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Wagener M, Dolan E, Arnous S, Galvin J, Murphy AW, Casserly I, Eustace J, O’Connor S, McCreery C, Shand J, Wall C, Matiullah S, Sharif F. Renal Denervation as a Complementary Treatment Option for Uncontrolled Arterial Hypertension: A Situation Assessment. J Clin Med 2023; 12:5634. [PMID: 37685701 PMCID: PMC10488551 DOI: 10.3390/jcm12175634] [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: 07/23/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Uncontrolled arterial hypertension is a major global health issue. Catheter-based renal denervation has shown to lower blood pressure in sham-controlled trials and represents a device-based, complementary treatment option for hypertension. In this situation assessment, the authors, who are practicing experts in hypertension, nephrology, general practice and cardiology in the Republic of Ireland, discuss the current evidence base for the BP-lowering efficacy and safety of catheter-based renal denervation with different modalities. Although important questions remain regarding the identification of responders, and long-term efficacy and safety of the intervention, renal denervation has the potential to provide much-needed help to address hypertension and its adverse consequences. The therapeutic approach needs to be multidisciplinary and personalised to take into account the perspective of patients and healthcare professionals in a shared decision-making process.
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Affiliation(s)
- Max Wagener
- University Hospital Galway, University of Galway, H91 TK33 Galway, Ireland
| | - Eamon Dolan
- Stroke and Hypertension Unit, Connolly Hospital, D15 X40D Dublin, Ireland
| | - Samer Arnous
- University Hospital Limerick, V94 F858 Limerick, Ireland
| | - Joseph Galvin
- The Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland
| | - Andrew W. Murphy
- Turloughmore Medical Centre, University of Galway, H91 TK33 Galway, Ireland
| | - Ivan Casserly
- The Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland
| | | | | | | | - James Shand
- St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | | | | | - Faisal Sharif
- University Hospital Galway, University of Galway, H91 TK33 Galway, Ireland
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2
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Richards HL, Wormald A, O'Dwyer A, Najt P, Eustace J, O'Connor K, McKiernan M, O'Dea E, Burke P, Fortune DG. Healthcare Workers Beliefs about COVID-19; a Longitudinal, Mixed Methods Analysis. PSYCHOL HEALTH MED 2023; 28:110-123. [PMID: 35089104 DOI: 10.1080/13548506.2022.2032773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The psychological impact of COVID-19 on Health Care Workers (HCWs) has been widely reported. Few studies have sought to examine HCWs personal models of COVID-19 utilising an established theoretical framework. We undertook a mixed methods study of beliefs about COVID-19 held by HCWs in the Mid-West and South of Ireland during the first and third waves of COVID-19. Template analysis was undertaken on the free text responses of 408 HCWs about their perceptions of the Cause of COVID-19 as assessed by the Brief Illness Perception Questionnaire (B-IPQ). Responses were re-examined in the same cohort for stability at 3 months follow-up (n = 100). This analytic template was subsequently examined in a new cohort (n = 253) of HCWs in the third wave. Female HCWs perceived greater emotional impact of COVID-19 than men (t = -4.31, df405, p < 0.01). Differences between occupational groups were evident in relation to Timeline (F4,401 = 3.47, p < 0.01), Treatment Control (F4,401 = 5.64, p < 0.001) and Concerns about COVID-19 (F4,401 = 3.68, p < 0.01). Administration staff believed that treatment would be significantly more helpful and that COVID-19 would last a shorter amount of time than medical/nursing staff and HSCP. However, administration staff were significantly more concerned than HSCP about COVID-19. Template analysis on 1059 responses to the Cause items of the B-IPQ identified ten higher order categories of perceived Cause of COVID-19. The top two Causes identified at both Waves were 'individual behavioural factors' and 'overseas travel'. This study has progressed our understanding of the models HCWs hold about COVID-19 over time, and has highlighted the utility of the template analysis approach in analysing free-text questionnaire data. We suggest that group and individual occupational identities of HCWs may be of importance in shaping HCWs responses to working through COVID-19.
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Affiliation(s)
- H L Richards
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
| | - A Wormald
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - A O'Dwyer
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - P Najt
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - J Eustace
- Department of Nephrology, Cork University Hospital and HRB Clinical Research Facility at University College Cork, Cork, Ireland
| | - K O'Connor
- Department of Geriatrics, Mercy University Hospital, Cork, Ireland
| | - M McKiernan
- Department of Nursing, Mercy University Hospital, Cork, Ireland
| | - E O'Dea
- Psychology Department, Mid West Community Healthcare Organisation 3, Limerick, Ireland
| | - P Burke
- Clinical Education & Research Centre, University Hospital Limerick, Limerick, Ireland
| | - D G Fortune
- Department of Psychology, University of Limerick, Limerick, Ireland
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3
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Richards HL, Eustace J, O' Dwyer A, Wormald A, Curtin Y, Fortune DG. Healthcare workers use of psychological support resources during COVID-19; a mixed methods approach utilising Pillar Integration Analysis. PLoS One 2022; 17:e0267458. [PMID: 35476796 PMCID: PMC9045652 DOI: 10.1371/journal.pone.0267458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 04/08/2022] [Indexed: 01/26/2023] Open
Abstract
Objectives We sought to examine healthcare workers (HCWs) utilisation of formal and informal psychological support resources in the workplace during the first and third waves of the COVID-19 pandemic in Ireland. Methods A convergent mixed methods approach was undertaken. Four hundred and thirty HCWs in the Mid West and South of Ireland responded to an online survey in terms of their use of psychological support resources during Wave 1 (April/May 2020) of COVID-19. Thirty-nine HCWs undertook in depth interviews at Wave 3 (January/February 2021), and a further quantitative survey was distributed and completed by 278 HCWs at this time. Quantitative data arising at Wave 1 and Wave 3, were synthesised with Qualitative data collected at Wave 3. A Pillar Integration Process (PIP) was utilised in the analysis of the quantitative and qualitative data. Results Five pillars were identified from the integration of results. These were: a) the primacy of peer support, b) the importance of psychologically informed management, c) a need to develop the organisational well-being ethos, d) support for all HCWs, and e) HCWs ideas for developing the well-being path. These pillars encapsulated a strong emphasis on collegial support, an emphasis on the need to support managers, a questioning of the current supports provided within the healthcare organisations and critical reflections on what HCWs viewed as most helpful for their future support needs. Conclusions HCWs who utilised supportive resources indicated ‘in house’ supports, primarily collegial resources, were the most frequently used and perceived as most helpful. While formal psychological supports were important, the mechanism by which such psychological support is made available, through utilising peer support structures and moving towards psychologically informed supervisors and workplaces is likely to be more sustainable and perceived more positively by HCWs.
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Affiliation(s)
- Helen L Richards
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Joseph Eustace
- Department of Nephrology, Cork University Hospital and HRB Clinical Research Facility at University College Cork, Cork, Ireland
| | - Amanda O' Dwyer
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Andrew Wormald
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Yvonne Curtin
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Dónal G Fortune
- Department of Psychology, University of Limerick, Limerick, Ireland
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4
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Kenny G, McCann K, O’Brien C, Savinelli S, Tinago W, Yousif O, Lambert JS, O’Broin C, Feeney ER, De Barra E, Doran P, Mallon PWG, Cotter A, Muldoon E, Sheehan G, McGinty T, Lambert JS, Green S, Leamy K, Kenny G, McCann K, McCann R, O’Broin C, Waqas S, Savinelli S, Feeney E, Mallon PWG, Garcia Leon A, Miles S, Alalwan D, Negi R, de Barra E, McConkey S, Hurley K, Sulaiman I, Horgan M, Sadlier C, Eustace J, Kelly C, Bracken T, Whelan B, Low J, Yousif O, McNicholas B, Courtney G, Gavin P. Identification of Distinct Long COVID Clinical Phenotypes Through Cluster Analysis of Self-Reported Symptoms. Open Forum Infect Dis 2022; 9:ofac060. [PMID: 35265728 PMCID: PMC8900926 DOI: 10.1093/ofid/ofac060] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/01/2022] [Indexed: 12/14/2022] Open
Abstract
Background We aimed to describe the clinical presentation of individuals presenting with prolonged recovery from coronavirus disease 2019 (COVID-19), known as long COVID. Methods This was an analysis within a multicenter, prospective cohort study of individuals with a confirmed diagnosis of COVID-19 and persistent symptoms >4 weeks from onset of acute symptoms. We performed a multiple correspondence analysis (MCA) on the most common self-reported symptoms and hierarchical clustering on the results of the MCA to identify symptom clusters. Results Two hundred thirty-three individuals were included in the analysis; the median age of the cohort was 43 (interquartile range [IQR], 36–54) years, 74% were women, and 77.3% reported a mild initial illness. MCA and hierarchical clustering revealed 3 clusters. Cluster 1 had predominantly pain symptoms with a higher proportion of joint pain, myalgia, and headache; cluster 2 had a preponderance of cardiovascular symptoms with prominent chest pain, shortness of breath, and palpitations; and cluster 3 had significantly fewer symptoms than the other clusters (2 [IQR, 2–3] symptoms per individual in cluster 3 vs 6 [IQR, 5–7] and 4 [IQR, 3–5] in clusters 1 and 2, respectively; P < .001). Clusters 1 and 2 had greater functional impairment, demonstrated by significantly longer work absence, higher dyspnea scores, and lower scores in SF-36 domains of general health, physical functioning, and role limitation due to physical functioning and social functioning. Conclusions Clusters of symptoms are evident in long COVID patients that are associated with functional impairments and may point to distinct underlying pathophysiologic mechanisms of disease.
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Affiliation(s)
- Grace Kenny
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Kathleen McCann
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Conor O’Brien
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Stefano Savinelli
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Willard Tinago
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
| | - Obada Yousif
- Endocrinology Department, Wexford General Hospital, Carricklawn, Wexford, Ireland
| | - John S Lambert
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Cathal O’Broin
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Eoin R Feeney
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Eoghan De Barra
- Department of Infectious Diseases, Beaumont Hospital, Beaumont, Dublin, Ireland
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Peter Doran
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Patrick W G Mallon
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
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5
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Walsh LJ, Deasy KF, Gomez F, O'Sullivan E, Eustace J, Ryan AM, Murphy DM. Use of non-invasive ventilation in motor neuron disease - a retrospective cohort analysis. Chron Respir Dis 2021; 18:14799731211063886. [PMID: 34854787 PMCID: PMC8646818 DOI: 10.1177/14799731211063886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Motor neuron disease (MND) is a neurodegenerative disorder which leads to progressive muscle weakness including respiratory muscle decline. The introduction of non-invasive ventilation (NIV) has been shown to improve quality of life, survival and slow the rate of pulmonary function decline. A retrospective chart analysis of patients who attended the MND clinic from 2014 to 2019 at a tertiary-referral, academic, teaching hospital was carried out to evaluate if NIV and greater compliance with NIV was associated with improved survival. 111 patients were included. The mean age at diagnosis was 63.8 years and 61.3% were males. 66.7% of our cohort used NIV and of this 66.7%, 44.1% were compliant. There was a significantly longer survival in those who used NIV (p = 0.002) and in those who used NIV optimally (p = 0.02) when both groups were compared to those who did not use NIV. In the bulbar MND group those who were compliant with NIV survived longer than who those who did not use NIV (p = 0.001). We found a significantly longer survival with the use of NIV, the use of NIV optimally and with use of NIV in those with bulbar onset MND compared to those who did not use NIV.
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Affiliation(s)
- Laura J Walsh
- Department of Respiratory Medicine, 57983Cork University Hospital, Cork, Ireland
| | - Kevin F Deasy
- Department of Respiratory Medicine, 57983Cork University Hospital, Cork, Ireland
| | - Fernando Gomez
- Department of Respiratory Medicine, 57983Cork University Hospital, Cork, Ireland
| | | | - Joseph Eustace
- Health Research Board, Clinical Research Facility, 8795University College Cork, Cork, Ireland
| | - Aisling M Ryan
- Department of Neurology, 57983Cork University Hospital, Cork, Ireland
| | - Desmond M Murphy
- Department of Respiratory Medicine, 57983Cork University Hospital, Cork, Ireland.,Health Research Board, Clinical Research Facility, 8795University College Cork, Cork, Ireland
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6
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Byrne F, Gillman B, Palmer B, Kiely M, Eustace J, Kearney P, Davidson F, Shiely F. The effect of dietary phosphorus load and food matrix on postprandial serum phosphate in hemodialysis patients: a pilot study. HRB Open Res 2021; 4:119. [PMID: 35187396 PMCID: PMC8822142 DOI: 10.12688/hrbopenres.13382.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Potential dietary strategies for controlling hyperphosphataemia include the use of protein sources with lower phosphorus bioavailability such as pulses and nuts, focus on phosphorus to protein ratios and the avoidance of all phosphate additives. Methods: We conducted a controlled crossover feeding study in 8 haemodialysis (HD) patients to investigate the acute postprandial effect of a modified versus standard low phosphorus diet for one day on serum phosphate, potassium and intact parathyroid levels in prevalent HD patients. Each participant consumed the modified diet on one day and the standard diet on a second day one week apart. The modified diet included beef and less dairy, with a lower phosphorus to protein ratio, as well as plant-based protein, whole grains, pulses and nuts containing phytates which reduces phosphorus bioavailability. Both diets were tailored for each participant to provide 1.1g protein/kg ideal body weight. Participants provided fasting bloods before breakfast, a pre-prandial sample before the lunch time main meal and samples at one-hour intervals for the four hours after the lunch time main meal, for analysis of phosphate, potassium and intact parathyroid hormone (iPTH). Results: At four hours post the lunch time main meal on each study day, individuals on the modified diet had serum phosphate readings 0.30 mmol/l lower than when on the standard diet (p-value = 0.015, 95% confidence interval [CI] -0.57, -0.04). The corresponding change in serum potassium at four hours was a decrease of 0.675 mmol/l (p-value = 0.011, CI -1.25, -0.10). Conclusions: Decreases in both serum phosphate and serum potassium readings on a modified low phosphorus diet encourage further larger studies to explore the possibility of greater food choice and healthier plant-based diets in HD patients. ClinicalTrials.gov registration: NCT04845724 (15/04/2021)
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Affiliation(s)
- Fiona Byrne
- Department of Nutrition & Dietetics, Cork, Cork University Hospital, Cork, T12 DC4A, Ireland
- Department of Renal Medicine, Cork University Hospital, Cork, T12 DC4A, Ireland
- Health Research Board, Clinical Research Facility Cork, University College Cork, Cork, T12 WE28, Ireland
| | - Barbara Gillman
- Department of Nutrition & Dietetics, Mater Misericordiae University Hospital, Dublin, D07 R2WY, Ireland
| | - Brendan Palmer
- Health Research Board, Clinical Research Facility Cork, University College Cork, Cork, T12 WE28, Ireland
- School of Public Health, University College Cork, Cork, T12 XF62, Ireland
| | - Mairead Kiely
- School of Food and Nutritional Sciences, University College Cork, Cork, T12 T656, Ireland
| | - Joseph Eustace
- Department of Renal Medicine, Cork University Hospital, Cork, T12 DC4A, Ireland
- Health Research Board, Clinical Research Facility Cork, University College Cork, Cork, T12 WE28, Ireland
| | - Patricia Kearney
- School of Public Health, University College Cork, Cork, T12 XF62, Ireland
| | - Fred Davidson
- Cork Public Analyst's Laboratory, St. Finbarr's Hospital, Cork, T12 XH60, Ireland
| | - Frances Shiely
- Health Research Board, Clinical Research Facility Cork, University College Cork, Cork, T12 WE28, Ireland
- School of Public Health, University College Cork, Cork, T12 XF62, Ireland
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O'Mahony D, Gudmundsson A, Soiza RL, Petrovic M, Jose Cruz-Jentoft A, Cherubini A, Fordham R, Byrne S, Dahly D, Gallagher P, Lavan A, Curtin D, Dalton K, Cullinan S, Flanagan E, Shiely F, Samuelsson O, Sverrisdottir A, Subbarayan S, Vandaele L, Meireson E, Montero-Errasquin B, Rexach-Cano A, Correa Perez A, Lozano-Montoya I, Vélez-Díaz-Pallarés M, Cerenzia A, Corradi S, Soledad Cotorruelo Ferreiro M, Dimitri F, Marinelli P, Martelli G, Fong Soe Khioe R, Eustace J. Corrigendum to: Prevention of adverse drug reactions in hospitalized older patients with multi-morbidity and polypharmacy: the SENATOR* randomized controlled clinical trial. Age Ageing 2021; 50:e10-e11. [PMID: 34166483 DOI: 10.1093/ageing/afab120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Denis O'Mahony
- University College Cork School of Medicine-Medicine Cork Ireland, Cork University Hospital Group, Cork, Ireland
| | | | - Roy L Soiza
- NHS Grampian, University of Aberdeen Institute of Applied Health Sciences-Ageing Clinical and Experimental Research, Aberdeen, UK
| | - Mirko Petrovic
- University of Ghent-Medicine, University Hospital Ghent, Ghent, Belgium
| | | | - Antonio Cherubini
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | - Richard Fordham
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Stephen Byrne
- School of Pharmacy, University College Cork, Cork, Ireland
| | | | - Paul Gallagher
- Cork University Hospital-Geriatric Medicine, Cork, Ireland
| | - Amanda Lavan
- University College Cork, School of Medicine-Geriatrics, Cork, Ireland
| | - Denis Curtin
- University College Cork, School of Medicine-Geriatrics, Cork, Ireland
| | - Kieran Dalton
- University College Cork, National University of Ireland, Pharmaceutical Care Research Group, School of Pharmacy, Cork Ireland
| | - Shane Cullinan
- Royal College of Surgeons, School of Pharmacy, Dublin, Ireland
| | - Evelyn Flanagan
- University College Cork, Clinical Research Facility, Cork, Ireland
| | - Frances Shiely
- University College Cork, School of Epidemiology and Public Health, Cork, Ireland
| | - Olafur Samuelsson
- Landspitali University Hospital, Geriatric Medicine Reykjavik, Iceland
| | | | | | | | | | | | | | | | | | | | - Annarita Cerenzia
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | - Samanta Corradi
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | | | - Federica Dimitri
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | - Paolo Marinelli
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | - Gaia Martelli
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | | | - Joseph Eustace
- University College Cork, National University of Ireland-Clinical Research Facility, Cork, Ireland
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8
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O'Riordan A, Farrell A, Baqer N, Kant S, Farrelly S, Hunt E, Clarkson M, Henry M, Kennedy M, Plant W, Plant B, Eustace J, Murphy D. Breathlessness and Respiratory Disability After Kidney Transplantation. Transplant Proc 2021; 53:2272-2277. [PMID: 34412915 DOI: 10.1016/j.transproceed.2021.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/22/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dyspnea is a common symptom in patients with end-stage kidney disease being treated with dialysis. This study aimed to ascertain the level of respiratory disability in patients after kidney transplantation through assessing a cohort of kidney allograft recipients for respiratory compromise and thereby identifying a potential target for therapeutic intervention. METHODS Kidney transplant recipients who were under active observation in a single tertiary referral center were invited to take part in this prevalence study at the time of clinic follow-up. All patients agreed to take part in the study, which involved completing a Medical Research Council (MRC) dyspnea scale, completing the St George's Respiratory Questionnaire, and performing basic spirometry. An MRC score of ≥2 and/or a forced expiratory volume in 1 second <90% predicted prompted formal clinical assessment by a respiratory physician. RESULTS This study enrolled 103 patients; 35% of all patients reported breathlessness, and 56% of all patients warranted formal respiratory medicine review. After completion of their investigations, 33 patients were found to have an underlying condition accounting for their symptoms. CONCLUSION Our study highlights the issues of respiratory disability and breathlessness in patients who have undergone kidney transplantation. Although extensive cardiologic evaluation is performed routinely and can rule out many causes of dyspnea, respiratory assessment is not a preoperative prerequisite. This study could suggest that a formal pulmonological evaluation and basic spirometry should be part of the pretransplant evaluation of the kidney transplant recipient.
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Affiliation(s)
- Anthony O'Riordan
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Aisling Farrell
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Nouh Baqer
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Sam Kant
- Department of Renal Medicine, Cork University Hospital and College of Medicine, University College Cork, Cork, Ireland
| | - Sean Farrelly
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Eoin Hunt
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Michael Clarkson
- Department of Renal Medicine, Cork University Hospital and College of Medicine, University College Cork, Cork, Ireland
| | - Michael Henry
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Marcus Kennedy
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - William Plant
- Department of Renal Medicine, Cork University Hospital and College of Medicine, University College Cork, Cork, Ireland
| | - Barry Plant
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland; The HRB-funded Clinical Research Facility, University College Cork, Cork, Ireland
| | - Joseph Eustace
- Department of Renal Medicine, Cork University Hospital and College of Medicine, University College Cork, Cork, Ireland; The HRB-funded Clinical Research Facility, University College Cork, Cork, Ireland
| | - Desmond Murphy
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland; The HRB-funded Clinical Research Facility, University College Cork, Cork, Ireland.
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9
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Fortune DG, Richards HL, Wormald A, O Connor K, McKiernan M, Najt P, O Dwyer A, O Dea E, Burke P, Eustace J. An investigation of psychological responses to COVID-19 in Irish healthcare workers: longitudinal quantitative and nested qualitative study. HRB Open Res 2021; 4:15. [PMID: 34109298 PMCID: PMC8150119 DOI: 10.12688/hrbopenres.13204.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 12/23/2022] Open
Abstract
COVID-19 is an unprecedent occurrence in modern times and individuals who work within healthcare settings, face a broad array of challenges in responding to this worldwide event. Key information on the psychosocial responses of such healthcare workers (HCWs) in the context of COVID-19 is limited and in particular there is a need for studies that utilise longitudinal methods, an overarching theoretical model, and use of a cohort of participants within a defined geographical area across acute and community settings. The work packages making up the current research project use quantitative and qualitative methods to examine the psychological sequelae for HCWs in the context of COVID-19 in geographically adjacent healthcare areas (South and Mid-West of Ireland) across four time points (induction, 3 months, 6 months, and 1 year follow-up). The quantitative arm of the project (WP 1) utilises the Common-Sense Model of Self-Regulation (CSM-SR) and examines a number of key psychological factors pertinent to this model including perceptions about COVID-19 and infection more generally, coping, formal and informal support and a number of impact variables including mood, sleep quality, and perceptions of stigma. The qualitative study (WP 2) will address HCWs experiences of working during the pandemic, ascertain any additional areas of psychological functioning, environmental and workplace factors and resources that may be utilised by HCWs and that are not assessed by the quantitative study protocol, focusing particularly on those staff groups typically underrepresented in previous studies.
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Affiliation(s)
- Donal G Fortune
- Psychology, University of Limerick, Limerick, Ireland.,Clinical Psychology, HSE Mid West Community Healthcare, Limerick, Ireland
| | | | | | | | | | - Pablo Najt
- Psychology, University of Limerick, Limerick, Ireland
| | | | - Edmond O Dea
- Clinical Psychology, HSE Mid West Community Healthcare, Limerick, Ireland
| | - Paul Burke
- Clinical Education and Research Centre, University of Limerick Hospitals Group, Limerick, Ireland
| | - Joseph Eustace
- Medicine and HRB CRF, University College Cork, Cork, Ireland
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10
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Byrne F, Gillman B, O' Reilly E, Smith O, Cronin I, Eustace J. European food safety guidelines on dietary phosphate additives: implications for people with chronic kidney disease. Ir J Med Sci 2021; 190:1655-1657. [PMID: 33492577 DOI: 10.1007/s11845-020-02497-9] [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] [Received: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Fiona Byrne
- Department of Nutrition and Dietetics, Cork University Hospital, Wilton, Cork, Ireland. .,Department of Renal Medicine, Cork University Hospital, Cork, Ireland. .,Health Research Board, Clinical Research Facility, Cork, Ireland.
| | - Barbara Gillman
- Department of Nutrition & Dietetics, Mater Misericordiae University Hospital, Dublin, Ireland.,Department of Renal Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Emer O' Reilly
- Chemical Safety Team, Food Science and Standards Department, Food Safety Authority of Ireland, Dublin, Ireland
| | - Oonagh Smith
- Department of Nutrition and Dietetics, Tallaght University Hospital, Dublin, Ireland.,Department of Nephrology, Tallaght University Hospital, Dublin, Ireland
| | - Irene Cronin
- Department of Nutrition and Dietetics, Cork University Hospital, Wilton, Cork, Ireland.,Department of Renal Medicine, Cork University Hospital, Cork, Ireland
| | - Joseph Eustace
- Department of Renal Medicine, Cork University Hospital, Cork, Ireland.,Health Research Board, Clinical Research Facility, Cork, Ireland
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11
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Fennelly M, O'Connor DJ, Hellebust S, Murphy N, Casey C, Eustace J, Plant BJ, Sodeau JR, Prentice MB. Effectiveness of a plasma treatment device on microbial air quality in a hospital ward, monitored by culture. J Hosp Infect 2020; 108:109-112. [PMID: 33188867 PMCID: PMC7658605 DOI: 10.1016/j.jhin.2020.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/26/2020] [Accepted: 11/06/2020] [Indexed: 11/28/2022]
Abstract
This study analysed the effectiveness of plasma treatment on airborne bacteria and surface counts during a 14-day intervention within a four-bedded bay in an adult respiratory ward at Cork University Hospital, Ireland. One-hundred-litre air samples were collected twice daily every weekday for 4 weeks, with settle plates and surface swabs. The plasma treatment did not have an effect on airborne bacteria and fungi that was detectable by culture. However, the possibility that culture-based sampling may be insufficiently sensitive to detect an effect, or that the duration of the study was insufficient for plasma treatment to affect a complex environment, cannot be excluded.
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Affiliation(s)
- M Fennelly
- Environmental Research Institute, University College Cork, Cork, Ireland; Department of Pathology, University College Cork, Cork, Ireland; School of Chemistry, University College Cork, Cork, Ireland.
| | - D J O'Connor
- School of Chemical and Pharmaceutical Sciences, Technological University Dublin, Dublin, Ireland
| | - S Hellebust
- Environmental Research Institute, University College Cork, Cork, Ireland; School of Chemistry, University College Cork, Cork, Ireland
| | - N Murphy
- Adult Cystic Fibrosis Centre, Cork University Hospital, Cork, Ireland
| | - C Casey
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - J Eustace
- Health Research Board Clinical Research Facility-Cork, Cork, Ireland
| | - B J Plant
- Adult Cystic Fibrosis Centre, Cork University Hospital, Cork, Ireland; College of Medicine and Health, University College Cork, Cork, Ireland; APC Microbiome Institute, University College Cork, Cork, Ireland
| | - J R Sodeau
- Environmental Research Institute, University College Cork, Cork, Ireland; School of Chemistry, University College Cork, Cork, Ireland
| | - M B Prentice
- Department of Pathology, University College Cork, Cork, Ireland; College of Medicine and Health, University College Cork, Cork, Ireland; APC Microbiome Institute, University College Cork, Cork, Ireland
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12
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Byrne FN, Gillman BA, Kiely M, Palmer B, Shiely F, Kearney PM, Earlie J, Bowles MB, Keohane FM, Connolly PP, Wade S, Rennick TA, Moore BL, Smith ON, Sands CM, Slevin O, McCarthy DC, Brennan KM, Mellett H, Dahly D, Bergin E, Casserly LF, Conlon PJ, Hannan K, Holian J, Lappin DW, O'Meara YM, Mellotte GJ, Reddan D, Watson A, Eustace J. Pilot Randomized Controlled Trial of a Standard Versus a Modified Low-Phosphorus Diet in Hemodialysis Patients. Kidney Int Rep 2020; 5:1945-1955. [PMID: 33163715 PMCID: PMC7609990 DOI: 10.1016/j.ekir.2020.08.008] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/09/2020] [Accepted: 08/10/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The standard low-phosphorus diet restricts pulses, nuts, and whole grains and other high phosphorus foods to control hyperphosphatemia. We conducted a randomized controlled trial to evaluate the effectiveness, safety, and tolerability of the modified diet, which introduced some pulses and nuts, increased the use of whole grains, increased focus on the avoidance of phosphate additives, and introduced the prescription of low-biological-value protein such as bread. METHODS We conducted a multicenter, pragmatic, parallel-arm, open-label, randomized controlled trial of modified versus standard diet in 74 adults on hemodialysis with hyperphosphatemia over 1 month. Biochemistry was assessed using monthly laboratory tests. Dietary intake was assessed using a 2-day record of weighed intake of food, and tolerability was assessed using a patient questionnaire. RESULTS There was no significant difference in the change in serum phosphate between the standard and modified diets. Although total dietary phosphorus intake was similar, phytate-bound phosphorus, found in pulses, nuts, and whole grains, was significantly higher in the modified diet (P < 0.001). Dietary fiber intake was also significantly higher (P < 0.003), as was the percentage of patients reporting an increase in bowel movements while following the modified diet (P = 0.008). There was no significant difference in the change in serum potassium or in reported protein intake between the 2 diets. Both diets were similarly well tolerated. CONCLUSION The modified low phosphorus diet was well tolerated and was associated with similar phosphate and potassium control but with a wider food choice and greater fiber intake than the standard diet.
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Affiliation(s)
- Fiona N. Byrne
- Department of Nutrition and Dietetics, Cork University Hospital, Cork, Ireland
- Department of Renal Medicine, Cork University Hospital, Cork, Ireland
- Health Research Board, Clinical Research Facility, Cork, Ireland
| | - Barbara A. Gillman
- Department of Nutrition and Dietetics, Mater Misericordiae University Hospital, Dublin, Ireland
- Department of Renal Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Mairead Kiely
- School of Food and Nutritional Sciences University College Cork, Cork, Ireland
| | - Brendan Palmer
- Health Research Board, Clinical Research Facility, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Frances Shiely
- Health Research Board, Clinical Research Facility, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | | | | | - Maria B. Bowles
- Department of Nutrition and Dietetics, University Hospital Limerick, Limerick, Ireland
- Departments of Nephrology and Internal Medicine, University Hospital Limerick, Limerick, Ireland
| | - Fiona M. Keohane
- Department of Nutrition and Dietetics, Cork University Hospital, Cork, Ireland
- Department of Renal Medicine, Cork University Hospital, Cork, Ireland
| | - Pauline P. Connolly
- Department of Nutrition and Dietetics, Cavan General Hospital, Cavan, Ireland
- Department of Medicine, Cavan General Hospital, Cavan, Ireland
| | - Sarah Wade
- Department of Nutrition and Dietetics, St. Vincent’s University Hospital Dublin, Dublin, Ireland
- Department of Nephrology, St. Vincent’s University Hospital Dublin, Dublin, Ireland
| | - Theresa A. Rennick
- Department of Nutrition and Dietetics, Midland Regional Hospital, Tullamore, Ireland
- Department of Nephrology, Midland Regional Hospital, Tullamore, Ireland
| | - Bernice L. Moore
- Department of Nutrition and Dietetics, Beaumont Hospital, Dublin, Ireland
- Beaumont Hospital Kidney Center, Beaumont Hospital, Dublin, Ireland
| | - Oonagh N. Smith
- Department of Nutrition and Dietetics, Beaumont Hospital, Dublin, Ireland
- Beaumont Hospital Kidney Center, Beaumont Hospital, Dublin, Ireland
| | - Celene M. Sands
- Department of Nutrition and Dietetics, Mayo University Hospital, Mayo, Ireland
| | - Orla Slevin
- Department of Nutrition and Dietetics, Galway University Hospitals, Galway, Ireland
- Department of Nephrology, Galway University Hospitals, Galway, Ireland
| | | | | | - Halóg Mellett
- Department of Nutrition and Dietetics, Tallaght University Hospital, Dublin, Ireland
- Department of Nephrology, Tallaght University Hospital, Dublin, Ireland
| | - Darren Dahly
- Health Research Board, Clinical Research Facility, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Eoin Bergin
- Department of Nephrology, Midland Regional Hospital, Tullamore, Ireland
| | - Liam F. Casserly
- Departments of Nephrology and Internal Medicine, University Hospital Limerick, Limerick, Ireland
| | - Peter J. Conlon
- Beaumont Hospital Kidney Center, Beaumont Hospital, Dublin, Ireland
| | - Kieran Hannan
- Department of Medicine, Cavan General Hospital, Cavan, Ireland
| | - John Holian
- Department of Nephrology, St. Vincent’s University Hospital Dublin, Dublin, Ireland
| | - David W. Lappin
- Department of Nephrology, Galway University Hospitals, Galway, Ireland
| | - Yvonne M. O'Meara
- Department of Renal Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Donal Reddan
- Department of Nephrology, Galway University Hospitals, Galway, Ireland
| | - Alan Watson
- Department of Nephrology, St. Vincent’s University Hospital Dublin, Dublin, Ireland
| | - Joseph Eustace
- Department of Renal Medicine, Cork University Hospital, Cork, Ireland
- Health Research Board, Clinical Research Facility, Cork, Ireland
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13
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Byrne FN, Gillman B, Kiely M, Bowles M, Connolly P, Earlie J, Murphy J, Rennick T, Reilly EO, Shiely F, Kearney P, Eustace J. Translation of Nutrient Level Recommendations to Control Serum Phosphate Into Food-Based Advice. J Ren Nutr 2020; 31:43-48. [PMID: 32631781 DOI: 10.1053/j.jrn.2020.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/08/2020] [Accepted: 04/12/2020] [Indexed: 02/08/2023] Open
Abstract
The control of hyperphosphatemia is key to the management of chronic kidney disease mineral and bone disorder. Dietary restriction of phosphorus is essential to control hyperphosphatemia. Guidelines for chronic kidney disease and end-stage kidney disease generally provide high-level guidance on whether a nutrient should be restricted e.g, restrict dietary phosphorus. Dietitians translate such guidance into nutrient-based strategies and finally into food-based practical dietary advice for patients to follow. The practical aspects of dietary advice are not well described in the literature, neither are the challenges of concurrently altering 1 nutrient e.g., phosphorus while continuing to restrict others e.g., potassium, while maintaining overall nutritional adequacy and quality of life. In this article, we describe how we translated updated nutrient level recommendations into practical dietary advice to be delivered at the bedside.
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Affiliation(s)
- Fiona N Byrne
- Department of Nutrition & Dietetics, Cork University Hospital, Cork, Ireland; Department of Renal Medicine, Cork University Hospital, Cork, Ireland; Health Research Board, Clinical Research Facility, Cork, Ireland.
| | - Barbara Gillman
- Department of Nutrition & Dietetics, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Mairead Kiely
- School of Food and Nutritional Sciences University College Cork, Cork, Ireland
| | - Maria Bowles
- Department of Nutrition & Dietetics, University Hospital Limerick, Limerick Ireland
| | - Pauline Connolly
- Department of Nutrition & Dietetics, Cavan General Hospital, Cavan Ireland
| | - Joyce Earlie
- Beacon Renal, Sandyford & Tallaght, Dublin, Ireland
| | - Jean Murphy
- Department of Nutrition & Dietetics, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Theresa Rennick
- Department of Nutrition & Dietetics, Midland Regional Hospital, Tullamore, Ireland
| | | | - Frances Shiely
- Health Research Board, Clinical Research Facility, Cork, Ireland; School of Public Health, University College Cork, Cork, Ireland
| | | | - Joseph Eustace
- Department of Renal Medicine, Cork University Hospital, Cork, Ireland; Health Research Board, Clinical Research Facility, Cork, Ireland
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14
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O'Mahony D, Gudmundsson A, Soiza RL, Petrovic M, Cruz-Jentoft AJ, Cherubini A, Fordham R, Byrne S, Dahly D, Gallagher P, Lavan A, Curtin D, Dalton K, Cullinan S, Flanagan E, Shiely F, Samuelsson O, Sverrisdottir A, Subbarayan S, Vandaele L, Meireson E, Montero-Errasquin B, Rexach-Cano A, Correa Perez A, Lozano-Montoya I, Vélez-Díaz-Pallarés M, Cerenzia A, Corradi S, Soledad Cotorruelo Ferreiro M, Dimitri F, Marinelli P, Martelli G, Fong Soe Khioe R, Eustace J. Prevention of adverse drug reactions in hospitalized older patients with multi-morbidity and polypharmacy: the SENATOR* randomized controlled clinical trial. Age Ageing 2020; 49:605-614. [PMID: 32484850 DOI: 10.1093/ageing/afaa072] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [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: 01/17/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Multi-morbidity and polypharmacy increase the risk of non-trivial adverse drug reactions (ADRs) in older people during hospitalization. Despite this, there are no established interventions for hospital-acquired ADR prevention. METHODS We undertook a pragmatic, multi-national, parallel arm prospective randomized open-label, blinded endpoint (PROBE) controlled trial enrolling patients at six European medical centres. We randomized 1,537 older medical and surgical patients with multi-morbidity and polypharmacy on admission in a 1:1 ratio to SENATOR software-guided medication optimization plus standard care (intervention, n = 772, mean number of daily medications = 9.34) or standard care alone (control, n = 765, mean number of daily medications = 9.23) using block randomization stratified by site and admission type. Attending clinicians in the intervention arm received SENATOR-generated advice at a single time point with recommendations they could choose to adopt or not. The primary endpoint was occurrence of probable or certain ADRs within 14 days of randomization. Secondary endpoints were primary endpoint derivatives; tertiary endpoints included all-cause mortality, re-hospitalization, composite healthcare utilization and health-related quality of life. RESULTS For the primary endpoint, there was no difference between the intervention and control groups (24.5 vs. 24.8%; OR 0.98; 95% CI 0.77-1.24; P = 0.88). Similarly, with secondary and tertiary endpoints, there were no significant differences. Among attending clinicians in the intervention group, implementation of SENATOR software-generated medication advice points was poor (~15%). CONCLUSIONS In this trial, uptake of software-generated medication advice to minimize ADRs was poor and did not reduce ADR incidence during index hospitalization.
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Affiliation(s)
- Denis O'Mahony
- University College Cork School of Medicine-Medicine Cork Ireland, Cork University Hospital Group, Cork, Ireland
| | | | - Roy L Soiza
- NHS Grampian, University of Aberdeen Institute of Applied Health Sciences-Ageing Clinical and Experimental Research, Aberdeen, UK
| | - Mirko Petrovic
- University of Ghent-Medicine, University Hospital Ghent, Ghent, Belgium
| | | | - Antonio Cherubini
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | - Richard Fordham
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Stephen Byrne
- School of Pharmacy, University College Cork, Cork, Ireland
| | | | - Paul Gallagher
- Cork University Hospital-Geriatric Medicine, Cork, Ireland
| | - Amanda Lavan
- University College Cork, School of Medicine-Geriatrics, Cork, Ireland
| | - Denis Curtin
- University College Cork, School of Medicine-Geriatrics, Cork, Ireland
| | - Kieran Dalton
- University College Cork, National University of Ireland, Pharmaceutical Care Research Group, School of Pharmacy, Cork Ireland
| | - Shane Cullinan
- Royal College of Surgeons, School of Pharmacy, Dublin, Ireland
| | - Evelyn Flanagan
- University College Cork, Clinical Research Facility, Cork, Ireland
| | - Frances Shiely
- University College Cork, School of Epidemiology and Public Health, Cork, Ireland
| | - Olafur Samuelsson
- Landspitali University Hospital, Geriatric Medicine Reykjavik, Iceland
| | | | | | | | | | | | | | | | | | | | - Annarita Cerenzia
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | - Samanta Corradi
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | | | - Federica Dimitri
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | - Paolo Marinelli
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | - Gaia Martelli
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | | | - Joseph Eustace
- University College Cork, National University of Ireland-Clinical Research Facility, Cork, Ireland
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15
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Byrne FN, Gillman B, Kiely M, Bowles M, Connolly P, Earlie J, Murphy J, Rennick T, Reilly EO, Shiely F, Kearney P, Eustace J. Revising Dietary Phosphorus Advice in Chronic Kidney Disease G3-5D. J Ren Nutr 2020; 31:132-143. [PMID: 32586712 DOI: 10.1053/j.jrn.2020.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/15/2020] [Accepted: 04/12/2020] [Indexed: 12/20/2022] Open
Abstract
We summarize how practicing dietitians combined available evidence with clinical experience, to define revised dietary recommendations for phosphorus in chronic kidney disease G3-5D. As well as a review of the evidence base, 4 priority topics were reviewed. These were translated into 3 nutrient level recommendations: the introduction of some plant protein where phosphorus is largely bound by phytate; consideration of protein intake in terms of phosphorus load and the phosphorus to protein ratio; and an increased focus on avoiding phosphate additives. This review summarizes and interprets the available evidence in order to support the development of practical food-based advice for patients with chronic kidney disease.
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Affiliation(s)
- Fiona N Byrne
- Department of Nutrition & Dietetics, Cork University Hospital, Cork, Ireland; Department of Renal Medicine, Cork University Hospital, Cork, Ireland; Health Research Board, Clinical Research Facility, Cork, Ireland.
| | - Barbara Gillman
- Department of Nutrition & Dietetics, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Mairead Kiely
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Maria Bowles
- Department of Nutrition & Dietetics, University Hospital Limerick, Limerick, Ireland
| | - Pauline Connolly
- Department of Nutrition & Dietetics, Cavan General Hospital, Cavan, Ireland
| | - Joyce Earlie
- Beacon Renal, Sandyford & Tallaght, Dublin, Ireland
| | - Jean Murphy
- Department of Nutrition & Dietetics, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Theresa Rennick
- Department of Nutrition & Dietetics, Midland Regional Hospital, Tullamore, Ireland
| | | | - Frances Shiely
- Health Research Board, Clinical Research Facility, Cork, Ireland; School of Public Health, University College Cork, Cork, Ireland
| | | | - Joseph Eustace
- Department of Renal Medicine, Cork University Hospital, Cork, Ireland; Health Research Board, Clinical Research Facility, Cork, Ireland
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16
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Jennings E, Lavan A, Dahly D, Eustace J, Flanagan E, Gallagher P, Cullinane S, Petrovic M, Perehudoff K, Gudmondsson A, Samuelsson Ó, Sverrisdóttir Á, Cherubin A, Dimitri F, Rimland J, Cruz-Jentoft A, Vélez-Díaz-Pallarés M, Lozano Montoya I, L Soiza R, Subbarayan S, O’Mahony D. 91 A Descriptive Analysis of Causative Drgs/Drg Classes of Incident Adverse Drg Reactions in Acutely Hospitalized Older-Adults: SENATOR (Phase I). Age Ageing 2019. [DOI: 10.1093/ageing/afz103.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Adverse drug reactions (ADRs) are common and have serious repercussions for older-adults. This descriptive-analysis elucidates clinical presentations, severity and responsible drugs of incident ADRs in the SENATOR (Software ENgine for the Assessment & optimization of drug and non-drug Therapy in Older peRsons) phase I feasibility study.
Methods
SENATOR-phase-I was a European multicentre-prospective-observational study. Participants were ≥ 65 years, experiencing acute-hospitalisation and on pharmacological treatment for ≥ 3 conditions.
Adverse events (AEs) were identified by trigger list at recruitment, day-14/discharge and classified as ADRs when association with an administered drug was adjudicated as being probable/certain, according to the World Health Organization Uppsala Monitoring Centre ADR causality criteria.
Results
Of 644 participants recruited, 382 (59.1%) experienced 732 AEs, 363 AEs (49.6%) being incident. 139 participants (21.6%) experienced 177 (48.8%) ADRs. Full drug details were recorded in 156 patients (88%). Cardiovascular-system drugs accounted for one-third of ADRs (55, 35.3%).
Five drug classes caused three-quarters of ADRs (135, 76.3%); diuretics 28.2% (furosemide 24.4%), opioid analgesics 16.7%, anti-bacterials for systemic use 14.1%, anti-thrombotic agents 10.3%, and drugs used in diabetes 7%.
68 patients (10.6%) experienced 81 (45.8%) clinically significant moderate-severe ADRs. Significant serum electrolyte disturbance (32, 18.1%), acute kidney injury [AKI] (22, 12.4%), unspecified adverse event (UAE; 21, 11.9%), dyspepsia/nausea/vomiting (20, 11.3%), new-onset major constipation (19, 10.7%) were the most common presentations of ADRs, accounting for 114, (64.4%) of all ADRs. In moderate-severe ADRs; AKI (12, 14.8%), acute bleeding (11, 13.6%), new-onset major constipation (11, 13.6%), UAE (11, 13.6%), significant serum electrolyte disturbance (10, 12.4%) were the most common presentations.
Conclusion
This analysis highlights that;
1-in-5 older adults will experience an incident ADR during acute hospitalisation.
1-in-10 patients experience moderate-severe incident ADRs.
3-of-4 ADRs were caused by 5 drug classes (diuretics, opioids, anti-bacterials, anti-thrombotics and anti-diabetic agents).
This study allows for identification of potentially high risk medications which could be targeted for future ADR prevention.
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Affiliation(s)
- Emma Jennings
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
- Department of Medicine, University College Cork National University of Ireland, Cork, Ireland
| | - Amanda Lavan
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
- Department of Medicine, University College Cork National University of Ireland, Cork, Ireland
| | - Darren Dahly
- Department of Epidemiology, University College Cork National University of Ireland, Cork, Ireland
| | - Joseph Eustace
- Department of Medicine, University College Cork National University of Ireland, Cork, Ireland
| | - Evelyn Flanagan
- Health Research Board Clinical Research Facility, Cork, Ireland
| | - Paul Gallagher
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
- Department of Medicine, University College Cork National University of Ireland, Cork, Ireland
| | - Shane Cullinane
- School of Pharmacy, University College Cork National University of Ireland, Cork, Ireland
| | - Mirko Petrovic
- Department of Internal Medicine, Section of Geriatrics, Universiteit Gent, Gent, Belgium
| | | | | | - Ólafur Samuelsson
- Department of Geriatric Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Ástrós Sverrisdóttir
- Department of Geriatric Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Antonio Cherubin
- Geriatria ed Accettazione Geriatrica d’urgenza, IRCCS-INRCA, Ancona, Italy
| | - Frederica Dimitri
- Geriatria ed Accettazione Geriatrica d’urgenza, IRCCS-INRCA, Ancona, Italy
| | - Joe Rimland
- Geriatria ed Accettazione Geriatrica d’urgenza, IRCCS-INRCA, Ancona, Italy
| | | | | | | | | | - Selvarani Subbarayan
- University of Aberdeen School of Medicine and Dentistry, Aberdeen, United Kingdom
| | - Denis O’Mahony
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
- Department of Medicine, University College Cork National University of Ireland, Cork, Ireland
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17
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Arooj P, Morrissy D, Ronan N, McCarthy Y, Daly M, Flanagan E, Shortt C, McCarthy M, Flemming C, Eustace J, Murphy D, Plant B. P264 Real-world Orkambi cohort CorK study (ROCK) - a prospective twelve months' analysis addressing the effectiveness of CFTR modulation in patients with cystic fibrosis homozygous for F508del CFTR. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30557-0] [Citation(s) in RCA: 1] [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: 11/17/2022]
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18
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Byrne F, Gillman B, Eustace J. FO046MULTICENTRE RANDOMIZED CONTROL Trial OF PHOSPHATE CONTROL WITH A MODIFIED AS COMPARED TO STANDARD RENAL DIET. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fo046] [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)
- Fiona Byrne
- Renal Dietetics, Cork University Hospital, Cork, Ireland
- HRB Clinical Research Facility - Cork, UCC, Cork, Ireland
| | - Barbara Gillman
- Nephrology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Joseph Eustace
- HRB Clinical Research Facility- Cork, UCC, Cork, Ireland
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19
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Murray S, Plant W, Eustace J, Dahly D. SP308SURVIVAL WITH ESKD IN AN IRISH POPULATION 2002-2015. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp308] [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: 11/15/2022] Open
Affiliation(s)
| | - William Plant
- Renal Medicine, Cork University Hospital, Cork, Ireland
| | - Joseph Eustace
- Clinicl Research Facility, University College Cork, Cork, Ireland
| | - Darren Dahly
- Clinicl Research Facility, University College Cork, Cork, Ireland
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20
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O'Caoimh R, Gao Y, Svendovski A, Gallagher P, Eustace J, Molloy DW. Comparing Approaches to Optimize Cut-off Scores for Short Cognitive Screening Instruments in Mild Cognitive Impairment and Dementia. J Alzheimers Dis 2018; 57:123-133. [PMID: 28222528 PMCID: PMC5345649 DOI: 10.3233/jad-161204] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although required to improve the usability of cognitive screening instruments (CSIs), the use of cut-off scores is controversial yet poorly researched. OBJECTIVE To explore cut-off scores for two short CSIs: the Standardized Mini-Mental State Examination (SMMSE) and Quick Mild Cognitive Impairment (Qmci) screen, describing adjustments in scores for diagnosis (MCI or dementia), age (≤, >75 years), and education (<, ≥12 years), comparing two methods: the maximal accuracy approach, derived from receiver operating characteristic curves, and Youden's Index. METHODS Pooled analysis of assessments from patients attending memory clinics in Canada between 1999-2010 : 766 with mild cognitive impairment (MCI) and 1,746 with dementia, and 875 normal controls. RESULTS The Qmci was more accurate than the SMMSE in differentiating controls from MCI or cognitive impairment (MCI and dementia). Employing the maximal accuracy approach, the optimal SMMSE cut-off for cognitive impairment was <28/30 (AUC 0.86, sensitivity 74%, specificity 88%) versus <63/100 for the Qmci (AUC 0.93, sensitivity 85%, specificity 85%). Using Youden's Index, the optimal SMMSE cut-off remained <28/30 but fell slightly to <62/100 for the Qmci (sensitivity 83%, specificity 87%). The optimal cut-off for MCI was <29/30 for the SMMSE and <67/100 for the Qmci, irrespective of technique. The maximal accuracy approach generally produced higher Qmci cut-offs than Youden's Index, both requiring adjustment for age and education. There were no clinically meaningful differences in SMMSE cut-off scores by age and education or method employed. CONCLUSION Caution should be exercised selecting cut-offs as these differ by age, education, and method of derivation, with the extent of adjustment varying between CSIs.
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Affiliation(s)
- Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork City, Ireland.,Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - Yang Gao
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork City, Ireland
| | | | - Paul Gallagher
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork City, Ireland
| | - Joseph Eustace
- Health Research Board, Clinical Research Facility Cork, Mercy Univeristy Hospital, Cork City, Ireland
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork City, Ireland
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21
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O’Mahony D, O’Connor MN, Eustace J, Byrne S, Petrovic M, Gallagher P. The adverse drug reaction risk in older persons (ADRROP) prediction scale: derivation and prospective validation of an ADR risk assessment tool in older multi-morbid patients. Eur Geriatr Med 2018; 9:191-199. [DOI: 10.1007/s41999-018-0030-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/15/2018] [Indexed: 01/02/2023]
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Lavan A, Eustace J, Dahly D, Flanagan E, Gallagher P, Cullinane S, Petrovic M, Perehudoff K, Gudmondsson A, Samuelsson Ó, Sverrisdóttir Á, Cherubin A, Dimitri F, Rimland J, Cruz-Jentoft A, Vélez-Díaz-Pallarés M, Lozano Montoya I, Soiza RL, Subbarayan S, O'Mahony D. Incident adverse drug reactions in geriatric inpatients: a multicentred observational study. Ther Adv Drug Saf 2017; 9:13-23. [PMID: 29318003 DOI: 10.1177/2042098617736191] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 08/27/2017] [Indexed: 11/16/2022] Open
Abstract
Background Adverse drug reactions (ADRs) are common in older adults and frequently have serious clinical and economic consequences. This study was conducted as a feasibility study for a randomized control trial (RCT) that will investigate the efficacy of a software engine to optimize medications and reduce incident (in-hospital) ADRs. This study's objectives were to (i) establish current incident ADR rates across the six sites participating in the forthcoming RCT and (ii) assess whether incident ADRs are predictable. Methods This was a multicentre, prospective observational study involving six European hospitals. Adults aged ⩾ 65 years, hospitalized with an acute illness and on pharmacological treatment for three or more conditions were eligible for inclusion. Adverse events (AEs) were captured using a trigger list of 12 common ADRs. An AE was deemed an ADR when its association with an administered drug was adjudicated as being probable/certain, according to the World Health Organization Uppsala Monitoring Centre causality assessment. The proportion of patients experiencing at least one, probable/certain, incident ADR within 14 days of enrolment/discharge was recorded. Results A total of 644 patients were recruited, evenly split by sex and overwhelmingly of White ethnicity. Over 80% of admissions were medical. The median number of chronic conditions was five (interquartile range 4-6), with eight or more conditions present in approximately 10%. The mean number of prescribed medications was 9.9 (standard deviation 3.8), which correlated strongly with the number of conditions (r = 0.54, p < 0.0001). A total of 732 AEs were recorded in 382 patients, of which 363 were incident. The majority of events were classified as probably or possibly drug related, with heterogeneity across sites (χ2 = 88.567, df = 20, p value < 0.001). Out of 644 patients, 139 (21.6%; 95% confidence interval 18.5-25.0%) experienced an ADR. Serum electrolyte abnormalities were the most common ADR. The ADRROP (ADR Risk in Older People) and GerontoNet ADR risk scales correctly predicted ADR occurrence in 61% and 60% of patients, respectively. Conclusion This feasibility study established the rates of incident ADRs across the six study sites. The ADR predictive power of ADRROP and GerontoNet ADR risk scales were limited in this population.
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Affiliation(s)
- Amanda Lavan
- Department of Medicine, University College Cork National University of Ireland, Cork, Ireland
| | - Joseph Eustace
- Department of Medicine, University College Cork National University of Ireland, Cork, Ireland
| | - Darren Dahly
- Department of Epidemiology, University College Cork National University of Ireland, Cork, Ireland
| | | | - Paul Gallagher
- Department of Medicine, University College Cork National University of Ireland, Cork, Ireland
| | - Shane Cullinane
- Department of Pharmacy, University College Cork National University of Ireland, Cork, Ireland
| | - Mirko Petrovic
- Department of Internal Medicine, Section of Geriatrics, Universiteit Gent, Gent, Belgium
| | | | | | - Ólafur Samuelsson
- Department of Geriatric Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Ástrós Sverrisdóttir
- Department of Geriatric Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Antonio Cherubin
- Geriatria ed Accettazione Geriatrica d'urgenza, IRCCS-INRCA, Ancona, Italy
| | - Frederica Dimitri
- Geriatria ed Accettazione Geriatrica d'urgenza, IRCCS-INRCA, Ancona, Italy
| | - Joe Rimland
- Geriatria ed Accettazione Geriatrica d'urgenza, IRCCS-INRCA, Ancona, Italy
| | | | | | | | | | | | - Denis O'Mahony
- Department of Medicine, University College Cork & Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
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Hurley C, Sinnott C, Clarke M, Kearney P, Racine E, Eustace J, Shiely F. Perceived barriers and facilitators to Risk Based Monitoring in academic-led clinical trials: a mixed methods study. Trials 2017; 18:423. [PMID: 28893317 PMCID: PMC5594426 DOI: 10.1186/s13063-017-2148-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 05/29/2017] [Accepted: 08/14/2017] [Indexed: 11/25/2022] Open
Abstract
Background In November 2016, the ICH published a requirement for sponsors to develop a systematic, prioritised, risk-based approach to monitoring clinical trials. This approach is more commonly known as risk-based monitoring (RBM). However, recent evidence suggests that a ‘gold standard’, validated approach to RBM does not exist and it is unclear how sponsors will introduce RBM into their organisations. A first step needed to inform the implementation of RBM is to explore academic trialists’ readiness and ability to perform RBM. The aim of this paper is to identify the attitudes and perceived barriers and facilitators to the implementation of RBM in academic-led clinical trials in Ireland. Methods This is a mixed-methods, explanatory sequential design, with quantitative survey followed by semistructured interviews. Academic clinical researchers (N = 132) working in Ireland were surveyed to examine their use and perceptions of RBM. A purposive sample of survey participants (n = 22) were then interviewed to gain greater insight into the quantitative findings. The survey and interview data were merged to generate a list of perceived barriers and facilitators to RBM implementation, with suggestions for, and solutions to, these issues. Results Survey response rate was 49% (132/273). Thirteen percent (n = 18) of responders were not familiar with the term risk-based monitoring and less than a quarter of respondents (21%, n = 28) had performed RBM in a clinical trial. Barriers to RBM implementation included lack of RBM knowledge/training, increased costs caused by greater IT demands, increased workload for trial staff and lack of evidence to support RBM as an effective monitoring approach. Facilitators included participants’ legal obligation to perform RBM under the new ICH-GCP guidelines, availability of RBM guidance and perception of cost savings by performing RBM in future trials. Conclusion The results of this study demonstrate a need for training and regulatory-endorsed guidelines to support the implementation of RBM in academic-led clinical trials. The study provides valuable insights to inform interventions and strategies by policy-makers and clinical trial regulators to improve RBM uptake. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2148-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caroline Hurley
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), National University of Ireland, Galway, Ireland.
| | - Carol Sinnott
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Belfast, Ireland
| | - Patricia Kearney
- Department Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Emmy Racine
- Department Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Joseph Eustace
- Health Research Board - Clinical Research Facility, University College Cork, Cork, Ireland
| | - Frances Shiely
- Department Epidemiology and Public Health, University College Cork, Cork, Ireland.,Health Research Board - Clinical Research Facility, University College Cork, Cork, Ireland
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Boland F, Quirke M, Gannon B, Plunkett S, Hayden J, McCourt J, O'Sullivan R, Eustace J, Deasy C, Wakai A. The Penicillin for the Emergency Department Outpatient treatment of CELLulitis (PEDOCELL) trial: update to the study protocol and detailed statistical analysis plan (SAP). Trials 2017; 18:391. [PMID: 28836993 PMCID: PMC5571617 DOI: 10.1186/s13063-017-2121-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/06/2017] [Accepted: 07/26/2017] [Indexed: 11/23/2022] Open
Abstract
Background Cellulitis is a painful, potentially serious, infectious process of the dermal and subdermal tissues and represents a significant disease burden. The statistical analysis plan (SAP) for the Penicillin for the Emergency Department Outpatient treatment of CELLulitis (PEDOCELL) trial is described here. The PEDOCELL trial is a multicentre, randomised, parallel-arm, double-blinded, non-inferiority clinical trial comparing the efficacy of flucloxacillin (monotherapy) with combination flucloxacillin/phenoxymethylpenicillin (dual therapy) for the outpatient treatment of cellulitis in the emergency department (ED) setting. To prevent outcome reporting bias, selective reporting and data-driven results, the a priori-defined, detailed SAP is presented here. Methods/design Patients will be randomised to either orally administered flucloxacillin 500 mg four times daily and placebo or orally administered 500 mg of flucloxacillin four times daily and phenoxymethylpenicillin 500 mg four times daily. The trial consists of a 7-day intervention period and a 2-week follow-up period. Study measurements will be taken at four specific time points: at patient enrolment, day 2–3 after enrolment and commencing treatment (early clinical response (ECR) visit), day 8–10 after enrolment (end-of-treatment (EOT) visit) and day 14–21 after enrolment (test-of-cure (TOC) visit). The primary outcome measure is investigator-determined clinical response measured at the TOC visit. The secondary outcomes are as follows: lesion size at ECR, clinical treatment failure at each follow-up visit, adherence and persistence of trial patients with orally administered antibiotic therapy at EOT, health-related quality of life (HRQoL) and pharmacoeconomic assessments. The plan for the presentation and comparison of baseline characteristics and outcomes is described in this paper. Discussion This trial aims to establish the non-inferiority of orally administered flucloxacillin monotherapy with orally administered flucloxacillin/phenoxymethylpenicillin dual therapy for the ED-directed outpatient treatment of cellulitis. In doing so, this trial will bridge a knowledge gap in this understudied and common condition and will be relevant to clinicians across several different disciplines. The SAP for the PEDOCELL trial was developed a priori in order to minimise analysis bias. Trial registration EU Clinical Trials Register (EudraCT number: 2016-001528-69). Registered on 5 April 2016. ClinicalTrials.gov, ID: NCT02922686. Registered on 9 August 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2121-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fiona Boland
- Division of Population Health Sciences, Royal College of Surgeons in Ireland (RCSI), 123 St Stephen's Green, Dublin 2, Ireland
| | - Michael Quirke
- Emergency Care Research Unit (ECRU), Division of Population Health Sciences, RCSI, 123 St Stephen's Green, Dublin 2, Ireland
| | - Brenda Gannon
- Centre for Business and Economics of Health, The University of Queensland, Brisbane, QLD, Australia
| | - Sinead Plunkett
- Emergency Care Research Unit (ECRU), Division of Population Health Sciences, RCSI, 123 St Stephen's Green, Dublin 2, Ireland
| | - John Hayden
- School of Pharmacy, RCSI, 123 St Stephen's Green, Dublin 2, Ireland
| | - John McCourt
- Clinical Research Centre, RCSI Education and Research Centre, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - Ronan O'Sullivan
- National Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Ireland
| | - Joseph Eustace
- Department of Nephrology, Cardiac-Renal Centre, Cork University Hospital, Cork, Ireland
| | - Conor Deasy
- Department of Emergency Medicine, Cork University Hospital, Wilton, Cork, Ireland
| | - Abel Wakai
- Emergency Care Research Unit (ECRU), Division of Population Health Sciences, RCSI, 123 St Stephen's Green, Dublin 2, Ireland. .,Department of Emergency Medicine, Beaumont Hospital, Dublin 9, Ireland.
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Caplice N, Devoe M, Choi J, Dahly D, Spitzer E, Van Guens R, Maher M, Tuite D, Kerins D, Kelly P, Kearney P, Curtin R, Vaughan C, Eustace J, McFadden E. P2125Randomised placebo controlled trial evaluating the safety and efficacy of intracoronary insulin like growth factor 1 post percutaneous intervention for acute myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2125] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Lynch Cronin I, Byrne F, Doyle R, Chipchase A, Fraser W, Eustace J. SP377THE EFFECT OF SHORT-TERM VITAMIN D SUPPLEMENTATION ON HYPERCALCAEMIC VITAMIN D INSUFFICIENT RENAL TRANSPLANT RECIPIENTS. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx147.sp377] [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: 11/14/2022] Open
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Byrne F, Gillman B, Gleeson B, Scannell G, Long E, Eustace J. MP688COMPARISON OF TWO DIETS WITH DIFFERENT PHOSPHORUS CONTENTS AND BIOAVAILABILITY ON SERUM PHOSPHATE LEVELS IN HAEMODIALYSIS PATIENTS. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx179.mp688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hunt EB, Ward C, Power S, Sullivan A, Pearson JP, Lapthorne S, O'Byrne PM, Eustace J, Plant BJ, Maher MM, MacSharry J, Murphy DM. The Potential Role of Aspiration in the Asthmatic Airway. Chest 2017; 151:1272-1278. [PMID: 28300572 DOI: 10.1016/j.chest.2017.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/10/2017] [Accepted: 03/01/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Many people with asthma remain suboptimally controlled despite current treatments. Reasons include comorbidities that could aggravate asthma, including gastroesophageal reflux. We aimed to investigate whether aspiration occurs in patients with asthma and, if so, does it correlate with asthma control? METHODS Patients had Asthma Control Questionnaire 7 (ACQ-7), fractional exhaled nitric oxide, and spirometry performed to characterize their level of asthma control. Barium swallow with provocation was performed to assess for predisposition to aspiration. Patients underwent bronchoscopic investigation, with BAL pepsin measured as a marker of aspiration. RESULTS Seventy-eight patients stratified by disease severity (Global Initiative for Asthma) into mild (35.8%), moderate (21.7%) and severe (42.3%) were studied. Pepsin was detectable in BAL in 46/78 (58.9%). There were no differences between pepsin levels in patients with different disease severity. Furthermore, no significant associations were seen between pepsin level and measures of asthma control, FEV1, ACQ-7 or exacerbation frequency. Similarly no associations were found with adjustments for smoking history, BMI, proton pump inhibitor use, eosinophil count or IgE. When stratified into eosinophilic or neutrophilic asthmatic populations on the basis of BAL, there was no relationship to detected pepsin concentrations. A positive barium swallow (seen in 33/60 patients) did not correlate with BAL pepsin level and we found no significant association between barium swallow result and ACQ-7, Global Initiative for Asthma, exacerbation frequency or FEV1 using either univariate or multivariate analyses. CONCLUSIONS This study suggests that the importance of aspiration on current asthma symptom control and exacerbation rate may be overstated. However, this study did not address the role of aspiration and future risk of exacerbation.
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Affiliation(s)
- Eoin B Hunt
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland; The HRB Clinical Research Facility, University College Cork, Cork, Ireland
| | - Chris Ward
- The Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, England
| | - Stephen Power
- The Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Ashley Sullivan
- The APC Microbiome Institute, Schools of Medicine and Microbiology, University College Cork, Ireland
| | - Jeffrey P Pearson
- The Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, England
| | - Susan Lapthorne
- The APC Microbiome Institute, Schools of Medicine and Microbiology, University College Cork, Ireland
| | - Paul M O'Byrne
- The Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Joseph Eustace
- The HRB Clinical Research Facility, University College Cork, Cork, Ireland
| | - Barry J Plant
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland; The HRB Clinical Research Facility, University College Cork, Cork, Ireland
| | - Michael M Maher
- The Department of Radiology, Cork University Hospital, Cork, Ireland; The HRB Clinical Research Facility, University College Cork, Cork, Ireland
| | - John MacSharry
- The APC Microbiome Institute, Schools of Medicine and Microbiology, University College Cork, Ireland
| | - Desmond M Murphy
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland; The HRB Clinical Research Facility, University College Cork, Cork, Ireland.
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O'Connor MN, O'Sullivan D, Gallagher PF, Eustace J, Byrne S, O'Mahony D. Prevention of Hospital-Acquired Adverse Drug Reactions in Older People Using Screening Tool of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment Criteria: A Cluster Randomized Controlled Trial. J Am Geriatr Soc 2016; 64:1558-66. [PMID: 27365262 DOI: 10.1111/jgs.14312] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To determine whether use of the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) criteria reduces incident hospital-acquired adverse drug reactions (ADRs), 28-day medication costs, and median length of hospital stay in older adults admitted with acute illness. DESIGN Single-blind cluster randomized controlled trial (RCT) of unselected older adults hospitalized over a 13-month period. SETTING Tertiary referral hospital in southern Ireland. PARTICIPANTS Consecutively admitted individuals aged 65 and older (N = 732). INTERVENTION Single time point presentation to attending physicians of potentially inappropriate medications according to the STOPP/START criteria. MEASUREMENTS The primary outcome was the proportion of participants experiencing one or more ADRs during the index hospitalization. Secondary outcomes were median length of stay (LOS) and 28-day total medication cost. RESULTS One or more ADRs occurred in 78 of the 372 control participants (21.0%; median age 78, interquartile range (IQR) 72-84) and in 42 of the 360 intervention participants (11.7%; median age 80, IQR 73-85) (absolute risk reduction = 9.3%, number needed to treat = 11). The median LOS in the hospital was 8 days (IQR 4-14 days) in both groups. At discharge, median medication cost was significantly lower in the intervention group (€73.16, IQR €38.68-121.72) than in the control group (€90.62, IQR €49.38-162.53) (Wilcoxon rank test Z statistic = -3.274, P < .001). CONCLUSION Application of STOPP/START criteria resulted in significant reductions in ADR incidence and medication costs in acutely ill older adults but did not affect median LOS.
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Affiliation(s)
- Marie N O'Connor
- Division of Geriatrics, Department of Medicine, University College Cork, Cork, Ireland
| | | | - Paul F Gallagher
- Division of Geriatrics, Department of Medicine, University College Cork, Cork, Ireland.,Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
| | - Joseph Eustace
- Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
| | - Stephen Byrne
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Denis O'Mahony
- Division of Geriatrics, Department of Medicine, University College Cork, Cork, Ireland.,Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
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Kant S, Flynn D, Clarkson M, Plant W, Plant B, Murphy D, Eustace J. SP843RESPIRATORY IMPAIRMENT IN RENAL TRANSPLANT RECIPIENTS: AN UNDER-RECOGNISED PHENOMENON. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv202.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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O'Caoimh R, Healy L, Gao Y, Svendrovski A, Kerins DM, Eustace J, Kehoe PG, Guyatt G, Molloy DW. Effects of centrally acting angiotensin converting enzyme inhibitors on functional decline in patients with Alzheimer's disease. J Alzheimers Dis 2014; 40:595-603. [PMID: 24496072 DOI: 10.3233/jad-131694] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Centrally acting angiotensin converting enzyme inhibitors (CACE-Is) are associated with reduced rates of cognitive decline in patients with dementia. CACE-Is may also improve exercise tolerance in functionally impaired older adults with normal cognition, suggesting that CACE-Is may positively influence activities of daily living (ADL) in dementia. OBJECTIVE To compare rates of decline in patients with mild to moderate Alzheimer's disease (AD) receiving CACE-Is to those not currently treated with CACE-Is (NoCACE-I), included in the Doxycycline and Rifampicin for Alzheimer's Disease study (n = 406). METHODS Patients were included if baseline and end-point (twelve months apart) scores were available for measures including the Standardized Alzheimer's Disease Assessment Scale - Cognitive Subscale; Quick Mild Cognitive Impairment screen; Clinical Dementia Rating Scale (CDR-SB), and Lawton-Brody ADL Scale. RESULTS There was a significant, 25% difference (median one-point) in the 12-month rate of decline in ADL scores in patients taking CACE-Is (n = 91), compared to the NoCACE-I group (n = 274), p = 0.024. This remained significant after adjusting for age, gender, education, and blood pressure, p = 0.034. When individual CACE-Is were compared to the NoCACE-I group, a significant reduction in the rate of decline in ADLs (median one versus four points), were only observed for perindopril, p = 0.01. The CDR-SB was also reduced (median one-point) for the perindopril compared to the NoCACE-I group, p = 0.04. CONCLUSION This observational study suggests that CACE-Is, and potentially perindopril in particular, are associated with a reduced rate of functional decline in patients with AD, without an association with mood or behavior. This suggests that CACE-Is may slow disease progression in AD.
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Affiliation(s)
- Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork, Ireland
| | - Liam Healy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork, Ireland
| | - Yang Gao
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork, Ireland
| | - Anton Svendrovski
- Department of Clinical Epidemiology & Biostatistics, McMaster University, ON, Canada
| | - David M Kerins
- Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland Mercy University Hospital, Cork, Ireland
| | - Joseph Eustace
- Clinical Research Facility, Mercy University Hospital, Cork, Ireland
| | - Patrick Gavin Kehoe
- Dementia Research Group, School of Clinical Sciences, University of Bristol, Frenchay Hospital, Bristol, UK
| | - Gordon Guyatt
- Department of Clinical Epidemiology & Biostatistics, McMaster University, ON, Canada
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork, Ireland
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O'Caoimh R, Svendrovski A, Johnston BC, Gao Y, McGlade C, Eustace J, Timmons S, Guyatt G, Molloy DW. The Quick Mild Cognitive Impairment screen correlated with the Standardized Alzheimer's Disease Assessment Scale–cognitive section in clinical trials. J Clin Epidemiol 2014; 67:87-92. [DOI: 10.1016/j.jclinepi.2013.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 07/06/2013] [Accepted: 07/09/2013] [Indexed: 11/15/2022]
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Abstract
OBJECTIVES There is growing evidence that antihypertensive agents, particularly centrally acting ACE inhibitors (CACE-Is), which cross the blood-brain barrier, are associated with a reduced rate of cognitive decline. Given this, we compared the rates of cognitive decline in clinic patients with dementia receiving CACE-Is (CACE-I) with those not currently treated with CACE-Is (NoCACE-I), and with those who started CACE-Is, during their first 6 months of treatment (NewCACE-I). DESIGN Observational case-control study. SETTING 2 university hospital memory clinics. PARTICIPANTS 817 patients diagnosed with Alzheimer's disease, vascular or mixed dementia. Of these, 361 with valid cognitive scores were included for analysis, 85 CACE-I and 276 NoCACE-I. MEASUREMENTS Patients were included if the baseline and end-point (standardised at 6 months apart) Standardised Mini-Mental State Examination (SMMSE) or Quick Mild Cognitive Impairment (Qmci) scores were available. Patients with comorbid depression or other dementia subtypes were excluded. The average 6-month rates of change in scores were compared between CACE-I, NoCACE-I and NewCACE-I patients. RESULTS When the rate of decline was compared between groups, there was a significant difference in the median, 6-month rate of decline in Qmci scores between CACE-I (1.8 points) and NoCACE-I (2.1 points) patients (p=0.049), with similar, non-significant changes in SMMSE. Median SMMSE scores improved by 1.2 points in the first 6 months of CACE treatment (NewCACE-I), compared to a 0.8 point decline for the CACE-I (p=0.003) group and a 1 point decline for the NoCACE-I (p=0.001) group over the same period. Multivariate analysis, controlling for baseline characteristics, showed significant differences in the rates of decline, in SMMSE, between the three groups, p=0.002. CONCLUSIONS Cognitive scores may improve in the first 6 months after CACE-I treatment and use of CACE-Is is associated with a reduced rate of cognitive decline in patients with dementia.
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Affiliation(s)
- Yang Gao
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs' Hospital, Cork City, Ireland
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Abstract
OBJECTIVES Hurling is Ireland's national sport, played with a stick and ball; injury to the hand is common. A decrease in the proportion of head injury among emergency department (ED) presentations for hurling-related injury has coincided with voluntary use of helmet and face protection since 2003. A similar decrease in proportions has not occurred in hand injury. We aim to quantify hurling-related ED presentations and examine variables associated with injury. In particular, we were interested in comparing the occurrence of hand injury in those using head and face protection versus those who did not. DESIGN This study utilised a retrospective cross-sectional study design. SETTING This study took place at a university hospital ED over a 3-month period. OUTCOME MEASURES A follow-up telephone interview was performed with 163 players aged ≥16 years to reflect voluntary versus obligatory helmet use. RESULTS The hand was most often injured (n=85, 52.1%). Hand injury most commonly occurred from a blow of a hurley (n=104, 65%), and fracture was confirmed in 62% of cases. Two-thirds of players (66.3%) had multiple previous (1-5) hand injuries. Most patients 149 (91.4%) had tried commercially available hand protection, but only 4.9% used hand protection regularly. Univariate analysis showed a statistically significant association between wearing a helmet and faceguard and hand injury; OR 2.76 (95% CI 1.42 to 5.37) p=0.003. On further analysis adjusting simultaneously for age, prior injury, foul play and being struck by a hurley, this relationship remained significant (OR 3.15 95% CI 1.51 to 6.56, p=0.002). CONCLUSIONS We report that hurling-related hand injury is common. We noted the low uptake of hand protection. We found that hand injury was significantly associated with the use of helmet and faceguard protection, independent of the other factors studied. Further studies are warranted to develop strategies to minimise the occurrence of this injury.
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Affiliation(s)
- Éanna Falvey
- Department of Sport Medicine, Sports Surgery Clinic, Dublin, Ireland
- Department of Medicine, Cork University Hospital, Cork, Ireland
| | - Paul McCrory
- Florey Neurosciences Institutes and the Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, Australia
| | - Brendan Crowley
- Department of Medicine, Cork University Hospital, Cork, Ireland
| | - Aiden Kelleher
- Department of Medicine, Cork University Hospital, Cork, Ireland
| | - Joseph Eustace
- Department of Medicine, Cork University Hospital, Cork, Ireland
| | - Fergus Shanahan
- Department of Medicine, Cork University Hospital, Cork, Ireland
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Coyle J, Kinsella S, McCarthy S, MacWilliams S, McLaughlin P, Eustace J, Maher MM. Cumulative ionizing radiation exposure in patients with end stage kidney disease: a 6-year retrospective analysis. ACTA ACUST UNITED AC 2013; 37:632-8. [PMID: 21842156 DOI: 10.1007/s00261-011-9786-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To quantify cumulative exposure to ionizing radiation in patients with end stage kidney disease (ESKD). To investigate factors which may be independently associated with risk of high cumulative effective dose (CED). MATERIALS AND METHODS The study had local institutional review board ethical approval. We conducted a retrospective study of 394 period prevalent ESKD patients attending a single tertiary referral centre between 2004 and 2009. Patient demographics were obtained from case records. Details of radiological investigations were obtained from the institutional radiology computerized database. CED was calculated using standard procedure specific radiation levels. High exposure was defined as CED > 50 mSv, an exposure which has been reported to increase cancer mortality by 5%. Data were compared using Pearson χ(2) and Mann-Whitney U test or Kruskal-Wallis tests. RESULTS 394 patients were followed for a median of 4 years (1518 patient years follow-up). Of these 63% were male. Seventeen percent of patients had a CED of >50 mSv. Computed tomography (CT) accounted for 9% of total radiological studies/procedures while contributing 61.4% of total study dose. Median cumulative dose and median dose per patient year were significantly higher in the hemodialysis (HD) group (15.13 and 5.79 mSv, respectively) compared to the post-transplant group (2.9 and 0.52 mSv, respectively) (P < 0.001). CONCLUSION ESKD patients are at risk of cumulative exposure to significant levels of diagnostic radiation. The majority of this exposure is imparted as a result of CT examinations to patients in the HD group.
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Affiliation(s)
- Joe Coyle
- Radiology Department, Cork University Hospital, Wilton, Ireland.
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O’Connor M, O'Sullivan D, Gallagher P, Byrne S, Eustace J, O’Mahony D. Prevention of adverse drug events in hospitalized older patients: A randomised controlled trial using STOPP/START criteria. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.07.328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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O'Regan J, Walsh R, Kelly D, Plant L, Eustace J, McNamara B. Neuropathy in the Hemodialysis Population: A Review of Neurophysiology Referrals in a Tertiary Center. Ren Fail 2012; 34:538-41. [DOI: 10.3109/0886022x.2012.655682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- John O'Regan
- Department of Nephrology, Cork University Hospital, Cork, Ireland.
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O'Connell OJ, McWilliams S, McGarrigle A, O'Connor OJ, Shanahan F, Mullane D, Eustace J, Maher MM, Plant BJ. Radiologic imaging in cystic fibrosis: cumulative effective dose and changing trends over 2 decades. Chest 2011; 141:1575-1583. [PMID: 22207674 DOI: 10.1378/chest.11-1972] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE With the increasing life expectancy for patients with cystic fibrosis (CF), and a known predisposition to certain cancers, cumulative radiation exposure from radiologic imaging is of increasing significance. This study explores the estimated cumulative effective radiation dose over a 17-year period from radiologic procedures and changing trends of imaging modalities over this period. METHODS Estimated cumulative effective dose (CED) from all thoracic and extrathoracic imaging modalities and interventional radiology procedures for both adult and pediatric patients with CF, exclusively attending a nationally designated CF center between 1992-2009 for > 1 year, was determined. The study period was divided into three equal tertiles, and estimated CED attributable to all radiologic procedures was estimated for each tertile. RESULTS Two hundred thirty patients met inclusion criteria (2,240 person-years of follow-up; 5,596 radiologic procedures). CED was > 75 mSv for one patient (0.43%), 36 patients (15.6%) had a CED between 20 and 75 mSv, 56 patients (24.3%) had a CED between 5 and 20 mSv, and in 138 patients (60%) the CED was estimated to be between 0 and 5 mSv over the study period. The mean annual CED per patient increased consecutively from 0.39 mSv/y to 0.47 mSv/y to 1.67 mSv/y over the tertiles one to three of the study period, respectively (P < .001). Thoracic imaging accounted for 46.9% of the total CED and abdominopelvic imaging accounted for 42.9% of the CED, respectively. There was an associated 5.9-fold increase in the use of all CT scanning per patient (P < .001). CONCLUSIONS This study highlights the increasing exposure to ionizing radiation to patients with CF as a result of diagnostic imaging, primarily attributable to CT scanning. Increased awareness of CED and strategies to reduce this exposure are needed.
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Affiliation(s)
- Oisin J O'Connell
- Cork Cystic Fibrosis Center, Cork University Hospital, University College Cork, Cork, Ireland
| | - Sebastian McWilliams
- Cork Cystic Fibrosis Center, Cork University Hospital, University College Cork, Cork, Ireland
| | - AnneMarie McGarrigle
- Department of Radiation Physics, Cork University Hospital, University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Fergus Shanahan
- Department of Medicine, Cork University Hospital, University College Cork, Cork, Ireland
| | - David Mullane
- Cork Cystic Fibrosis Center, Cork University Hospital, University College Cork, Cork, Ireland
| | - Joseph Eustace
- Department of Renal Medicine, Cork University Hospital, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Barry J Plant
- Cork Cystic Fibrosis Center, Cork University Hospital, University College Cork, Cork, Ireland.
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Falvey EC, Eustace J, Whelan B, Molloy MS, Cusack SP, Shanahan F, Molloy MG. Sport and recreation-related injuries and fracture occurrence among emergency department attendees: implications for exercise prescription and injury prevention. Emerg Med J 2009; 26:590-5. [DOI: 10.1136/emj.2008.062315] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Moff SL, Kamel IR, Eustace J, Lawler LP, Kantsevoy S, Kalloo AN, Thuluvath PJ. Diagnosis of primary sclerosing cholangitis: a blinded comparative study using magnetic resonance cholangiography and endoscopic retrograde cholangiography. Gastrointest Endosc 2006; 64:219-23. [PMID: 16860072 DOI: 10.1016/j.gie.2005.12.034] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Accepted: 12/17/2005] [Indexed: 02/07/2023]
Abstract
BACKGROUND We hypothesized that magnetic resonance cholangiography (MRC) may have less accuracy for the diagnosis and the assessment of the severity of primary sclerosing cholangitis (PSC) than endoscopic retrograde cholangiography (ERC). OBJECTIVE The aim of this study was to determine the diagnostic accuracy and interobserver agreement of both ERC and MRC in PSC. DESIGN A case-control study. SETTING University Hospital. PATIENTS ERCs and MRCs of 36 patients with PSC and 51 controls (normal/other biliary tract diseases) were read in an independent, blinded, and random fashion by 2 magnetic resonance radiologists and 2 interventional endoscopists by using a previously validated classification system. Readers had no access to clinical history, laboratory results, or patient mix. RESULTS Extrahepatic ductal (EHD) and intrahepatic ductal (IHD) visualization was excellent in 64% of 66% of MRCs and 86% of 74% of ERCs. Sensitivity and specificity for diagnosis of PSC for readers 1 to 4 were 91% and 85%, 88% and 90%, 81% and 96%, and 83% and 96%. respectively. Receiver operating curve values were excellent for all readers (all >0.9). Interobserver agreement (kappa statistics) for the diagnosis of PSC (MRC, 0.83; ERC, 0.73) and for identifying the presence of IHD strictures (MRC, 0.64; ERC, 0.86) was good for both modalities, but only ERC (ERC, 0.55; MRC, 0.36) was good for the presence and the severity of EHD strictures. When assessment of disease severity was limited to the 36 patients with PSC, interobserver agreement was very poor for both MRC (0.23 and 0.07 for EHD and IHD, respectively) and ERC (0.24 and 0.34 for EHD and IHD, respectively). LIMITATIONS The retrospective case-control study made it difficult to assess the impact of the diagnosis on patient management. CONCLUSIONS ERC and MRC were comparable for diagnosing PSC, with very good interobserver agreement for the diagnosis of PSC and IHD strictures. Only ERC had good agreement for EHD strictures. Interobserver agreement was very poor for both MRC and ERC when disease severity of PSC was assessed.
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Affiliation(s)
- Stephen L Moff
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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Oberai PC, Dalal D, Zhang L, Wang C, Eustace J, Parekh RS. Incidence of Atherosclerotic Cardiovascular Disease Among HIV Patients Receiving Dialysis. Am J Kidney Dis 2006; 47:848-55. [PMID: 16632024 DOI: 10.1053/j.ajkd.2006.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 08/11/2005] [Accepted: 01/06/2006] [Indexed: 11/11/2022]
Abstract
BACKGROUND Atherosclerotic cardiovascular disease (ASCVD) is increasing in incidence in persons with human immunodeficiency virus (HIV). It is not known whether the morbidity and mortality rate of ASCVD is similarly increasing among patients with HIV end-stage renal disease (ESRD), who are living longer since the initiation of newer therapeutic regimens in 1997. METHODS We conducted a population-based study of 8,312 HIV ESRD patients enrolled in the US Renal Data System from 1987 to 2001. We determined the incidence of fatal and nonfatal ASCVD events stratified by date of dialysis therapy initiation. RESULTS There were 3,112 HIV ESRD patients (77.9% men; mean age, 39.6 +/- 9.6 years) who initiated dialysis therapy before 1997 and 2,371 patients (71.5% men; mean age, 41.3 +/- 9.7 years) who initiated dialysis therapy after 1997. Cumulative incidences of ASCVD for those initiating dialysis therapy before 1997 compared with after 1997 were 10.6% versus 13.5% at 12 months, 18.8% versus 27.6% at 24 months, 26.2% versus 42.4% at 36 months, and 33.7% versus 65.9% at 48 months (P < 0.0001 by log rank). Those who initiated dialysis therapy after 1997 had a greater risk for developing ASCVD (adjusted hazard ratio, 1.57; 95% confidence interval, 1.29 to 1.92) than those who initiated dialysis therapy before 1997 after adjusting for demographics and ASCVD risk factors. CONCLUSION There is an increased risk for ASCVD in patients with HIV who initiated dialysis therapy after 1997. This may reflect the long-term complications of multidrug regimens, as well as improved survival from these regimens leading to prolonged exposure to ASCVD risk factors.
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Affiliation(s)
- Pooja C Oberai
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
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Eustace J. Q & A: ask the experts. An interview with Joseph Eustace. Nephrol News Issues 2005; 19:S7. [PMID: 15813316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Abstract
BACKGROUND There is significant evidence to suggest that long-term survival after renal transplantation is significantly lower in African Americans than in other races. We aimed to establish whether there was a difference in survival in African Americans compared with other races after orthotopic liver transplantation (OLT) and whether race was an independent predictor of survival. METHODS We collected data from the United Network of Organ Sharing transplant registry for all liver transplants done between 1988 and 1996 in the USA. We also recorded information on age, sex, race, blood group, and cause of death for the donors and recipients. FINDINGS 2-year graft survival was significantly lower for African Americans (601 of 884, 68%) and Asians (266 of 416, 64%) compared with white Americans (8703 of 11762, 74%) and Hispanics (878 of 1220, 72%). 2-year and 5-year patient survival were significantly lower for African Americans (654 of 884 [74%], 270 of 565 [48%]) and Asians (287 of 416 [69%], 92 of 252 [37%]) compared with white Americans (9786 of 11762 [83%], 4357 of 7514 [58%]) and Hispanics (964 of 1220 [79%], 341 of 657 [52%]). Compared with white Americans, African American (hazard ratio 1.36, 95% CI 1.16-1.60, p<0.0001) and Asian (1.25, 1.01-1.56, p=0.03) race were independent predictors of poor survival at 2 years. INTERPRETATION African Americans and Asians have a worse outcome after OLT compared with white Americans and Hispanics. The higher rate of chronic rejection in African Americans and a relatively worse outcome in other minority races merits further examination.
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Affiliation(s)
- Satheesh Nair
- Division of Gastroenterology and Hepatology, Ochsner Medical Foundation, New Orleans, LA, USA
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Briggs WA, Gimenez LF, Samaniego-Picota M, Choi MJ, Nadasdy T, Eustace J, Scheel PJ. Relationship between lymphocyte and clinical steroid responsiveness in focal segmental glomerulosclerosis. J Clin Pharmacol 2000; 40:115-23. [PMID: 10664916 DOI: 10.1177/00912700022008757] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A remission in nephrotic proteinuria with steroid treatment appears to favorably alter the natural history of focal segmental glomerulosclerosis (FSGS). It is not known why some patients have a favorable response to steroid treatment whereas others do not. Considering the possibility that differences in the pharmacodynamic responsiveness to steroids among patients might be one factor, the authors examined the relationship between the pretreatment suppressive effect of steroids on lymphocyte proliferation (% inhibition) in vitro and the short- and intermediate-term responses of creatinine clearance (Clcr) and/or nephrotic proteinuria (urine protein/creatinine ratio = Up/c) in 13 patients with FSGS. There were significant correlations between % inhibition and the changes in Clcr at 3 (r = 0.92, p < 0.001) and 6 (r = 0.86, p < 0.01) months and the changes in Up/c at 3 months (r = -0.74, p = 0.02). Thus, the greater the pretreatment lymphocyte steroid sensitivity, the greater the increase in Clcr or decrease in Up/c. The changes in these parameters could not be accounted for on the basis of steroid dose or histopathology. The in vitro sensitivity of FSGS patients' lymphocytes to steroids may be of value in anticipating their clinical response to treatment.
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Affiliation(s)
- W A Briggs
- Johns Hopkins University School of Medicine, Division of Nephrology, Baltimore, MD 21205, USA
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Briggs WA, Eustace J, Gimenez LF, Choi MJ, Scheel PJ, Burdick JF. Lymphocyte suppression by glucocorticoids with cyclosporine, tacrolimus, pentoxifylline, and mycophenolic acid. J Clin Pharmacol 1999; 39:125-30. [PMID: 11563403 DOI: 10.1177/00912709922007660] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Methylprednisolone has been found to be significantly more suppressive than prednisolone (the pharmacologically active metabolite of prednisone) of mitogen-stimulated human lymphocyte proliferation. In this study, peripheral blood mononuclear cells (PBMC) from end stage renal disease patients were cultured with phytohemagglutinin (PHA) alone and with methylprednisolone and prednisolone individually, as well as each glucocorticoid (10(-7) mol/L) in combination with 300 ng/ml cyclosporine, 10 ng/ml tacrolimus, 25 microg/ml pentoxifylline, and 10(-7) mol/L mycophenolic acid. Under each experimental condition, the mean +/- SD % inhibition of PHA-stimulated 3H-thymidine incorporation was significantly greater with methylprednisolone than with prednisolone: methylprednisolone 55 +/- 17 versus prednisolone 28 +/- 14, p < 0.001; methylprednisolone + cyclosporine 76 +/- 18 versus prednisolone + cyclosporine 52 +/- 18, p < 0.001; methylprednisolone + tacrolimus 74 +/- 18 versus prednisolone + tacrolimus 50 +/- 20, p = 0.001; methylprednisolone + mycophenolic acid 69 +/- 14 versus prednisolone + mycophenolic acid 46 +/- 15, p < 0.001. These results confirm and extend previous observations and suggest that methylprednisolone might be more effective than prednisone in treatment protocols used to suppress allograft rejection.
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Affiliation(s)
- W A Briggs
- Johns Hopkins University School of Medicine, Division of Nephrology, Baltimore, Maryland 21505-2196, USA
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Briggs WA, Eustace J, Mathew S, Gimenez LF, Choi M, Scheel PJ, Burdick J. Pentoxifylline potentiates in vitro lymphocyte suppression by glucocorticoids and immunosuppressive drugs. J Clin Pharmacol 1998; 38:561-6. [PMID: 9650547 DOI: 10.1002/j.1552-4604.1998.tb05795.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Pentoxifylline, which has immunomodulatory effects in addition to its better known rheologic effects, might potentiate the effectiveness of traditional immunosuppressive drugs. We therefore studied the suppressive effect of pentoxifylline in combination with clinically relevant concentrations of prednisolone, methylprednisolone, cyclosporine, tacrolimus, rapamycin, and mycophenolic acid on mitogen-stimulated lymphocytes from 29 patients with glomerular diseases. Inhibition of lymphocyte proliferation obtained with 10(-7) and 10(-8) mol/L concentrations of the glucocorticoids and with 300 ng/mL cyclosporine was significantly increased when each was combined with 5, 25, or 50 microg/mL of pentoxifylline. The additive inhibitory effect of pentoxifylline in combination with 10(-7) mol/L glucocorticoids was inversely proportional to the inhibitory effect of the 10(-7) mol/L concentration of glucocorticoid alone, suggesting that the less sensitive the patient's cells, the greater the potentiation by pentoxifylline. The greatest degree of potentiation by pentoxifylline occurred when combined with the lower (10(-8) mol/L) concentration of glucocorticoids. Pentoxifylline also significantly increased lymphocyte suppression in combination with 150 and 300 ng/mL concentrations of cyclosporine, 5 ng/mL of tacrolimus, 2.5 x 10(-7) mol/L mycophenolic acid, and 10 ng/mL of rapamycin. These in vitro results suggest that pentoxifylline might have steroid-sparing effects and contribute to improved clinical outcomes from immunosuppressive treatment of renal diseases.
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Affiliation(s)
- W A Briggs
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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Killalea AG, Eustace J, Keogh B, Love WC. Factors in post dialysis CAPD fluid affecting 3H cholesterol efflux from human skin fibroblasts. Biochem Soc Trans 1997; 25:123S. [PMID: 9057021 DOI: 10.1042/bst025123s] [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: 02/03/2023]
Affiliation(s)
- A G Killalea
- Clinical Biochemistry Dept., Trinity College, Dublin
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Affiliation(s)
- J Eustace
- Department of Nephrology, Meath Hospital, Dublin, Ireland
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