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Newell K, Ferguson-Steele Z, Shin D, Noh MG, Pipavath S, Gutschenritter T, Tsai J, Kang J. Quantitative and Qualitative Impact of CT-Based Radiotherapy Dose Maps on Radiologists' Interpretation of Post-treatment Thoracic Surveillance Imaging. Int J Radiat Oncol Biol Phys 2023; 117:S96-S97. [PMID: 37784614 DOI: 10.1016/j.ijrobp.2023.06.430] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) For diagnostic radiologists, interpretation of surveillance imaging for oncology patients treated with radiation therapy (RT) can be challenging because (1) the imaging order may not adequately describe the radiation fields and (2) RT treatment effect and progression can appear similar. Volumetric dose visualization used for plan review is often inaccessible to radiologists. We hypothesize that displaying RT dose would improve radiologists' confidence and ability to correctly identify and distinguish irradiated targets and treatment effects. MATERIALS/METHODS CT images were read by a board-certified cardiothoracic radiologist and a diagnostic radiology resident. The readers interpreted pre-RT, treatment planning, and 3-4 month post-RT CT images in anonymized software sessions first without, then-after a 1 month "washout" period-with access to RT dose overlay. Six color-coded isodose lines ranging from 25% to 110% represented in absolute cGy were displayed along with a brief clinical history. RT fractionation schedules ranged in BED10 from 39 to 112.5 Gy. Readers were asked to label the treated lesion(s) and treatment effect(s), and record their confidence using a Likert scale of 1-5 and agreement with statements using yes/no responses. RESULTS Two readersindependently interpreted imaging for 32 patients who received thoracic RT to 1-5 lesion(s) for primary (24) or metastatic (8) cancer. Nineteen patients had 1 lesion and 13 patients had >1 lesion. Correct identification of all treated lesions significantly increased with the addition of dose visualization (61% to 81%; McNemar test, p = 0.00079), with the largest increase noted for cases with >1 lesion (15% to 54%; McNemar test, p = 0.0039). With the addition of dose information, the number of false negatives attributable to missed extranodal targets fell from 52% to 18%. Without dose information, 13% of labeled lesions and treatment effects fell outside of the 25% isodose lines, representing false positives. With the addition of dose information, false positives fell below 2% for both lesions and treatment effects. The readers' confidence that they had identified treated lesion(s) increased from a rating of 4.1 to 4.8 on a scale of 1-5 (Paired two-tail t test; p = 0.000005). CONCLUSION Whendiagnostic radiologists have access to dose visualization, correct identification rate of irradiated lesions and treatment effects, as well as confidence in these identifications significantly increased. The decrease in false negatives could reduce potential missed identification of tumor progression while the decrease in false positives could reduce inaccurate identification of treatment failure in a new or stable lesion. Our results demonstrate that adding volumetric visualization of dose to imaging could improve quality of surveillance care for patients with irradiated thoracic malignancies.
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Affiliation(s)
- K Newell
- University of Washington School of Medicine, Seattle, WA
| | | | - D Shin
- University of Washington, Seattle, WA
| | - M G Noh
- University of Washington, Department of Radiology, Seattle, WA
| | - S Pipavath
- University of Washington, Department of Radiology, Seattle, WA
| | - T Gutschenritter
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - J Tsai
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - J Kang
- University of Washington, Department of Radiation Oncology, Seattle, WA
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Abstract
Purpose Patients with severe asthma were choosing not to use the emergency department (ED) in extremis and were self-medicating when experiencing severe asthma, putting their lives at risk. This local issue reflected a nationwide situation. The purpose of this paper is to better understand the reasons behind patients' reluctance to attend ED and to consider practical solutions in a structured way. Design/methodology/approach Systems thinking (soft systems methodology) was used to examine the issues resulting in this reluctance to attend the ED. Once this tame (well-defined) problem was revealed, a potential solution was developed in co-production with patients. Findings Patients feared attending the ED and felt vulnerable while in the ED for several reasons. This appeared to be a well-defined and solvable problem. The solution proposed was an asthma patient passport (APP), which increased patient's confidence in their ability to communicate their needs while in severe distress. The APP decreases (from 12 to 5 steps) the work patients had to do to achieve care. The APP project is currently being evaluated. Practical implications The APP should be offered to all people with severe asthma. Originality/value By revisiting systems thinking and identifying problems, a solution was identified. Although methods such as soft systems methodology have limitations when used in wicked (difficult or impossible to resolve) problems, such methods still have merit in tame problems and were applicable in this case to fully understand the issues, and to design practical solutions.
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Affiliation(s)
- Karen Newell
- Central London Community Healthcare NHS Trust, London, UK
| | - Chris Corrigan
- School of Medical Education, King's College London, London, UK
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Russell AM, Olive S, Lines S, Murphy A, Hocking J, Newell K, Morris H, Harris E, Dixon C, Agnew S, Burge G. Contemporary challenges for specialist nursing in interstitial lung disease. Breathe (Sheff) 2018. [PMID: 29515666 PMCID: PMC5832013 DOI: 10.1183/20734735.014917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The role of clinical nurse specialists (CNSs) in interstitial lung disease (ILD) is evolving in response to clinical guidelines and the growth of clinical research. The role is well established in the UK, although more ILD posts are needed to ensure supply meets clinical demand. This phenomenon is also happening across Europe. An appreciation of the similarities and differences between CNS and advanced nurse practitioners is important given the challenges in defining, developing and supporting this nursing specialisation. Globally, different models exist. In some countries charitable organisations take a leading role in supporting patients. Many European centres look to the National Institute for Health and Care Excellence guidelines and quality standards as a template to develop and evaluate the role of the ILD CNS. We present a UK perspective in the context of a government subsidised healthcare system to promote professional discussion and debate regarding the future of nursing practice in the ILD specialty. Specialist nurses and interdisciplinary healthcare professionals are fundamental to the care of patients diagnosed with ILD. ILD specific clinical and academic standards are needed to sustain and develop a dedicated ILD workforcehttp://ow.ly/toee30h1UkW
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Affiliation(s)
- Anne Marie Russell
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Sandra Olive
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Sarah Lines
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Anna Murphy
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Julie Hocking
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Karen Newell
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Helen Morris
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Emma Harris
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Catherine Dixon
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Sarah Agnew
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Geraldine Burge
- For a full list of the authors' affiliations please see the Acknowledgements section
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Abstract
This article outlines the development, testing and evaluation of an asthma patient passport (APP). The APP was designed specifically for patients with severe and difficult-to-manage asthma. This patient group tends not to access emergency services when needed, potentially putting life at risk. These individuals prefer to self-manage rather than expose themselves to feelings of vulnerability in the emergency department (ED). The aims of the project were to save lives by ensuring these patients attend the ED, to improve patient experience in the ED and to assist healthcare professionals in their clinical decision making, enabling them to deliver appropriate and individualised emergency treatment.
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Affiliation(s)
- Karen Newell
- Respiratory medicine, Guy's and St Thomas' NHS Foundation Trust, London
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Hall CL, Taylor JA, Newell K, Baldwin L, Sayal K, Hollis C. The challenges of implementing ADHD clinical guidelines and research best evidence in routine clinical care settings: Delphi survey and mixed-methods study. BJPsych Open 2016; 2:25-31. [PMID: 27703750 PMCID: PMC4995556 DOI: 10.1192/bjpo.bp.115.002386] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/13/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The landmark US Multimodal Treatment of ADHD (MTA) study established the benefits of individualised medication titration and optimisation strategies to improve short- to medium-term outcomes in attention-deficit hyperactivity disorder (ADHD). This individualised medication management approach was subsequently incorporated into the National Institute for Health and Care Excellence (NICE) ADHD Clinical Guidelines (NICE CG78). However, little is known about clinicians' attitudes towards implementing these medication management strategies for ADHD in routine care. AIMS To examine National Health Service (NHS) healthcare professionals' consensus on ADHD medication management strategies. METHOD Using the Delphi method, we examined perceptions on the importance and feasibility of implementing 103 ADHD treatment statements from sources including the UK NICE ADHD guidelines and US medication management algorithms. RESULTS Certain recommendations for ADHD medication management were judged as important and feasible to implement, including a stepwise titration of stimulant medication. Other recommendations were perceived as important but not feasible to implement in routine practice, such as weekly clinic follow-up with the family during titration and collection of follow-up symptom questionnaires. CONCLUSIONS Many of the key guideline recommendations for ADHD medication management are viewed by clinicians as important and feasible to implement. However, some recommendations present significant implementation challenges within the context of routine NHS clinical care in England. DECLARATION OF INTEREST C.H. and K.S. were members of the Guideline Development Group for the NICE ADHD Clinical Guideline (NICE CG78). COPYRIGHT AND USAGE © 2016 The Royal College of Psychiatrists. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
| | | | - Karen Newell
- , BSc, MSc, CLAHRC, University of Nottingham, Nottingham, UK
| | - Laurence Baldwin
- , BSc, MA, PhD, RN, RNT, CAMHS, Derbyshire Healthcare NHS Foundation Trust, Derbyshire, UK
| | | | - Chris Hollis
- , PhD, FRCPsych, Developmental Psychiatry, Queen's Medical Centre, University of Nottingham, Nottingham, UK
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Multak N, Newell K, Spear S, Scalese RJ, Issenberg SB. A multi-institutional study using simulation to teach cardiopulmonary physical examination and diagnosis skills to physician assistant students. J Physician Assist Educ 2015; 26:70-76. [PMID: 25933013 DOI: 10.1097/jpa.0000000000000021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 06/04/2023]
Abstract
PURPOSE Research demonstrates limitations in the ability of health care trainees/practitioners, including physician assistants (PAs), to identify important cardiopulmonary examination findings and diagnose corresponding conditions. Studies also show that simulation-based training leads to improved performance and that these skills can transfer to real patients. This study evaluated the effectiveness of a newly developed curriculum incorporating simulation with deliberate practice for teaching cardiopulmonary physical examination/bedside diagnosis skills in the PA population. METHODS This multi-institutional study used a pretest/posttest design. Participants, PA students from 4 different programs, received a standardized curriculum including instructor-led activities interspersed among small-group/independent self-study time. Didactic sessions and independent study featured practice with the "Harvey" simulator and use of specially developed computer-based multimedia tutorials. Preintervention: participants completed demographic questionnaires, rated self-confidence, and underwent baseline evaluation of knowledge and cardiopulmonary physical examination skills. Students logged self-study time using various learning resources. Postintervention: students again rated self-confidence and underwent repeat cognitive/performance testing using equivalent written/simulator-based assessments. RESULTS Physician assistant students (N = 56) demonstrated significant gains in knowledge, cardiac examination technique, recognition of total cardiac findings, identification of key auscultatory findings (extra heart sounds, systolic/diastolic murmurs), and the ability to make correct diagnoses. Learner self-confidence also improved significantly. CONCLUSIONS This study demonstrated the effectiveness of a simulation-based curriculum for teaching essential physical examination/bedside diagnosis skills to PA students. Its results reinforce those of similar/previous research, which suggest that simulation-based training is most effective under certain educational conditions. Future research will include subgroup analyses/correlation of other variables to explore best features/uses of simulation technology for training PAs.
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Affiliation(s)
- Nina Multak
- Nina Multak, MPAS, PA-C, is an associate clinical professor at the Drexel University Physician Assistant Program, Philadelphia, Pennsylvania. Karen Newell, MMSc, PA-C, is an assistant professor at the Emory University Physician Assistant Program, Atlanta, Georgia. Sherrie Spear, MHS, PA-C, is an assistant professor at the Duke University Physician Assistant Program, Durham, North Carolina. Ross J. Scalese, MD, is an associate professor of Medicine and director of Educational Technology Development at the Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, Florida. S. Barry Issenberg, MD, is the associate dean for Research in Medical Education, professor of Medicine, and director of the Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, Florida
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Newell K, Bunce R, Hume S. Using patient passports to improve A&E asthma care. Nurs Times 2015; 111:15-17. [PMID: 26021030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The asthma patient passport (APP) is a patient-specific asthma plan that details what to do when asthma is out of control. It helps patients who have severe, difficult-to-manage asthma, and health professionals when these patients present at accident and emergency. This article shows that, while the APP acts as a patient's advocate, it also facilitates accessing emergency care by making it more streamlined. Case studies explore why people with asthma have avoided going to A&E, putting their lives at risk, and provide an insight into how difficult it can be for people to navigate the healthcare system when they are at their most vulnerable.
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Hall CL, Newell K, Taylor J, Sayal K, Hollis C. Services for young people with attention deficit/hyperactivity disorder transitioning from child to adult mental health services: a national survey of mental health trusts in England. J Psychopharmacol 2015; 29:39-42. [PMID: 25237121 DOI: 10.1177/0269881114550353] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 11/15/2022]
Abstract
Transition from child to adult mental health services is considered to be a difficult process, particularly for individuals with neurodevelopmental disorders such as attention deficit/hyperactivity disorder (ADHD). This article presents results from a national survey of 36 mental health National Health Service (NHS) trusts across England, the findings indicate a lack of accurate data on the number of young people with ADHD transitioning to, and being seen by, adult services. Less than half of the trusts had a specialist adult ADHD service and in only a third of the trusts were there specific commissioning arrangements for adult ADHD. Half of the trusts reported that young people with ADHD were prematurely discharged from child and adolescent mental health services (CAMHS) because there were no suitable adult services. There was also a lack of written transition protocols, care pathways, commissioned services for adults with ADHD and inadequate information sharing between services. The findings advocate the need to provide a better transition service underpinned by clear, structured guidelines and protocols, routine data collection and information sharing across child and adult services. An increase in the commission of specialist adult ADHD clinics is needed to ensure individuals have access to appropriate support and care.
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Affiliation(s)
- Charlotte L Hall
- Collaboration for Leadership in Applied Health Research and Care, University of Nottingham, Nottingham, UK
| | - Karen Newell
- Collaboration for Leadership in Applied Health Research and Care, University of Nottingham, Nottingham, UK
| | - John Taylor
- Collaboration for Leadership in Applied Health Research and Care, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Queens Medical Centre, Developmental Psychiatry, University of Nottingham, Nottingham, UK
| | - Chris Hollis
- Queens Medical Centre, Developmental Psychiatry, University of Nottingham, Nottingham, UK
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Hall CL, Taylor J, Moldavsky M, Marriott M, Pass S, Newell K, Goodman R, Sayal K, Hollis C. A qualitative process evaluation of electronic session-by-session outcome measurement in child and adolescent mental health services. BMC Psychiatry 2014; 14:113. [PMID: 24731701 PMCID: PMC4021403 DOI: 10.1186/1471-244x-14-113] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 04/03/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Regular monitoring of patient progress is important to assess the clinical effectiveness of an intervention. Recently, initiatives within UK child and adolescent mental health services (CAMHS) have advocated the use of session-by-session monitoring to continually evaluate the patient's outcome throughout the course of the intervention. However, the feasibility and acceptability of such regular monitoring is unknown. METHOD Semi-structured qualitative interviews were conducted with clinicians (n = 10), administrative staff (n = 8) and families (n = 15) who participated in a feasibility study of an electronic session-by-session outcome monitoring tool, (SxS), which is based on the Strengths and Difficulties Questionnaire (SDQ). This study took place in three CAMHS clinics in Nottinghamshire. The interview transcripts were thematically analysed. RESULTS We found clinicians accepted the need to complete outcome measures, particularly valuing those completed by the patient. However, there were some difficulties with engaging clinicians in this practice and in the training offered. Generally, patients were supportive of completing SxS in the waiting room prior to the clinic session and assistance with the process from administrative staff was seen to be a key factor. Clinicians and families found the feedback reports created from SxS to be helpful for tracking progress, facilitating communication and engagement, and as a point of reflection. The use of technology was considered positively, although some technological difficulties hindered the completion of SxS. Clinicians and families appreciated the brevity of SxS, but some were concerned that a short questionnaire could not adequately encapsulate the complexity of the patient's issues. CONCLUSIONS The findings show the need for appropriate infrastructure, mandatory training, and support to enable an effective system of session-by-session monitoring. Our findings indicate that clinicians, administrative staff and young people and their parents/carers would support regular monitoring if the system is easy to implement, with a standard 'clinic-wide' adoption of the procedure, and the resulting data are clinically useful.
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Affiliation(s)
- Charlotte L Hall
- CLAHRC-NDL, University of Nottingham, Nottingham, UK
- B07 Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham NG7 2TU, UK
| | - John Taylor
- CLAHRC-NDL, University of Nottingham, Nottingham, UK
| | | | | | - Sarah Pass
- CLAHRC-NDL, University of Nottingham, Nottingham, UK
| | - Karen Newell
- CLAHRC-NDL, University of Nottingham, Nottingham, UK
| | - Robert Goodman
- King's College London, Institute of Psychiatry, London, UK
| | - Kapil Sayal
- Developmental Psychiatry, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | - Chris Hollis
- Developmental Psychiatry, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
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Ambady P, Holdhoff M, Ferrigno C, Grossman S, Anderson MD, Liu D, Conrad C, Penas-Prado M, Gilbert MR, Yung AWK, de Groot J, Aoki T, Nishikawa R, Sugiyama K, Nonoguchi N, Kawabata N, Mishima K, Adachi JI, Kurisu K, Yamasaki F, Tominaga T, Kumabe T, Ueki K, Higuchi F, Yamamoto T, Ishikawa E, Takeshima H, Yamashita S, Arita K, Hirano H, Yamada S, Matsutani M, Apok V, Mills S, Soh C, Karabatsou K, Arimappamagan A, Arya S, Majaid M, Somanna S, Santosh V, Schaff L, Armentano F, Harrison C, Lassman A, McKhann G, Iwamoto F, Armstrong T, Yuan Y, Liu D, Acquaye A, Vera-Bolanos E, Diefes K, Heathcock L, Cahill D, Gilbert M, Aldape K, Arrillaga-Romany I, Ruddy K, Greenberg S, Nayak L, Avgeropoulos N, Avgeropoulos G, Riggs G, Reilly C, Banerji N, Bruns P, Hoag M, Gilliland K, Trusheim J, Bekaert L, Borha A, Emery E, Busson A, Guillamo JS, Bell M, Harrison C, Armentano F, Lassman A, Connolly ES, Khandji A, Iwamoto F, Blakeley J, Ye X, Bergner A, Dombi E, Zalewski C, Follmer K, Halpin C, Fayad L, Jacobs M, Baldwin A, Langmead S, Whitcomb T, Jennings D, Widemann B, Plotkin S, Brandes AA, Mason W, Pichler J, Nowak AK, Gil M, Saran F, Revil C, Lutiger B, Carpentier AF, Milojkovic-Kerklaan B, Aftimos P, Altintas S, Jager A, Gladdines W, Lonnqvist F, Soetekouw P, van Linde M, Awada A, Schellens J, Brandsma D, Brenner A, Sun J, Floyd J, Hart C, Eng C, Fichtel L, Gruslova A, Lodi A, Tiziani S, Bridge CA, Baldock A, Kumthekar P, Dilfer P, Johnston SK, Jacobs J, Corwin D, Guyman L, Rockne R, Sonabend A, Cloney M, Canoll P, Swanson KR, Bromberg J, Schouten H, Schaafsma R, Baars J, Brandsma D, Lugtenburg P, van Montfort C, van den Bent M, Doorduijn J, Spalding A, LaRocca R, Haninger D, Saaraswat T, Coombs L, Rai S, Burton E, Burzynski G, Burzynski S, Janicki T, Marszalek A, Burzynski S, Janicki T, Burzynski G, Marszalek A, Cachia D, Smith T, Cardona AF, Mayor LC, Jimenez E, Hakim F, Yepes C, Bermudez S, Useche N, Asencio JL, Mejia JA, Vargas C, Otero JM, Carranza H, Ortiz LD, Cardona AF, Ortiz LD, Jimenez E, Hakim F, Yepes C, Useche N, Bermudez S, Asencio JL, Carranza H, Vargas C, Otero JM, Bartels C, Quintero A, Restrepo CE, Gomez S, Bernal-Vaca L, Lema M, Cardona AF, Ortiz LD, Useche N, Bermudez S, Jimenez E, Hakim F, Yepes C, Mejia JA, Bernal-Vaca L, Restrepo CE, Gomez S, Quintero A, Bartels C, Carranza H, Vargas C, Otero JM, Carlo M, Omuro A, Grommes C, Kris M, Nolan C, Pentsova E, Pietanza M, Kaley T, Carrabba G, Giammattei L, Draghi R, Conte V, Martinelli I, Caroli M, Bertani G, Locatelli M, Rampini P, Artoni A, Carrabba G, Bertani G, Cogiamanian F, Ardolino G, Zarino B, Locatelli M, Caroli M, Rampini P, Chamberlain M, Raizer J, Soffetti R, Ruda R, Brandsma D, Boogerd W, Taillibert S, Le Rhun E, Jaeckle K, van den Bent M, Wen P, Chamberlain M, Chinot OL, Wick W, Mason W, Henriksson R, Saran F, Nishikawa R, Carpentier AF, Hoang-Xuan K, Kavan P, Cernea D, Brandes AA, Hilton M, Kerloeguen Y, Guijarro A, Cloughsey T, Choi JH, Hong YK, Conrad C, Yung WKA, deGroot J, Gilbert M, Loghin M, Penas-Prado M, Tremont I, Silberman S, Picker D, Costa R, Lycette J, Gancher S, Cullen J, Winer E, Hochberg F, Sachs G, Jeyapalan S, Dahiya S, Stevens G, Peereboom D, Ahluwalia M, Daras M, Hsu M, Kaley T, Panageas K, Curry R, Avila E, Fuente MDL, Omuro A, DeAngelis L, Desjardins A, Sampson J, Peters K, Ranjan T, Vlahovic G, Threatt S, Herndon J, Boulton S, Lally-Goss D, McSherry F, Friedman A, Friedman H, Bigner D, Gromeier M, Prust M, Kalpathy-Cramer J, Poloskova P, Jafari-Khouzani K, Gerstner E, Dietrich J, Fabi A, Villani V, Vaccaro V, Vidiri A, Giannarelli D, Piludu F, Anelli V, Carapella C, Cognetti F, Pace A, Flowers A, Flowers A, Killory B, Furuse M, Miyatake SI, Kawabata S, Kuroiwa T, Garciarena P, Anderson MD, Hamilton J, Schellingerhout D, Fuller GN, Sawaya R, Gilbert MR, Gilbert M, Pugh S, Won M, Blumenthal D, Vogelbaum M, Aldape K, Colman H, Chakravarti A, Jeraj R, Dignam J, Armstrong T, Wefel J, Brown P, Jaeckle K, Schiff D, Brachman D, Werner-Wasik M, Tremont-Lukats I, Sulman E, Mehta M, Gill B, Yun J, Goldstein H, Malone H, Pisapia D, Sonabend AM, Mckhann GK, Sisti MB, Sims P, Canoll P, Bruce JN, Girvan A, Carter G, Li L, Kaltenboeck A, Chawla A, Ivanova J, Koh M, Stevens J, Lahn M, Gore M, Hariharan S, Porta C, Bjarnason G, Bracarda S, Hawkins R, Oudard S, Zhang K, Fly K, Matczak E, Szczylik C, Grossman R, Ram Z, Hamza M, O'Brien B, Mandel J, DeGroot J, Han S, Molinaro A, Berger M, Prados M, Chang S, Clarke J, Butowski N, Hashimoto N, Chiba Y, Tsuboi A, Kinoshita M, Hirayama R, Kagawa N, Oka Y, Oji Y, Sugiyama H, Yoshimine T, Hawkins-Daarud A, Jackson PR, Swanson KR, Sarmiento JM, Ly D, Jutla J, Ortega A, Carico C, Dickinson H, Phuphanich S, Rudnick J, Patil C, Hu J, Iglseder S, Nowosielski M, Nevinny-Stickel M, Stockhammer G, Jain R, Poisson L, Scarpace L, Mikkelsen T, Kirby J, Freymann J, Hwang S, Gutman D, Jaffe C, Brat D, Flanders A, Janicki T, Burzynski S, Burzynski G, Marszalek A, Jiang C, Wang H, Jo J, Williams B, Smolkin M, Wintermark M, Shaffrey M, Schiff D, Juratli T, Soucek S, Kirsch M, Schackert G, Kakkar A, Kumar S, Bhagat U, Kumar A, Suri A, Singh M, Sharma M, Sarkar C, Suri V, Kaley T, Barani I, Chamberlain M, McDermott M, Raizer J, Rogers L, Schiff D, Vogelbaum M, Weber D, Wen P, Kalita O, Vaverka M, Hrabalek L, Zlevorova M, Trojanec R, Hajduch M, Kneblova M, Ehrmann J, Kanner AA, Wong ET, Villano JL, Ram Z, Khatua S, Fuller G, Dasgupta S, Rytting M, Vats T, Zaky W, Khatua S, Sandberg D, Foresman L, Zaky W, Kieran M, Geoerger B, Casanova M, Chisholm J, Aerts I, Bouffet E, Brandes AA, Leary SES, Sullivan M, Bailey S, Cohen K, Mason W, Kalambakas S, Deshpande P, Tai F, Hurh E, McDonald TJ, Kieran M, Hargrave D, Wen PY, Goldman S, Amakye D, Patton M, Tai F, Moreno L, Kim CY, Kim T, Han JH, Kim YJ, Kim IA, Yun CH, Jung HW, Koekkoek JAF, Reijneveld JC, Dirven L, Postma TJ, Vos MJ, Heimans JJ, Taphoorn MJB, Koeppen S, Hense J, Kong XT, Davidson T, Lai A, Cloughesy T, Nghiemphu PL, Kong DS, Choi YL, Seol HJ, Lee JI, Nam DH, Kool M, Jones DTW, Jager N, Northcott PA, Pugh T, Hovestadt V, Markant S, Esparza LA, Bourdeaut F, Remke M, Taylor MD, Cho YJ, Pomeroy SL, Schuller U, Korshunov A, Eils R, Wechsler-Reya RJ, Lichter P, Pfister SM, Krel R, Krutoshinskaya Y, Rosiello A, Seidman R, Kowalska A, Kudo T, Hata Y, Maehara T, Kumthekar P, Bridge C, Patel V, Rademaker A, Helenowski I, Mrugala M, Rockhill J, Swanson K, Grimm S, Raizer J, Meletath S, Bennett M, Nestor VA, Fink KL, Lee E, Reardon D, Schiff D, Drappatz J, Muzikansky A, Hammond S, Grimm S, Norden A, Beroukhim R, McCluskey C, Chi A, Batchelor T, Smith K, Gaffey S, Gerard M, Snodgras S, Raizer J, Wen P, Leeper H, Johnson D, Lima J, Porensky E, Cavaliere R, Lin A, Liu J, Evans J, Leuthardt E, Dacey R, Dowling J, Kim A, Zipfel G, Grubb R, Huang J, Robinson C, Simpson J, Linette G, Chicoine M, Tran D, Liubinas SV, D'Abaco GM, Moffat B, Gonzales M, Feleppa F, Nowell CJ, Gorelick A, Drummond KJ, Morokoff AP, O'Brien TJ, Kaye AH, Loghin M, Melhem-Bertrandt A, Penas-Prado M, Zaidi T, Katz R, Lupica K, Stevens G, Ly I, Hamilton S, Rostomily R, Rockhill J, Mrugala M, Mandel J, Yust-Katz S, de Groot J, Yung A, Gilbert M, Burzynski S, Janicki T, Burzynski G, Marszalek A, Pachow D, Kliese N, Kirches E, Mawrin C, McNamara MG, Lwin Z, Jiang H, Chung C, Millar BA, Sahgal A, Laperriere N, Mason WP, Megyesi J, Salehi F, Merker V, Slusarz K, Muzikansky A, Francis S, Plotkin S, Mishima K, Adachi JI, Suzuki T, Uchida E, Yanagawa T, Watanabe Y, Fukuoka K, Yanagisawa T, Wakiya K, Fujimaki T, Nishikawa R, Moiyadi A, Kannan S, Sridhar E, Gupta T, Shetty P, Jalali R, Alshami J, Lecavalier-Barsoum M, Guiot MC, Tampieri D, Kavan P, Muanza T, Nagane M, Kobayashi K, Takayama N, Shiokawa Y, Nakamura H, Makino K, Hideo T, Kuroda JI, Shinojima N, Yano S, Kuratsu JI, Nambudiri N, Arrilaga I, Dunn I, Folkerth R, Chi S, Reardon D, Nayak L, Omuro A, DeAngelis L, Robins HI, Govindan R, Gadgeel S, Kelly K, Rigas J, Reimers HJ, Peereboom D, Rosenfeld S, Garst J, Ramnath N, Wing P, Zheng M, Urban P, Abrey L, Wen P, Nayak L, DeAngelis LM, Wen PY, Brandes AA, Soffietti R, Peereboom DM, Lin NU, Chamberlain M, Macdonald D, Galanis E, Perry J, Jaeckle K, Mehta M, Stupp R, van den Bent M, Reardon DA, Norden A, Hammond S, Drappatz J, Phuphanich S, Reardon D, Wong E, Plotkin S, Lesser G, Raizer J, Batchelor T, Lee E, Kaley T, Muzikansky A, Doherty L, LaFrankie D, Ruland S, Smith K, Gerard M, McCluskey C, Wen P, Norden A, Schiff D, Ahluwalia M, Lesser G, Nayak L, Lee E, Muzikansky A, Dietrich J, Smith K, Gaffey S, McCluskey C, Ligon K, Reardon D, Wen P, Bush NAO, Kesari S, Scott B, Ohno M, Narita Y, Miyakita Y, Arita H, Matsushita Y, Yoshida A, Fukushima S, Ichimura K, Shibui S, Okamura T, Kaneko S, Omuro A, Chinot O, Taillandier L, Ghesquieres H, Soussain C, Delwail V, Lamy T, Gressin R, Choquet S, Soubeyran P, Maire JP, Benouaich-Amiel A, Lebouvier-Sadot S, Gyan E, Barrie M, del Rio MS, Gonzalez-Aguilar A, Houllier C, Tanguy ML, Hoang-Xuan K, Omuro A, Abrey L, Raizer J, Paleologos N, Forsyth P, DeAngelis L, Kaley T, Louis D, Cairncross JG, Matasar M, Mehta J, Grimm S, Moskowitz C, Sauter C, Opinaldo P, Torcuator R, Ortiz LD, Cardona AF, Hakim F, Jimenez E, Yepes C, Useche N, Bermudez S, Mejia JA, Asencio JL, Carranza H, Vargas C, Otero JM, Lema M, Pace A, Villani V, Fabi A, Carapella CM, Patel A, Allen J, Dicker D, Sheehan J, El-Deiry W, Glantz M, Tsyvkin E, Rauschkolb P, Pentsova E, Lee M, Perez A, Norton J, Uschmann H, Chamczuck A, Khan M, Fratkin J, Rahman R, Hempfling K, Norden A, Reardon DA, Nayak L, Rinne M, Doherty L, Ruland S, Rai A, Rifenburg J, LaFrankie D, Wen P, Lee E, Ranjan T, Peters K, Vlahovic G, Friedman H, Desjardins A, Reveles I, Brenner A, Ruda R, Bello L, Castellano A, Bertero L, Bosa C, Trevisan E, Riva M, Donativi M, Falini A, Soffietti R, Saran F, Chinot OL, Henriksson R, Mason W, Wick W, Nishikawa R, Dahr S, Hilton M, Garcia J, Cloughesy T, Sasaki H, Nishiyama Y, Yoshida K, Hirose Y, Schwartz M, Grimm S, Kumthekar P, Fralin S, Rice L, Drawz A, Helenowski I, Rademaker A, Raizer J, Schwartz K, Chang H, Nikolai M, Kurniali P, Olson K, Pernicone J, Sweeley C, Noel M, Sharma M, Gupta R, Suri V, Singh M, Sarkar C, Shibahara I, Sonoda Y, Saito R, Kanamori M, Yamashita Y, Kumabe T, Watanabe M, Suzuki H, Watanabe T, Ishioka C, Tominaga T, Shih K, Chowdhary S, Rosenblatt P, Weir AB, Shepard G, Williams JT, Shastry M, Hainsworth JD, Singer S, Riely GJ, Kris MG, Grommes C, Sanders MWCB, Arik Y, Seute T, Robe PAJT, Leijten FSS, Snijders TJ, Sturla L, Culhane JJ, Donahue J, Jeyapalan S, Suchorska B, Jansen N, Wenter V, Eigenbrod S, Schmid-Tannwald C, Zwergal A, Niyazi M, Bartenstein P, Schnell O, Kreth FW, LaFougere C, Tonn JC, Taillandier L, Wittwer B, Blonski M, Faure G, De Carvalho M, Le Rhun E, Tanaka K, Sasayama T, Nishihara M, Mizukawa K, Kohmura E, Taylor S, Newell K, Graves L, Timmer M, Cramer C, Rohn G, Goldbrunner R, Turner S, Gergel T, Lacroix M, Toms S, Ueki K, Higuchi F, Sakamoto S, Kim P, Salgado MAV, Rueda AG, Urzaiz LL, Villanueva MG, Millan JMS, Cervantes ER, Pampliega RA, de Pedro MDA, Berrocal VR, Mena AC, van Zanten SV, Jansen M, van Vuurden D, Huisman M, Hoekstra O, van Dongen G, Kaspers GJ, Schlamann A, von Bueren AO, Hagel C, Kramm C, Kortmann RD, Muller K, Friedrich C, Muller K, von Hoff K, Kwiecien R, Pietsch T, Warmuth-Metz M, Gerber NU, Hau P, Kuehl J, Kortmann RD, von Bueren AO, Rutkowski S, von Bueren AO, Friedrich C, von Hoff K, Kwiecien R, Muller K, Pietsch T, Warmuth-Metz M, Kuehl J, Kortmann RD, Rutkowski S, Walker J, Tremont I, Armstrong T, Wang H, Jiang C, Wang H, Jiang C, Warren P, Robert S, Lahti A, White D, Reid M, Nabors L, Sontheimer H, Wen P, Yung A, Mellinghoff I, Lamborn K, Ramkissoon S, Cloughesy T, Rinne M, Omuro A, DeAngelis L, Gilbert M, Chi A, Batchelor T, Colman H, Chang S, Nayak L, Massacesi C, DiTomaso E, Prados M, Reardon D, Ligon K, Wong ET, Elzinga G, Chung A, Barron L, Bloom J, Swanson KD, Elzinga G, Chung A, Wong ET, Wu W, Galanis E, Wen P, Das A, Fine H, Cloughesy T, Sargent D, Yoon WS, Yang SH, Chung DS, Jeun SS, Hong YK, Yust-Katz S, Milbourne A, Diane L, Gilbert M, Armstrong T, Zaky W, Weinberg J, Fuller G, Ketonen L, McAleer MF, Ahmed N, Khatua S, Zaky W, Olar A, Stewart J, Sandberg D, Foresman L, Ketonen L, Khatua S. NEURO/MEDICAL ONCOLOGY. Neuro Oncol 2013; 15:iii98-iii135. [PMCID: PMC3823897 DOI: 10.1093/neuonc/not182] [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: 08/14/2023] Open
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Hall CL, Moldavsky M, Baldwin L, Marriott M, Newell K, Taylor J, Sayal K, Hollis C. The use of routine outcome measures in two child and adolescent mental health services: a completed audit cycle. BMC Psychiatry 2013; 13:270. [PMID: 24139139 PMCID: PMC4015925 DOI: 10.1186/1471-244x-13-270] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 10/10/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Routine outcome measurement (ROM) is important for assessing the clinical effectiveness of health services and for monitoring patient outcomes. Within Child and Adolescent Mental Health Services (CAMHS) in the UK the adoption of ROM in CAMHS has been supported by both national and local initiatives (such as government strategies, local commissioning policy, and research). METHODS With the aim of assessing how these policies and initiatives may have influenced the uptake of ROM within two different CAMHS we report the findings of two case-note audits: a baseline audit conducted in January 2011 and a re-audit conducted two years later in December 2012-February 2013. RESULTS The findings show an increase in both the single and repeated use of outcome measures from the time of the original audit, with repeated use (baseline and follow-up) of the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) scale increasing from 10% to 50% of cases. Re-audited case-notes contained more combined use of different outcome measures, with greater consensus on which measures to use. Outcome measures that were applicable across a wide range of clinical conditions were more likely to be used than symptom-specific measures, and measures that were completed by the clinician were found more often than measures completed by the service user. CONCLUSIONS The findings show a substantial improvement in the use of outcome measures within CAMHS. These increases in use were found across different service organisations which were subject to different types of local service priorities and drivers.
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Affiliation(s)
- Charlotte L Hall
- CLAHRC, University of Nottingham, Nottingham, UK
- B07 Institute of Mental Health, University of Nottingham, Triumph Road, NG7 2TU Nottingham, UK
| | - Maria Moldavsky
- CAMHS, Nottinghamshire Healthcare NHS Trust, Nottinghamshire, UK
| | - Laurence Baldwin
- CAMHS, Derbyshire Healthcare NHS Foundation Trust, Derbyshire, UK
| | - Michael Marriott
- CAMHS, Nottinghamshire Healthcare NHS Trust, Nottinghamshire, UK
| | - Karen Newell
- CLAHRC, University of Nottingham, Nottingham, UK
| | - John Taylor
- CLAHRC, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Chris Hollis
- Queens Medical Centre, University of Nottingham, Nottingham, UK
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Hall CL, Newell K, Taylor J, Sayal K, Swift KD, Hollis C. 'Mind the gap'--mapping services for young people with ADHD transitioning from child to adult mental health services. BMC Psychiatry 2013; 13:186. [PMID: 23842080 PMCID: PMC3717001 DOI: 10.1186/1471-244x-13-186] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 07/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Once considered to be a disorder restricted to childhood, Attention Deficit/Hyperactivity Disorder (ADHD) is now recognised to persist into adult life. However, service provision for adults with ADHD is limited. Additionally, there is little guidance or research on how best to transition young people with ADHD from child to adult services. METHOD We report the findings of a survey of 96 healthcare professionals working in children's (Child and Adolescent Mental Health Services and Community Paediatrics) and adult services across five NHS Trusts within the East Midlands region of England to gain a better understanding of the current provision of services for young people with ADHD transitioning into adult mental health services. RESULTS Our findings indicate a lack of structured guidelines on transitioning and little communication between child and adult services. Child and adult services had differing opinions on what they felt adult services should provide for ADHD cases. Adult services reported feeling ill-prepared to deal with ADHD patients, with clinicians in these services citing a lack of specific knowledge of ADHD and a paucity of resources to deal with such cases. CONCLUSIONS We discuss suggestions for further research, including the need to map the national provision of services for adults with ADHD, and provide recommendations for commissioned adult ADHD services. We specifically advocate an increase in ADHD-specific training for clinicians in adult services, the development of specialist adult ADHD clinics and greater involvement of Primary Care to support the work of generic adult mental health services in adult ADHD management.
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Affiliation(s)
- Charlotte L Hall
- CLAHRC-NDL, University of Nottingham, Nottingham, UK
- B07 Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham NG7 2TU, UK
| | - Karen Newell
- CLAHRC-NDL, University of Nottingham, Nottingham, UK
| | - John Taylor
- CLAHRC-NDL, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Developmental Psychiatry, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | | | - Chris Hollis
- Developmental Psychiatry, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
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Auer D, Chapman V, Hirsch G, Hale E, Kitas G, Klocke R, Abraham A, Pearce MS, Mann KD, Francis RM, Birrell F, Tucker M, Mellon SJ, Jones L, Price AJ, Dieppe PA, Gill HS, Ashraf S, Chapman V, Walsh DA, McCollum D, McCabe C, Grieve S, Shipley J, Gorodkin R, Oldroyd AG, Evans B, Greenbank C, Bukhari M, Rajak R, Bennett C, Williams A, Martin JC, Abdulkader R, MacNicol C, Brixey K, Stephenson S, Clunie G, Andrews RN, Oldroyd AG, Evans B, Greenbank C, Bukhari M, Clark EM, Gould VC, Carter L, Morrison L, Tobias JH, Pye SR, Vanderschueren D, O'Neill TW, Lee DM, Jans I, Billen J, Gielen E, Laurent M, Claessens F, Adams JE, Ward KA, Bartfai G, Casanueva F, Finn JD, Forti G, Giwercman A, Han TS, Huhtaniemi I, Kula K, Lean ME, Pendleton N, Punab M, Wu FC, Boonen S, Mercieca C, Webb J, Shipley J, Bhalla A, Fairbanks S, Moss KE, Collins C, Sedgwick P, Clark EM, Gould VC, Morrison L, Tobias JH, Parker J, Greenbank C, Evans B, Oldroyd AG, Bukhari M, Harvey NC, Cole ZA, Crozier SR, Ntani G, Mahon PA, Robinson SM, Inskip HM, Godfrey KM, Dennison EM, Cooper C, Bridges M, Ruddick S, Holroyd CR, Mahon P, Crozier SR, Godfrey K, Inskip HM, Cooper C, Harvey NC, Bridges M, Ruddick S, McNeilly T, McNally C, Beringer T, Finch M, Coda A, Davidson J, Walsh J, Fowlie P, Carline T, Santos D, Patil P, Rawcliffe C, Olaleye A, Moore S, Fox A, Sen D, Ioannou Y, Nisar S, Rankin K, Birch M, Finnegan S, Rooney M, Gibson DS, Malviya A, Ferris CM, Rushton SP, Foster HE, Hanson H, Muthumayandi K, Deehan DJ, Birt L, Poland F, MacGregor A, Armon K, Pfeil M, McErlane F, Beresford MW, Baildam EM, Thomson W, Hyrich K, Chieng A, Davidson J, Foster HE, Gardner-Medwin J, Lunt M, Wedderburn L, Gibson DS, Finnegan S, Newell K, Evans A, Manning G, Scaife C, McAllister C, Pennington SR, Duncan M, Moore T, Rooney M, Pericleous C, Croca SC, Giles I, Alber K, Yong H, Isenberg D, Midgely A, Beresford MW, Rahman A, Ioannou Y, Rzewuska M, Mallen C, Strauss VY, Belcher J, Peat G, Byng-Maddick R, Wijendra M, Penn H, Roddy E, Muller S, Hayward R, Mallen C, Kamlow F, Pakozdi A, Jawad A, Green DJ, Muller S, Mallen C, Hider SL, Singh Bawa S, Bawa S, Turton A, Palmer M, Grieve S, Lewis J, Moss T, McCabe C, Goodchild CE, Tang N, Scott D, Salkovskis P, Selvan S, Williamson L, Selvan S, Williamson L, Thalayasingam N, Higgins M, Saravanan V, Rynne M, Hamilton JD, Heycock C, Kelly C, Norton S, Sacker A, Done J, Young A, Smolen JS, Fleischmann RM, Emery P, van Vollenhoven RF, Guerette B, Santra S, Kupper H, Redden L, Kavanaugh A, Keystone EC, van der Heijde D, Weinblatt ME, Mozaffarian N, Guerette B, Kupper H, Liu S, Kavanaugh A, Zhang N, Wilkinson S, Riaz M, Ostor AJ, Nisar MK, Burmester G, Mariette X, Navarro-Blasco F, Oezer U, Kary S, Unnebrink K, Kupper H, Jobanputra P, Maggs F, Deeming A, Carruthers D, Rankin E, Jordan A, Faizal A, Goddard C, Pugh M, Bowman S, Brailsford S, Nightingale P, Tugnet N, Cooper SC, Douglas KM, Edwin Lim CS, Bee Lian Low S, Joy C, Hill L, Davies P, Mukherjee S, Cornell P, Westlake SL, Richards S, Rahmeh F, Thompson PW, Breedveld F, Keystone E, van der Heijde D, Landewe R, Smolen JS, Guerette B, McIlraith M, Kupper H, Liu S, Kavanaugh A, Byng-Maddick R, Penn H, Abdulkader R, Dharmapalaiah C, Shand L, Rose G, Clunie G, Watts R, Eldashan A, Dasgupta B, Borg FA, Bell GM, Anderson AE, Harry RA, Stoop JN, Hilkens CM, Isaacs J, Dickinson A, McColl E, Banik S, Smith L, France J, Bawa S, Rutherford A, Scott Russell A, Smith J, Jassim I, Withrington R, Bacon P, De Lord D, McGregor L, Morrison I, Stirling A, Porter DR, Saunders SA, Else S, Semenova O, Thompson H, Ogunbambi O, Kallankara S, Baguley E, Patel Y, Alzabin S, Abraham S, Taher TE, Palfeeman A, Hull D, McNamee K, Jawad A, Pathan E, Kinderlerer A, Taylor P, Williams RO, Mageed RA, Iaremenko O, Mikitenko G, Ferrari M, Kamalati T, Pitzalis C, Tugnet N, Pearce F, Tosounidou S, Obrenovic K, Erb N, Packham J, Sandhu R, White C, Cardy CM, Justice E, Frank M, Li L, Lloyd M, Ahmed A, Readhead S, Ala A, Fittall M, Manson J, 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Desjuzeur ML, Gemmen EK, Mpofu C, Gottenberg JE, Bukhari M, Shah P, Kitas G, Cox M, Nye A, O'Brien A, Jones P, Sargeant I, Jones GT, Paudyal P, MacPherson H, Sim J, Doherty M, Ernst E, Fisken M, Lewith G, Tadman J, Macfarlane GJ, Mariette X, Bertin P, Arendt C, Terpstra I, VanLunen B, de Longueville M, Zhou H, Cai A, Lacy E, Kay J, Keystone E, Matteson E, Hu C, Hsia E, Doyle M, Rahman M, Shealy D, Scott DL, Ibrahim F, Abozaid H, Choy E, Hassell A, Plant M, Richards S, Walker D, Simpson G, Kowalczyk A, Prouse P, Brown A, George M, Kumar N, Mackay K, Marshall S, Nash PT, Ludivico CL, Delaet I, Qi K, Murthy B, Corbo M, Kaine JL, Emery P, Smolen JS, Samborski W, Berenbaum F, Davies O, Ambrugeat J, Bennett B, Burkhardt H, Prouse P, Brown A, George M, Kumar N, Mackay K, Marshall S, Bykerk V, Ostor AJ, Roman Ivorra J, Wollenhaupt J, Stancati A, Bernasconi C, Sibilia J, Scott DGI, Claydon P, Ellis C, Buchan S, Pope J, Fleischmann R, Dougados M, Bingham CO, Massarotti EM, Wollenhaupt J, Duncan B, Coteur G, Weinblatt M, Hull D, Ball C, Abraham S, Ainsworth T, Kermik J, Woodham J, Haq I, Quesada-Masachs E, Carolina Diaz A, Avila G, Acosta I, Sans X, Alegre C, Marsal S, McWilliams D, Kiely PD, Young A, Walsh DA, Fleischmann R, Bolce R, Wang J, Ingham M, Dehoratius R, Decktor D, Rao V, Pavlov A, Klearman M, Musselman D, Giles J, Bathon J, Sattar N, Lee J, Baxter D, McLaren JS, Gordon MM, Thant KZ, Williams EL, Earl S, White P, Williams J, Westlake SL, Ledingham J, Jan AK, Bhatti AI, Stafford C, Carolan M, Ramakrishnan SA. Muscle disorders * 111. The impact of fatigue in patients with idiopathic inflammatory myopathy: a mixed method study. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes109] [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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Ssebugenyi I, Kizza A, Mpoza B, Aluma G, Boaz I, Newell K, Laeyendecker O, Shott JP, Serwadda D, Reynolds SJ. Comparison of the Abbott m2000 HIV-1 Real-Time and Roche AMPLICOR Monitor v1.5 HIV-1 assays on plasma specimens from Rakai, Uganda. Int J STD AIDS 2011; 22:373-5. [PMID: 21729954 DOI: 10.1258/ijsa.2009.009526] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The need for viral load (VL) monitoring of HIV patients receiving antiretroviral therapy (ART) in resource-limited settings (RLS) has become apparent with studies showing the limitations of immunological monitoring. We compared the Abbott m2000 Real-Time (Abbott) HIV-1 assay with the Roche AMPLICOR Monitor v1.5 (Roche) HIV-1 assay over a range of VL concentrations. Three hundred and eleven plasma samples were tested, including 164 samples from patients on ART ≥ six months and 147 from ART-naïve patients. The Roche assay detected ≥400 copies/mL in 158 (50.8%) samples. Of these, Abbott produced 145 (91.8%) detectable results ≥400 copies/mL; 13 (8.2%) samples produced discrepant results. Concordance between the assays for detecting HIV-1 RNA ≥400 copies/mL was 95.8% (298/311). The sensitivity, specificity, positive predictive value and negative predictive value of Abbott to detect HIV-1 RNA ≥400 copies/mL were 91.8%, 100%, 100% and 92.2%, respectively. For the 151 samples with HIV-1 RNA ≥400 copies/mL for both assays, a good linear correlation was found (r = 0.81, P < 0.0001; mean difference, 0.05). The limits of agreement were -0.97 and 1.07 log(10) copies/mL (mean ± 2 SD). The Abbott assay performed well in our setting, offering an alternative methodology for HIV-1 VL for laboratories with realtime polymerase chain reaction (PCR) capacity.
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Affiliation(s)
- I Ssebugenyi
- Rakai Health Sciences Program, Kalisizo, Rakai, Uganda
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Popescu BFG, Lennon VA, Parisi JE, Howe CL, Weigand SD, Cabrera-Gómez JA, Newell K, Mandler RN, Pittock SJ, Weinshenker BG, Lucchinetti CF. Neuromyelitis optica unique area postrema lesions: nausea, vomiting, and pathogenic implications. Neurology 2011; 76:1229-37. [PMID: 21368286 DOI: 10.1212/wnl.0b013e318214332c] [Citation(s) in RCA: 208] [Impact Index Per Article: 16.0] [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 To characterize the neuropathologic features of neuromyelitis optica (NMO) at the medullary floor of the fourth ventricle and area postrema. Aquaporin-4 (AQP4) autoimmunity targets this region, resulting in intractable nausea associated with vomiting or hiccups in NMO. METHODS This neuropathologic study was performed on archival brainstem tissue from 15 patients with NMO, 5 patients with multiple sclerosis (MS), and 8 neurologically normal subjects. Logistic regression was used to evaluate whether the presence of lesions at this level increased the odds of a patient with NMO having an episode of nausea/vomiting. RESULTS Six patients with NMO (40%), but no patients with MS or normal controls, exhibited unilateral or bilateral lesions involving the area postrema and the medullary floor of the fourth ventricle. These lesions were characterized by tissue rarefaction, blood vessel thickening, no obvious neuronal or axonal pathology, and preservation of myelin in the subependymal medullary tegmentum. AQP4 immunoreactivity was lost or markedly reduced in all 6 cases, with moderate to marked perivascular and parenchymal lymphocytic inflammatory infiltrates, prominent microglial activation, and in 3 cases, eosinophils. Complement deposition in astrocytes, macrophages, and/or perivascularly, and a prominent astroglial reaction were also present. The odds of nausea/vomiting being documented clinically was 16-fold greater in NMO cases with area postrema lesions (95% confidence interval 1.43-437, p = 0.02). CONCLUSIONS These neuropathologic findings suggest the area postrema may be a selective target of the disease process in NMO, and are compatible with clinical reports of nausea and vomiting preceding episodes of optic neuritis and transverse myelitis or being the heralding symptom of NMO.
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Affiliation(s)
- B F Gh Popescu
- Mayo Clinic, College of Medicine, Rochester, MN 55905, USA
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Gibson P, Newell K, Sam D, Mansoor A, Jiang X. P.11 Weight-adjusted dosing of tinzaparin in pregnancy. Thromb Res 2011. [DOI: 10.1016/s0049-3848(11)70066-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Popescu BFG, Parisi JE, Cabrera-Gómez JA, Newell K, Mandler RN, Pittock SJ, Lennon VA, Weinshenker BG, Lucchinetti CF. Absence of cortical demyelination in neuromyelitis optica. Neurology 2011; 75:2103-9. [PMID: 21135384 DOI: 10.1212/wnl.0b013e318200d80c] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To asses the presence of cortical demyelination in brains of patients with neuromyelitis optica (NMO). NMO is an autoimmune inflammatory demyelinating disease that specifically targets aquaporin-4-rich regions of the CNS. Since aquaporin-4 is highly expressed in normal cortex, we anticipated that cortical demyelination may occur in NMO. METHODS This is a cross-sectional neuropathologic study performed on archival forebrain and cerebellar tissue sections from 19 autopsied patients with a clinically and/or pathologically confirmed NMO spectrum disorder. RESULTS Detailed immunohistochemical analyses of 19 archival NMO cases revealed preservation of aquaporin-4 in a normal distribution within cerebral and cerebellar cortices, and no evidence of cortical demyelination. CONCLUSIONS This study provides a plausible explanation for the absence of a secondary progressive clinical course in NMO and shows that cognitive and cortical neuroimaging abnormalities previously reported in NMO cannot be attributed to cortical demyelination. Lack of cortical demyelination is another characteristic that further distinguishes NMO from MS.
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Affiliation(s)
- B F Gh Popescu
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
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20
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Shen L, Kuppachi S, Agarwal A, Turgeon N, Tso P, Newell K, Pearson T, Larsen C, Kirk A. INFLUENCE OF DONOR TYPE ON ELDERLY KIDNEY TRANSPLANT SURVIVAL AND ALLOGRAFT FUNCTION. Transplantation 2008. [DOI: 10.1097/01.tp.0000332432.68459.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Adam Y, van Gelderen CJ, Newell K. 'Look and Lletz'--a Chris Hani Baragwanath Hospital experience. S Afr Med J 2008; 98:119-122. [PMID: 18350207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVES An audit was undertaken of a 'colposcopy and treatment' clinic between April 2003 and December 2006, to determine: (i) the frequency of overtreatment with Papanicolaou smear on its own, colposcopy on its own or a combination of the two methods; (ii) differences in overtreatment between patients who are HIV positive and those who are HIV negative; and (iii) the short-term complications of Lletz (large loop excision of the transformation zone) at this clinic. DESIGN An analysis of the data from the colposcopy clinic database of patients, who were referred according to national guidelines. SETTING Patients who are referred to Chris Hani Baragwanath Hospital. RESULTS Normal histology was found in 1.3% of patients, and cervical intraepithelial neoplasia (CIN)1 or human papillomavirus (HPV) in 8.4%. The overall complication rate was 3%. CONCLUSION The high loss to follow-up and the low early complication rate together with an acceptable overtreatment rate make this a justifiable approach in our situation. HIV-negative women were more likely to be overtreated than HIV-positive patients(p=0.03).
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Affiliation(s)
- Y Adam
- Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg.
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22
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Abstract
This article assesses the suitability of inhaler devices for patients with asthma according to their individual needs. Three main types of inhalers are discussed: pressurised metered dose inhalers, breath-actuated inhalers and dry powder inhalers. The advantages and disadvantages of these devices are discussed in relation to lifestyle, ability and suitability for individuals.
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Green M, Michaels MG, Katz BZ, Burroughs M, Gerber D, Shneider BL, Newell K, Rowe D, Reyes J. CMV-IVIG for prevention of Epstein Barr virus disease and posttransplant lymphoproliferative disease in pediatric liver transplant recipients. Am J Transplant 2006; 6:1906-12. [PMID: 16889546 DOI: 10.1111/j.1600-6143.2006.01394.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [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] [Indexed: 01/25/2023]
Abstract
A randomized controlled trial of CMV-IVIG (cytomegalovirus-intravenous immunoglobulin) for prevention of Epstein Barr virus (EBV) posttransplant lymphoproliferative disease (PTLD) in pediatric liver transplantation (PLTx) recipients was begun in Pittsburgh and subsequently expanded to four additional sites. Protocol EB viral loads were obtained in a blinded fashion; additional loads could be obtained for clinical indications. Patients were followed for 2 years post-LTx. Eighty-two evaluable patients (39 CMV-IVIG, 43 placebo) developed 18 episodes of EBV disease (7 CMV-IVIG, 11 placebo) including nine cases of PTLD (three CMV-IVIG, six placebo). No significant differences were seen in the adjusted 2-year EBV disease-free rate (CMV-IVIG 79%, placebo 71%) and PTLD-free rate (CMV-IVIG 91%, placebo 84%) between treatment and placebo groups at 2 years (p > 0.20). The absence of significant effect of CMV-IVIG may be explained by a lack of efficacy of the drug or limitations of sample size.
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Affiliation(s)
- M Green
- Department of Pediatrics, University of Pitttsburgh School of Medicine, Pennsylvania, USA.
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Abstract
Low levels of concordance with asthma medication programmes have negative effects on patients' short and long-term health. Nurses can support patients to develop self-management skills by listening to their individual concerns and tailoring advice accordingly. Simplifying medication routines and choosing the correct inhaler for individual patients can assist with concordance. Causes, triggers and symptoms associated with asthma and variations in patient responses are also discussed.
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Murphy KM, Savelli B, Newell K. Case report For facial swelling, look below the belt. JAAPA 2005; 18:57-8, 60, 67-8. [PMID: 16255183 DOI: 10.1097/01720610-200510000-00007] [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: 11/26/2022]
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Schroeder SR, Oster-Granite ML, Berkson G, Bodfish JW, Breese GR, Cataldo MF, Cook EH, Crnic LS, DeLeon I, Fisher W, Harris JC, Horner RH, Iwata B, Jinnah HA, King BH, Lauder JM, Lewis MH, Newell K, Nyhan WL, Rojahn J, Sackett GP, Sandman C, Symons F, Tessel RE, Thompson T, Wong DF. Self-injurious behavior: gene-brain-behavior relationships. Ment Retard Dev Disabil Res Rev 2001; 7:3-12. [PMID: 11241877 DOI: 10.1002/1098-2779(200102)7:1<3::aid-mrdd1002>3.0.co;2-#] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper summarizes a conference held at the National Institute of Child Health and Human Development on December 6-7, 1999, on self-injurious behavior [SIB] in developmental disabilities. Twenty-six of the top researchers in the U.S. from this field representing 13 different disciplines discussed environmental mechanisms, epidemiology, behavioral and pharmacological intervention strategies, neurochemical substrates, genetic syndromes in which SIB is a prominent behavioral phenotype, neurobiological and neurodevelopmental factors affecting SIB in humans as well as a variety of animal models of SIB. Findings over the last decade, especially new discoveries since 1995, were emphasized. SIB is a rapidly growing area of scientific interest to both basic and applied researchers. In many respects it is a model for the study of gene-brain-behavior relationships in developmental disabilities.
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Zhou P, Szot G, Guo Z, Kim O, He G, Wang J, Grusby M, Newell K, Thistlethwaite J, Bluestone J, Alegre M. Role of STAT6 signaling in the induction and long-term maintenance of tolerance mediated by CTLA4-Ig. Transplant Proc 2001; 33:214-6. [PMID: 11266784 DOI: 10.1016/s0041-1345(00)01979-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- P Zhou
- University of Chicago, Chicago, Illinois, USA
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Affiliation(s)
- M Alegre
- University of Chicago, Department of Medicine, Section of Rheumatology, Chicago, Illinois, USA.
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Abstract
The consistent regional and laminar distribution of cortical Lewy bodies (LB) in brains of patients with dementia with Lewy bodies (DLB) suggests that only a certain subpopulation of neurons develops these alpha-synuclein-immunoreactive cytoplasmic inclusions. This study examined whether four non-overlapping neuronal subpopulations, defined by the expression of non-phosphorylated neurofilaments (SMI-32) and several calcium binding proteins (parvalbumin, calretinin and calbindin D28k), are vulnerable to LB formation. We performed peroxidase immunostaining to examine the distribution and to quantitate each neuronal subpopulation within the superior temporal sulcus (STS) area, and double-label immunohistochemistry to test for colocalization of alpha-synuclein and each neuronal marker in the STS and the entorhinal cortex. There were no significant differences between DLB brains and controls in the proportional quantity or laminar distribution of each neuronal subpopulation. Parvalbumin-immunoreactive neurons represented around 7%, calbindin D28k 8%, calretinin 10%, and SMI-32 about 20% of the total neuronal population in the STS cortex. Neurons expressing parvalbumin and SMI-32 showed a widespread distribution across layers II to VI. Neurons expressing calretinin were present in superficial layers (II to IV), and calbindin D28k-immunoreactive neurons were mostly distributed within granular layers II and IV. None of the LB observed in the STS or the entorhinal cortex were located in neurons expressing calcium binding proteins; 25% of the LB were contained in SMI-32 immunoreactive neurons. In conclusion, cortical neurons expressing calcium binding proteins are spared in DLB, while SMI-32-positive neurons are affected in proportion to their density in the cortex. However, the majority of cortical LB develop in neurons not identified by any of these markers.
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Affiliation(s)
- E Gómez-Tortosa
- Neurology Department, Massachusetts General Hospital, Charlestown 02129, USA
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Kahane SM, Watt JP, Newell K, Kellam S, Wight S, Smith NJ, Reingold A, Adler R. Immunization levels and risk factors for low immunization coverage among private practices. Pediatrics 2000; 105:E73. [PMID: 10835086 DOI: 10.1542/peds.105.6.e73] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Previous studies have indicated that provider characteristics are an important determinant of immunization coverage. The objectives of this study were to: 1) assess immunization coverage levels among 2-year-old children receiving care in private practices in 3 California counties; and 2) evaluate practice and patient risk factors for low immunization coverage. STUDY DESIGN Cross-sectional chart review of immunization histories and provider survey of immunization policies. SETTING Forty-five randomly selected, private medical practices in 3 counties in California. PATIENTS Children 12 to 35 months old, followed by the participating practices. METHODS Providers underwent a detailed assessment of their immunization coverage and completed a questionnaire describing their immunization policies and procedures. Immunization data were abstracted from randomly selected medical charts of children 12 to 35 months old. Only patients who met the criteria for active status (>/=2 visits and >/=1 visit during the preceding 18 months) were included in analyses. Immunization coverage levels were calculated and logistic regression was used to estimate the risk of underimmunization associated with different practice and child characteristics. RESULTS Of the 72 eligible practices that were contacted, 45 participated in the study, yielding a participation rate of 62%. The median immunization coverage of participating offices was 54% (range: 0%-91%). Multivariate analysis revealed 5 independent risk factors for underimmunization. The strongest predictors were having fewer than 50% active children in the practice and children having fewer than 8 visits to the provider. Other significant predictors were the percentage of patients in the practice on Medicaid, administering diphtheria-tetanus-pertussis 4 at a separate visit from the Haemophilus influenzae type b booster, and practice location. CONCLUSIONS These data provide new insights into immunization practices in an important clinical setting that has been poorly characterized previously. Immunization coverage levels were found to be low and significant risk factors for underimmunization were identified. Recommendations are made for immunization policy changes and targeting of immunization improvement interventions at practices that may be at risk for low immunization coverage. immunization, vaccination, immunization programs, primary prevention, private practice, child, preschool, pediatrics, family practice.
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Affiliation(s)
- S M Kahane
- School of Public Health, University of California, Berkeley, California, USA.
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Gómez-Tortosa E, Newell K, Irizarry MC, Sanders JL, Hyman BT. alpha-Synuclein immunoreactivity in dementia with Lewy bodies: morphological staging and comparison with ubiquitin immunostaining. Acta Neuropathol 2000; 99:352-7. [PMID: 10787032 DOI: 10.1007/s004010051135] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.8] [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] [Indexed: 02/16/2023]
Abstract
alpha-Synuclein is a presynaptic protein recently identified as a specific component of Lewy bodies (LB) and Lewy neurites. The aim of this study was to assess the morphology and distribution of alpha-synuclein immunoreactivity in cases of dementia with LB (DLB), and to compare alpha-synuclein with ubiquitin immunostaining. We examined substantia nigra, paralimbic regions (entorhinal cortex, cingulate gyrus, insula and hippocampus), and neocortex (frontal and occipital association cortices) with double alpha-synuclein and ubiquitin immunostaining in 25 cases meeting neuropathological criteria for DLB. alpha-Synuclein immunostaining was more specific than ubiquitin immunostaining in that it differentiated LB from globose tangles. It was also slightly more sensitive, staining 4-5% more intracytoplasmic structures, especially diffuse alpha-synuclein deposits that were ubiquitin negative. In addition to LB, alpha-synuclein staining showed filiform and globose neurites in the substantia nigra, CA2-3 regions of the hippocampus, and entorhinal cortex. A spectrum of alpha-synuclein staining was seen in substantia nigra: from diffuse "cloud-like" inclusions to aggregated intracytoplasmic inclusions with variable ubiquitin staining to classic LB. We hypothesize that these represent different stages in LB formation.
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Affiliation(s)
- E Gómez-Tortosa
- Neurology Department, Massachusetts General Hospital, Charlestown 02129, USA
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Gómez-Isla T, Growdon WB, McNamara M, Newell K, Gómez-Tortosa E, Hedley-Whyte ET, Hyman BT. Clinicopathologic correlates in temporal cortex in dementia with Lewy bodies. Neurology 1999; 53:2003-9. [PMID: 10599772 DOI: 10.1212/wnl.53.9.2003] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.1] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To address the relationship between dementia and neuropathologic findings in dementia with Lewy bodies (DLB) in comparison with AD. METHODS We evaluated the clinical presentation of autopsy-confirmed DLB in comparison with AD according to new Consortium on DLB criteria and compared the two conditions using quantitative neuropathologic techniques. This clinicopathologic series included 81 individuals with AD, 20 with DLB (7 "pure" DLB and 13 "DLB/AD"), and 33 controls. We counted number of LB, neurons, senile plaques (SP), and neurofibrillary tangles (NFT) in a high order association cortex, the superior temporal sulcus (STS), using stereologic counting techniques. RESULTS The sensitivity and specificity of Consortium on DLB clinical criteria in this series for dementia, hallucinations, and parkinsonism are 53% and 83%, respectively, at the patient's initial visit and 90% and 68%, respectively, if data from all clinic visits are considered. In pathologically confirmed DLB brains, LB formation in an association cortical area does not significantly correlate with duration of illness, neuronal loss, or concomitant AD-type pathology. Unlike AD, there is no significant neuronal loss in the STS of DLB brains unless there is concomitant AD pathology (neuritic SP and NFT). CONCLUSIONS The evaluation of new Consortium on DLB criteria in this series highlights their utility and applicability in clinicopathologic studies but suggests that sensitivity and specificity, especially at the time of the first clinical evaluation, are modest. The lack of a relationship of LB formation to the amount of Alzheimer-type changes in this series suggests that DLB is a distinct pathology rather than a variant of AD.
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Affiliation(s)
- T Gómez-Isla
- Neurology Service, Massachusetts General Hospital, Boston, USA
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Gómez-Tortosa E, Newell K, Irizarry MC, Albert M, Growdon JH, Hyman BT. Clinical and quantitative pathologic correlates of dementia with Lewy bodies. Neurology 1999; 53:1284-91. [PMID: 10522886 DOI: 10.1212/wnl.53.6.1284] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.2] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To examine the distribution of cortical Lewy bodies (LB) and their contribution to the clinical syndrome in dementia with LB (DLB) and to address their relationship to the pathologic markers of AD and PD. METHODS We studied 25 cases meeting neuropathologic criteria for DLB: 13 cases without AD (Braak stage I or II) and 12 cases with concomitant AD changes (Braak stages III to V). Age at onset, disease duration, and clinical symptoms were reviewed for each case. We quantified the regional distribution of LB in substantia nigra, paralimbic areas (cingulate gyrus, insula, entorhinal cortex, and hippocampus), and neocortex (frontal and occipital association areas) using anti-alpha-synuclein immunostaining. We compared the LB pathology between groups of patients with different symptoms at onset or with specific clinical phenotypes. RESULTS There were no significant differences in clinical symptoms or LB density between cases with or without concomitant AD. LB density showed a consistent gradient as follows: substantia nigra > entorhinal cortex > cingulate gyrus > insula > frontal cortex > hippocampus > occipital cortex. LB density in substantia nigra and neocortex was not significantly different in cases that started with parkinsonism compared with those that started with dementia. There were no significant differences in LB density in any region among patients with or without cognitive fluctuations, visual hallucinations, delusions, recurrent falls, or parkinsonism. Duration of the disease correlated with a global LB burden for each case (p = 0.02) but did not correlate with LB density in any individual area. Paralimbic and neocortical LB density were highly correlated with each other (p<0.0001), but neither of these correlated well with the number of LB in substantia nigra. LB density did not correlate with Braak stage or frequency of neuritic plaques. CONCLUSIONS There is a consistent pattern of vulnerability to LB formation across subcortical, paralimbic, and neocortical structures that is similar for DLB cases with or without concomitant AD. Paralimbic and neocortical LB do not correlate with LB in substantia nigra, suggesting that DLB should not be considered just a severe form of PD. LB density correlates weakly with clinical symptoms and disease duration.
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Affiliation(s)
- E Gómez-Tortosa
- Department of Neurology, Massachusetts General Hospital, Charlestown, USA
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Triggs WJ, Menkes D, Onorato J, Yan RS, Young MS, Newell K, Sander HW, Soto O, Chiappa KH, Cros D. Transcranial magnetic stimulation identifies upper motor neuron involvement in motor neuron disease. Neurology 1999; 53:605-11. [PMID: 10449127 DOI: 10.1212/wnl.53.3.605] [Citation(s) in RCA: 90] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the sensitivity of transcranial magnetic stimulation (TMS) to identify upper motor neuron involvement in patients with motor neuron disease. BACKGROUND Diagnosis of ALS depends on upper and lower motor neuron involvement. Lower motor neuron involvement may be documented with electromyography, whereas definite evidence of upper motor neuron involvement may be elusive. A sensitive, noninvasive test of upper motor neuron function would be useful. METHODS TMS and clinical assessment in 121 patients with motor neuron disease. RESULTS TMS revealed evidence of upper motor neuron dysfunction in 84 of 121 (69%) patients, including 30 of 40 (75%) patients with only probable upper motor neuron signs and unsuspected upper motor neuron involvement in 6 of 22 (27%) patients who had purely lower motor neuron syndromes clinically. In selected cases, upper motor neuron involvement identified with TMS was verified in postmortem examination. Increased motor evoked potential threshold was the abnormality observed most frequently and was only weakly related to peripheral compound muscle action potential amplitude. In a subset of 12 patients reexamined after 11+/-6 months, TMS showed progression of abnormalities, including progressive inexcitability of central motor pathways and loss of the normal inhibitory cortical stimulation silent period. CONCLUSIONS TMS provides a sensitive means for the assessment and monitoring of excitatory and inhibitory upper motor neuron function in motor neuron disease.
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Affiliation(s)
- W J Triggs
- Department of Neurology, University of Florida College of Medicine, Gainesville, USA
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Silver M, Newell K, Hedley-White ET, Growden J, Hyman B, Perls T. Cognitive functioning of two centenarians with left hippocampal lesions. Arch Clin Neuropsychol 1999. [DOI: 10.1093/arclin/14.1.65a] [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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Irizarry MC, Growdon W, Gomez-Isla T, Newell K, George JM, Clayton DF, Hyman BT. Nigral and cortical Lewy bodies and dystrophic nigral neurites in Parkinson's disease and cortical Lewy body disease contain alpha-synuclein immunoreactivity. J Neuropathol Exp Neurol 1998; 57:334-7. [PMID: 9600226 DOI: 10.1097/00005072-199804000-00005] [Citation(s) in RCA: 281] [Impact Index Per Article: 10.8] [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] [Indexed: 02/07/2023] Open
Abstract
A mutation in the alpha-synuclein gene has recently been linked to some cases of familial Parkinson's disease (PD). We characterized the expression of this presynaptic protein in the midbrain, striatum, and temporal cortex of control, PD, and dementia with Lewy bodies (DLB) brain. Control brain showed punctate pericellular immunostaining. PD brain demonstrated alpha-synuclein immunoreactivity in nigral Lewy bodies, pale bodies and abnormal neurites. Rare neuronal soma in PD brain were immunoreactive for alpha-synuclein. DLB cases demonstrated these findings as well as alpha-synuclein immunoreactivity in cortical Lewy bodies and CA2-3 neurites. These results suggest that, even in sporadic cases, there is an early and direct role for alpha-synuclein in the pathogenesis of PD and the neuropathologically related disorder DLB.
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Affiliation(s)
- M C Irizarry
- Alzheimer's Disease Research Unit, Massachusetts General Hospital-East, Charlestown 02129, USA
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Silver M, Newell K, Hyman B, Growdon J, Hedley-Whyte ET, Perls T. Unraveling the mystery of cognitive changes in old age: correlation of neuropsychological evaluation with neuropathological findings in the extreme old. Int Psychogeriatr 1998; 10:25-41. [PMID: 9629522 DOI: 10.1017/s1041610298005122] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In order to understand what cognitive changes can be expected with aging versus those caused by disease, the New England Centenarian Study examined correlations between neuropsychological evaluation and neuropathological studies of centenarian subjects. Sixty-nine subjects were administered an extensive neuropsychological test battery designed for centenarians. Six brain donors from this group have subsequently died, and neuropathological studies of their brains have been performed to determine the presence of Alzheimer's disease (AD) and other pathological states. Of these six centenarians, three subjects had Clinical Dementia Rating scores of 0 and no dementia on neuropsychological testing, and subsequent neuropathology showed very limited AD changes. In fact, despite a range of neuropsychological findings, none of the subjects in this series met neuropathological criteria for a diagnosis of definite AD. Findings suggest that dementia is not inevitable with aging and that dementia in this age group is surprisingly often not attributable to AD.
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Affiliation(s)
- M Silver
- Beth Israel Deaconess Medical Center/Harvard Division on Aging, Boston, Massachusetts, USA.
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39
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Abstract
The clinical workup of patients with posttransplantation lymphoproliferative disorders (PTLPDs) frequently involves bone marrow biopsies. However, little is known about the morphologic bone marrow changes in patients with PTLPD. To define the spectrum of morphologic bone marrow changes in such patients, we evaluated the bone marrow biopsy samples of 26 transplant patients with proven extramedullary PTLPD and of 20 transplant patients without PTLPD. Morphologic changes were present in 14 of 26 patients with PTLPD (54%) and consisted of aggregates of lymphoid and plasma cells with variable histologic and cytologic features. Cells expressing Epstein-Barr virus-encoded small transcripts (EBER) were seen in 9 of 13 bone marrow biopsy samples with morphologic changes and in none of the biopsy samples without morphologic changes. Bone marrow changes were significantly more frequent in patients with PTLPD who were younger than 18 years of age (76%) compared with those who were older than 18 years of age (11%). The difference in mortality rates between the patient groups with and without bone marrow changes was statistically not significant, possibly because of the small sample size. The finding that children with PTLPD have an increased incidence of bone marrow changes supports the notion that Epstein-Barr virus-associated PTLPD involves different pathogenetic mechanisms in pediatric patients than in adults.
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Affiliation(s)
- H Koeppen
- Department of Pathology, University of Chicago, Illinois 60637, USA
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40
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Hofer MF, Newell K, Duke RC, Schlievert PM, Freed JH, Leung DY. Differential effects of staphylococcal toxic shock syndrome toxin-1 on B cell apoptosis. Proc Natl Acad Sci U S A 1996; 93:5425-30. [PMID: 8643591 PMCID: PMC39262 DOI: 10.1073/pnas.93.11.5425] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [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] [Indexed: 02/01/2023] Open
Abstract
Superantigens, such as toxic shock syndrome toxin 1 (TSST-1), have been implicated in the pathogenesis of several autoimmune and allergic diseases associated with polyclonal B cell activation. In this report, we studied the in vitro effects of TSST-1 on B cell activation. We show herein that TSST-1 produced antagonistic effects on Ig synthesis by peripheral blood mononuclear cells (PBMC) from normal subjects, depending on the concentration used; Ig production was inhibited at 1000 pg/ml (P < 0.01) and enhanced at 1 and 0.01 pg/ml (P < 0.01) of toxin. Cultures of PBMC were then examined for morphologic features and DNA fragmentation characteristic for apoptosis. B cells exhibited a significantly higher (P < 0.01) incidence of apoptosis after stimulation with 1000 pg/ml of TSST-1 compared with 1 or 0.01 pg/ml of toxin or medium alone. Abundant expression of Fas, a cell surface protein that mediates apoptosis, was detected on B cells after stimulation with 1000 pg/ml of TSST-1 and was significantly higher on B cells undergoing apoptosis than on live cells (P = 0.01). Additionally, increased Fas expression and B cell death occurred at concentrations of TSST-1 inducing the production of high amounts of gamma interferon (IFN-gamma), and both events could be blocked by neutralizing anti-IFN-gamma antibody. These findings suggest that high concentrations of TSST-1 can induce IFN-gamma-dependent B cell apoptosis, whereas at low concentrations it stimulates Ig synthesis by PBMC from normal subjects. These findings support the concept that staphylococcal toxins have a role in B cell hyperactivity in autoimmunity and allergy.
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Affiliation(s)
- M F Hofer
- Division of Pediatric Allergy-Immunology, The National Jewish Center for Immunology and Respiratory Medicine, Denver, CO 80206, USA
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Wood PJ, Sansom JM, Newell K, Tannock IF, Stratford IJ. Reduction of tumour intracellular pH and enhancement of melphalan cytotoxicity by the ionophore Nigericin. Int J Cancer 1995; 60:264-8. [PMID: 7829226 DOI: 10.1002/ijc.2910600222] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [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] [Indexed: 01/27/2023]
Abstract
Nigericin is an ionophore which permits the influx of H+ ions into cells down a concentration gradient, thus reducing intracellular pH (pHi) when extracellular pH is low. The effects of nigericin on the pHi of solid murine tumours in vivo were examined using 31P magnetic resonance spectroscopy. Nigericin at 2.5 mg/kg i.p. reduced pHi by 0.2-0.3 pH unit in the KHT and RIF-I tumours but had no effect on pHi in the SCCVII/Ha tumour. In vitro studies have shown that reduced pH can increase the toxicity of melphalan. Therefore, the anti-tumour effect of combining nigericin with melphalan was also examined. Nigericin at 2.5 mg/kg i.p. given before various doses of melphalan resulted in substantial delay in growth of the RIF-I tumour over that induced by melphalan alone. This observation was confirmed by an in vivo/in vitro excision assay, where nigericin given before melphalan produced a 30-fold increase in cell killing. By contrast, no enhancement of melphalan-induced cell killing by nigericin was observed in the KHT and SCCVII/Ha tumours, using growth delay and in vivo/in vitro excision assays, respectively.
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Affiliation(s)
- P J Wood
- MRC Radiobiology Unit, Didcot, Oxon, UK
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42
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Newell K, Franchi A, Pouysségur J, Tannock I. Studies with glycolysis-deficient cells suggest that production of lactic acid is not the only cause of tumor acidity. Proc Natl Acad Sci U S A 1993; 90:1127-31. [PMID: 8430084 PMCID: PMC45824 DOI: 10.1073/pnas.90.3.1127] [Citation(s) in RCA: 150] [Impact Index Per Article: 4.8] [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] [Indexed: 01/30/2023] Open
Abstract
Solid tumors have been observed to develop an acidic extracellular environment, which is believed to occur as a result of lactic acid accumulation produced during aerobic and anaerobic glycolysis. Experiments using glycolysis-deficient ras-transfected Chinese hamster lung fibroblasts have been performed to test the hypothesis that lactic acid production within solid tumors is responsible for the development of tumor acidity. The variant cells have defects in glucose transport and in the glycolytic enzyme phosphoglucose isomerase with 1% activity compared to parental cells. Consequently, the in vitro rate of lactic acid production by variant cells was < 4% compared to parental cells. An in vitro correlation between lactic acid production and acidification of exposure medium was observed for parental and variant cells. Implantation of both cell lines into nude mice led to tumors with minimal difference in growth rate. As expected, variant cells died when exposed to hypoxic conditions in culture, and parental tumors were observed to have a larger fraction of cells resistant to radiation due to hypoxia (27%) than variant tumors (2%). Using pH microelectrodes, parental (n = 12) and variant (n = 12) tumors were observed to have extracellular pH (pHe) values of 6.65 +/- 0.07 and 6.78 +/- 0.04 (mean +/- SE, P = 0.13), respectively, whereas normal muscle had a pHe of 7.29 +/- 0.06 (P < 0.0001 for both cell lines). The lactic acid content of variant tumors was found to be similar to that in serum, whereas parental tumors had lactic acid content that was higher than in serum (P < 0.0001). We conclude that there was no correlation between lactic acid content and acidosis for these tumors derived from ras-transfected fibroblasts. These results provide evidence that the production of lactic acid via glycolysis is not the only mechanism responsible for the development of an acidic environment within solid tumors.
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Affiliation(s)
- K Newell
- Department of Medical Biophysics, University of Toronto, ONT, Canada
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43
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Abstract
Cell killing can be achieved in an acidic environment in tissue culture (medium pH less than 7.0) by agents (nigericin, carbonylcyanide-3-chlorophenylhydrazone (CCCP)) which transport protons from the extracellular space into the cytoplasm. Cell killing is enhanced when these agents are used in combination with compounds (amiloride, 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid (DIDS)) which inhibit the membrane-based exchangers responsible for the regulation of intracellular pH (pHi). We describe experiments which assess the ability of these agents to kill tumour cells in spheroids and in vivo. Both nigericin and CCCP were observed to penetrate tissue based on their ability to kill tumour cells in spheroids. The mean extracellular pH (pHe) of the KHT fibrosarcoma and the EMT-6 sarcoma were observed to be 0.21 and 0.32 pH units more acidic than the mean pHe in muscle tissue. Intraperitoneal (i.p.) administration of the vasodilator hydralazine (10 mg kg-1) caused a reduction of the mean pHe of the KHT but not the EMT-6 tumour. Nigericin (2.5 mg kg-1, i.p.) plus amiloride (10 mg kg-1, i.p.) followed 30 min later by hydralazine (10 mg kg-1, i.p.) reduced the surviving fraction of cells in the KHT and EMT-6 tumours, but had minimal effects on growth delay. When KHT tumours were treated with 15 Gy X-rays followed immediately by nigericin plus amiloride and hydralazine a reduced surviving fraction as well as an increase in tumour growth delay was observed compared to radiation alone. The administration of nigericin (2.5 mg kg-1, i.p.) or the combination of nigericin (2.5 mg kg-1, i.p.) followed by hydralazine (10 mg kg-1, intravenous (i.v.)) resulted in reductions of tumour pHi of 0.27 and 0.29 pH units respectively as determined by 31P magnetic resonance spectroscopy (MRS). Our results show that the combination of nigericin and hydralazine (with or without amiloride) can kill cells in rodent solid tumours and that cell killing is associated with a reduction in the mean pHi of tumour cells.
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Affiliation(s)
- K Newell
- Department of Medical Biophysics, University of Toronto, Ontario, Canada
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Gell FM, White EM, Newell K, Mackenzie I, Smith A, Thompson S, Hatcher J. Practical screening priorities for hearing impairment among children in developing countries. Bull World Health Organ 1992; 70:645-55. [PMID: 1464152 PMCID: PMC2393373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Routine screening for hearing impairment in childhood is now widespread in industrial countries, although there is considerable controversy over the most efficient techniques and procedures. In most developing countries, however, routine screening programmes for hearing impairment do not currently exist. The problems involved in implementing screening programmes in developing and industrial countries are very different, and in selecting screening procedures for a particular population the following factors have to be taken into consideration: the environmental test conditions; the availability of resources for equipment and the training of testers; the local attitudes towards disability; the level of hearing impairment that may cause handicaps; and the major types of pathology causing hearing impairment. We suggest that in developing countries children should be screened at school entry using a simple field audiometer and that the external ear be inspected for the presence of a discharge. There is an urgent need to develop reliable and simple screening procedures for infants and young children; where possible, all children should be screened for severe or significant hearing impairment before the age of 2 years. No screening should, however, be implemented until appropriate follow-up services are available.
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Affiliation(s)
- F M Gell
- Acción Rural Fe y Alegria, Sucre, Bolivia
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45
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Julius M, Newell K, Maroun C, Haughn L. Functional consequences of CD4-TCR/CD3 interactions. Semin Immunol 1991; 3:161-6. [PMID: 1832322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The relative positions of CD4 and of the T cell receptor complex for antigen (TCR/CD3) determine whether signalling through the antigen receptor results in T cell growth. The following discussion focusses on those central observations which demonstrate that CD4 and the associated protein tyrosine kinase p56lck provide critical signals modulating the biological responses induced through the TCR/CD3 complex. Based on the available evidence, we suggest that antigen-mediated co-aggregation of CD4/Lck and TCR/CD3 is an obligate activation signal and that, in its absence, signalling through TCR alpha beta induces T cell death. The role of CD4 in self-non-self discrimination would therefore be critical and would provide a mechanism for the maintenance of peripheral T cell tolerance to non-major histocompatibility complex-related self-antigens.
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Affiliation(s)
- M Julius
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
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46
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Dobrowsky E, Newell K, Tannock IF. The potential of lactate and succinate to kill nutrient deprived tumor cells by intracellular acidification. Int J Radiat Oncol Biol Phys 1991; 20:275-9. [PMID: 1991688 DOI: 10.1016/0360-3016(91)90104-c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We have investigated the ability of the weak acids, lactate, succinate, and the monomethylester of succinate, to cause intracellular acidification of EMT-6 and MGH-U1 cells. Each of the three substances caused a decrease of intracellular pH (pHi) when the cell lines were exposed at low extracellular pH (pHe) in the range 6.0-6.5. Only monomethylsuccinate caused intracellular acidification at neutral pHe. The fall in pHi increased with increasing dose of each agent and with decreasing pHe. The pHi recovered to almost normal values after exposure of 30 minutes to 50 mM lactate, but there was little or no recovery of pHi in the presence of succinate or monomethylsuccinate. Succinate and its methylester were toxic to cells at low pHe (less than 6.5), and cell killing increased with exposure time and with dose of the agents used. Lactate did not cause cell death at low pHe, and none of the three substances exhibited any cytotoxicity at neutral pHe. Solid tumors are known to have an acidic microenvironment, and pHe may be particularly low in regions of hypoxia. Succinate and its monomethylester may have the potential to kill cells in acidic regions of tumors and might therefore enhance the effect of radiation.
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Affiliation(s)
- E Dobrowsky
- Physics Division, Ontario Cancer Institute, Toronto, Canada
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47
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McHenry C, Newell K, Chejfec G, Barbato A, Lawrence AM, Brooks M, Emanuele MA, Paloyan E. Adult nesidioblastosis. An unusual cause of fasting hypoglycemia. Am Surg 1989; 55:366-9. [PMID: 2729774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Laidlaw coined the term nesidioblastosis in 1938 to characterize the neodifferentiation of the islet cells of Langerhans from pancreatic duct epithelium. It is well recognized in the pediatric population as a frequent cause of persistent neonatal hypoglycemia. However, its occurrence in adults is presumed to be rare and, therefore, it is not appreciated as a cause of hyperinsulinism. Three women, aged 29, 42, and 63, with adult onset hyperinsulinism secondary to nesidioblastosis are reported. All three patients required near-total pancreatectomy. The preoperative findings were consistent with hyperinsulinemic hypoglycemia as with insulinomas. Results of pancreatic imaging studies were normal in two patients and one patient had a pancreatic examination by computerized tomography and magnetic resonance imaging, with false-positive results. Two of the three patients had previously undergone a 50 per cent distal pancreatectomy in which the resected specimens were interpreted as normal in one patient and consistent with nesidioblastosis in the second. Both patients subsequently developed recurrent symptomatic hyperinsulinemic hypoglycemia that persisted despite dosage adjustments in diazoxide therapy. The oldest patient underwent a 95 per cent pancreatectomy at the initial surgical exploration because an insulinoma could not be identified. The other patients underwent a completion 95 per cent pancreatectomy. In both, histochemical examination of each specimen disclosed nesidioblastosis, characterized by clusters of islet cells interspersed throughout the exocrine tissue.
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Affiliation(s)
- C McHenry
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
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Marks WH, Salvino C, Newell K, Wider M, Marks C. Circulating concentrations of porcine ileal peptide but not hexosaminidase are elevated following 1 hr of mesenteric ischemia. J Surg Res 1988; 45:134-9. [PMID: 2969065 DOI: 10.1016/0022-4804(88)90032-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Porcine Ileal Peptide (PIP) is located in the mucosa of the small bowel. We hypothesized that PIP may be useful as a marker for early intestinal ischemia or other acute processes of the mucosa. To test this hypothesis we developed a model of acute reversible intestinal ischemia in the pig. Following isolation of a 100-cm segment of ileum on a vascular pedicle baseline, serum and tissue samples were obtained. The vessels were then occluded for 60 min and the segment was reperfused. Serial serum samples were taken and analyzed for PIP and hexosaminidase (HEX). HEX enzyme activity in serum is known to be elevated in animals having intestinal necrosis. The Student t test for paired data was used. In preliminary studies we found that circulating HEX activity became elevated following 3 to 4 hr of vessel occlusion followed by reperfusion. In the current experiments, following 1 hr of ischemia, PIP rose significantly in the peripheral circulation, being 153.8 +/- 76.8, 909.0 +/- 150.4, and 898.3 +/- 128.1 ng/ml (P less than 0.001) at 0, 60, and 360 min after reperfusion of the segment. HEX on the other hand did not change significantly throughout the experiment, having been 766.0 +/- 28.1, 752.0 +/- 71.3, and 780.1 +/- 53.7 nM/liter (ns) at 0, 60, and 360 min following reperfusion of the segment. Histology demonstrated some clubbing, shortening and fracturing of villi with thinning of the tips of the villi in many cases. Immunospecific staining for PIP was present along the intact borders of the villi.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- W H Marks
- Department of Surgery, Loyola University, Maywood, Illinois
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Abstract
Of 26 patients with pheochromocytoma treated between 1974 and 1986, two presented with pheochromocytoma crisis. This unusual presentation consists of hyper- and/or hypotension, high fevers (greater than 40 degrees C), encephalopathy, and multiple organ system failure. Both patients had large tumors associated with markedly elevated levels of epinephrine. Although hypertension was adequately controlled in both patients with phenoxybenzamine, phentolamine (1 patient) and nitroprusside, both patients deteriorated rapidly. The first patient expired during attempts to identify a source of sepsis. None was found at autopsy. The second patient underwent urgent adrenalectomy which reversed the multiple organ system failure and resulted in patient survival. We conclude from review of these patients and three others in the literature that (a) crisis is an unusual presentation of pheochromocytoma; (b) its manifestations include vascular lability, high fever, encephalopathy and multiple organ system failure; (c) it may be the result of increased epinephrine secretion; (d) successful treatment of pheochromocytoma crisis demands prompt diagnosis, vigorous medical therapy and emergent tumor removal if the patient continues to deteriorate.
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Affiliation(s)
- K Newell
- Loyala University Medical Center, Department of Surgery and Medicine, Maywood, Illinois 60153
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Abstract
“Equitable resource distribution” is one of the health policy indicators used to monitor the World Health Organization's (WHO) Health for All by the Year 2000 strategy. However, many countries find the monitoring of equity problematic because it is a difficult notion to define. This article discusses various possible definitions and concludes that equality of expenditure per unit of population (or preferably, per unit of need) is the best definition of equity to pursue In operational terms. However, the weaknesses of this approach are acknowledged — most importantly, the definition ignores the fact that geography and the distribution of the population into small, Isolated groups result in different costs for equivalent items of service. This is clearly of great relevance to Pacific Island states. The state of resource distribution in 1986 in the government health services in Fiji is examined. Only equity amongst divisions and provinces — i.e., geographical equity — is considered. Per capita annual expenditure ranges from F$15.70 in Nadroga and Navosa province to F$36.20 in Naitasiri. It would be premature to conclude that such a distribution is necessarily inequitable and unfair. Rather, the data should be seen as a springboard for further research to investigate to what extent, if at all, the “over-funding” of some divisions and provinces is justified. This article does not answer neatly the question: are government health service resources distributed fairly in Fiji? This cannot be done without the development of either nationally defined norms of service or calculations of the costs of meeting needs in different regions. Finally, it is emphasised that empirical investigations into equity will lead nowhere unless the political will exists to supply services fairly, regardless of the user's race, religion or place of residence.
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