3 dietary treatments (0, 30, or 60% wet distillers grains with solubles [WDGS]; DM basis) and were fed individually to determine the effect of WDGS on live growth and carcass performance, visceral organ mass, trace mineral status, and polioencephalomalacia biomarkers. Steers were slaughtered at 125, 150, 164, and 192 d (2 blocks/slaughter date) when external fat depth was approximately 1.3 cm based on visual appraisal. Steers fed 30% WDGS had greater DMI than those fed 0 or 60% WDGS (P < 0.05), and steers fed 60% WDGS had the lowest carcass-adjusted ADG (P < 0.09) of the 3 treatments. Nonetheless, WDGS concentration did not alter feed efficiency (P > 0.41) on either live or carcass-adjusted basis. Steers fed 30% WDGS had greater liver S and Mn concentrations (DM basis) and lower liver Fe concentrations than control steers (P < 0.10; initial values used as a covariate), and feeding 60% WDGS decreased liver Cu and increased liver Fe (P < 0.10) compared with feeding 30% WDGS. Cytochrome c oxidase (COX) activity in brain tissue tended to be decreased with 60 vs. 30% WDGS (P = 0.12), and COX activity decreased linearly (P = 0.06) in lung tissue as dietary WDGS concentration increased. Likewise, gut fill linearly increased (P = 0.01) with increasing WDGS concentration. Feeding 30% WDGS increased fractional mass (g/kg of empty BW) of the small intestine (P < 0.10) compared with controls, whereas 60% WDGS increased fractional kidney mass (P < 0.10) compared with 30% WDGS. Overall, results suggest that gut fill, Cu status, and COX activity seem to be compromised by WDGS when fed at 60% of diet DM in diets based on steam-flaked corn, which suggests a greater susceptibility to polioencephalomalacia.
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Affiliation(s)
- C H Ponce
- West Texas A&M University, Canyon, TX
| | - M S Brown
- West Texas A&M University, Canyon, TX
| | | | | | | | | | - J MacDonald
- Department of Animal Sciences, Tarleton State University, Stephenville, TX
| | | | - C Maxwell
- West Texas A&M University, Canyon, TX
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Singh J, Wells G, Christensen R, Tanjong E, MacDonald J, Tugwell P, Buchbinder R. SAT0461 Adverse effects of biologics: a network meta-analysis and cochrane overview. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.3407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
The construction industry worldwide is moving towards more collaborative working practices, such as integrated project delivery (IPD). The era of the Master Builder has passed; modern construction projects are too complex for one person to understand all aspects. New specialist disciplines are emerging, with experts engaged at earlier stages of the design process. However, this collaborative approach is not reflected in the current education of architecture, engineering, and construction (AEC) professionals. Students of the separate disciplines are generally educated in isolation from the others. On graduation, they are then expected to be able to work in integrated teams without prior training in multidisciplinary teamwork. This contributes to the poor levels of trust and inadequate information sharing that plague the industry and prevents it from fully embracing the productivity savings that BIM (building information modelling) and IPD promise. Academics of the AEC disciplines also work in isolation, and the same courses are developed from scratch every time a new academic arrives at an institution. This paper proposes an integrated approach to the teaching of AEC subjects, including a framework to assist academics in adapting their existing curricula, and reports on some initial trials carried out in three Australian Universities.
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Dings R, Levine J, Astorgues-Xerri L, Kumar N, Serova M, MacDonald J, Raymond E, Hoye T, Mayo K. 568 Design of PTX008 That Allosterically Targets Galectin-1 to Inhibit Tumor Growth in Mice. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)72365-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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MacPherson IR, Bissett D, Petty RD, Tait B, Samuel LM, MacDonald J, Smith M, Birse-Archbold JA, Barnett AL, Wolf CR, Elcombe CR, Jeynes-Ellis A, Evans TRJ. A first-in-human phase I clinical trial of CXR1002 in patients (pts) with advanced cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Khanal A, Gillespie J, MacDonald J. Adoption of technology, management practices, and production systems in US milk production. J Dairy Sci 2010; 93:6012-22. [DOI: 10.3168/jds.2010-3425] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 08/20/2010] [Indexed: 11/19/2022]
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Holmuhamedov EL, Teplova VV, Johnson CB, MacDonald J. A study of the effect of ethanol on the synthesis of serine and the exchange of methyl groups in hepatocytes by NMR spectroscopy. Biophysics (Nagoya-shi) 2010. [DOI: 10.1134/s0006350910060138] [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: 11/23/2022] Open
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Kholmukhamedov EL, Teplova VV, Johnson CB, MacDonald J. [Effect of ethanol on synthesis of serine and exchange of methyl groups in hepatocytes by NMR spectroscopy]. Biofizika 2010; 55:1057-1062. [PMID: 21268350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The method of NMR spectroscopy was used to investigate the role of voltage-dependent anion channels in the outer mitochondrial membrane in the mechanism of ethanol hepatotoxicity using the synthesis of serine and exchange of methyl groups in hepatocytes metabolizing 13C-labeled glycine. Here we present and describe a methodological approach developed for the independent monitoring of the synthesis of serine in two intracellular compartments: the cytoplasm and mitochondria of intact hepatocytes, and quantification of different serine isotopomers synthesized in hepatocytes from 13C-labeled glycine. The data obtained indicate that the treatment of cells with ethanol as well as cysteamine (specific inhibitor of mitochondrial synthesis of serine) suppressed the level of mitochondria but not cytoplasmic serine isotopomers. It is concluded that the decrease in the production of mitochondrial serine isotopomers in hepatocytes exposed to ethanol can be caused not only by decreased permeability of the outer mitochondrial membrane due to the closure of voltage-dependent anion channels and suppression of the exchange of substrates of serine synthesis in mitochondria but also by the restoration of the cytoplasmic and/or mitochondrial pool of pyridine nucleotides (NADH) during the oxidation of ethanol. Our work reveals a new mechanism of action of ethanol (alcohol intoxication) in hepatocytes through the regulation of glycine metabolism and opens new possibilities in the treatment of alcohol poisoning.
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Berger A, Winter K, Hoffman J, Regine W, Abrams R, Safran H, Freedman G, Benson A, MacDonald J, Willet C. Five Year Results of US Intergroup/RTOG 9704 with Postoperative Ca 19-9 ≤90 and Comparison to the Conko-001 Trial. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.262] [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: 11/27/2022]
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Macpherson M, Bissett D, Tait B, Samuel L, MacDonald J, Barnett A, Wolf C, Elcombe C, Jeynes-Ellis A, Evans T. 391 A phase I clinical trial of CXR1002 in patients (pts) with advanced cancer. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)72098-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: 10/18/2022] Open
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Holmuhamedov EL, Czerny C, Lovelace G, Beeson CC, Baker T, Johnson CB, Pediaditakis P, Teplova VV, Tikunov A, MacDonald J, Lemasters JJ. Role of voltage-dependent anion channels of the mitochondrial outer membrane in regulation of cell metabolism. Biophysics (Nagoya-shi) 2010. [DOI: 10.1134/s0006350910050088] [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: 11/23/2022] Open
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Kholmukhamedov EL, Czerny C, Lovelace G, Beeson KC, Baker T, Johnson CB, Pediaditakis P, Teplova VV, Tikunov A, MacDonald J, Lemasters JJ. [The role of the voltage-dependent anion channels in the outer membrane of mitochondria in the regulation of cellular metabolism]. Biofizika 2010; 55:822-833. [PMID: 21033348 PMCID: PMC4547860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The role of voltage-dependent anion channels (VDAC/porins) of the mitochondrial outer membrane in the regulation of cell metabolism is assessed using an experimental model of ethanol toxicity in cultured hepatocytes. It is demonstrated that ethanol inhibits the phosphorylating and the uncoupled mitochondrial respiration, decreases the accessibility of mitochondrial adenylate kinase in the intermembrane space, and suppresses ureagenic respiration in the cells. Treatment with digitonin at high concentrations (>80 μM)—which creates pores in the mitochondrial outer membrane, allowing bypass of closed VDAC—restores all the processes suppressed with ethanol. It is concluded that the effect of ethanol in hepatocytes leads to global loss of mitochondrial function because of closure of VDAC, which limits the free diffusion of metabolites into the intermembrane space. Our studies also reveal the role of VDAC in the regulation of liver-specific intracellular processes such as ureagenesis. The data obtained can be used in development of pharmaceuticals that would prevent VDAC closure in mitochondria of ethanol-oxidizing liver, thus protecting liver tissue from the hepatotoxic action of alcohol.
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Wong K, Hughes CA, Plitt S, Foisy M, MacDonald J, Johnson M, Singh AE. HIV non-occupational postexposure prophylaxis in a Canadian province: treatment completion and follow-up testing. Int J STD AIDS 2010; 21:617-21. [DOI: 10.1258/ijsa.2008.008482] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Provincial guidelines for HIV non-occupational postexposure prophylaxis (NPEP) were implemented on January 2005 in Alberta, Canada. Human immunodeficiency virus (HIV) NPEP was provided free of charge following approval by a medical officer of health. Between 1 January 2005 and 30 June 2007, 174 individuals were prescribed NPEP; 135 (78%) were women with a median age of 24 years. Sexual assaults accounted for 68% of exposures. NPEP was completed in 49% of cases. Individuals who completed NPEP were less likely to have been exposed by sexual assault ( P = 0.04) and more likely to have received HIV follow-up testing ( P = 0.03).Individuals who received at least one HIV follow-up test were older ( P = 0.03) and more likely to have been exposed percutaneously ( P = 0.003). Those who received no follow-up testing were less likely to have filled an NPEP prescription ( P = 0.0001). New strategies are required to improve follow-up of individuals receiving NPEP, especially younger persons or sexual assault survivors.
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Affiliation(s)
- K Wong
- Alberta Health Services, Capital Health
| | - C A Hughes
- Alberta Health Services, Capital Health
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta
- Northern Alberta HIV Program, Edmonton, Alberta
| | - S Plitt
- Public Health Agency of Canada, Ottawa, Ontario
| | - M Foisy
- Alberta Health Services, Capital Health
- Northern Alberta HIV Program, Edmonton, Alberta
| | - J MacDonald
- Alberta Health Services, Calgary Health Region, Calgary
| | - M Johnson
- Alberta Health Services, Capital Health
| | - A E Singh
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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