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Homer C, Neylon K, Kennedy K, Baird K, Gilkison A, Keogh S, Middleton S, Gray R, Whitehead L, Finn J, Rickard C, Sharplin G, Neville S, Eckert M. Midwife led randomised controlled trials in Australia and New Zealand: A scoping review. Women Birth 2023; 36:401-408. [PMID: 36894484 DOI: 10.1016/j.wombi.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Midwives are the largest workforce involved in caring for pregnant women and their babies, and are well placed to translate research into practice and ensure midwifery priorities are appropriately targeted in researched. Currently, the number and focus of randomised controlled trials led by midwives in Australia and New Zealand is unknown. The Australasian Nursing and Midwifery Clinical Trials Network was established in 2020 to build nursing and midwifery research capacity. To aid this, scoping reviews of the quality and quantity of nurse and midwife led trials were undertaken. AIM To identify midwife led trials conducted between 2000 and 2021 in Australia and New Zealand. METHODS This review was informed by the JBI scoping review framework. Medline, Emcare, and Scopus were searched from 2000-August 2021. ANZCTR, NHMRC, MRFF, and HRC (NZ) registries were searched from inception to July 2021. FINDINGS Of 26,467 randomised controlled trials registered on the Australian and New Zealand Clinical Trials Registry, 50 midwife led trials, and 35 peer-reviewed publications were identified. Publications were of moderate to high quality with scores limited due to an inability to blind participants or clinicians. Blinding of assessors was included in 19 published trials. DISCUSSION Additional support for midwives to design and conduct trials and publish findings is required. Further support is needed to translate registration of trial protocols into peer reviewed publications. CONCLUSION These findings will inform the Australasian Nursing and Midwifery Clinical Trials Network plans to promote quality midwife led trials.
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Affiliation(s)
| | - Kim Neylon
- Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, South Australia, Australia
| | - Kate Kennedy
- Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, South Australia, Australia
| | - Kathleen Baird
- University Technology Sydney, School of Nursing and Midwifery, New South Wales, Australia
| | - Andrea Gilkison
- Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand
| | - Samantha Keogh
- Queensland University of Technology, Faculty of Health, School of Nursing, Queensland, Australia
| | - Sandy Middleton
- Australian Catholic University, Nursing Research Institute, New South Wales, Australia
| | | | | | - Judith Finn
- Curtin University, Faculty of Health Sciences, Curtin School of Nursing, Western Australia, Australia
| | - Claire Rickard
- University of Queensland, School of Nursing, Midwifery and Social Work, Queensland, Australia
| | - Greg Sharplin
- Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, South Australia, Australia
| | - Stephen Neville
- Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, South Australia, Australia.
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Eckert M, Kennedy K, Neylon K, Rickard CM, Keogh S, Gray R, Middleton S, Homer C, Whitehead L, Sharplin G. A scoping review of nurse-led randomised controlled trials. J Clin Nurs 2023; 32:5550-5561. [PMID: 36737840 DOI: 10.1111/jocn.16632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/14/2022] [Accepted: 01/04/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Nurses comprise the largest portion of the healthcare workforce worldwide. However, nurse representation in the leadership of clinical research and research funding is largely unknown. The Australasian Nursing and Midwifery Clinical Trials Network was established to provide a coordinated network, focussed on building research capacity in nursing and midwifery. To support this work, this scoping review of nurse-led randomised controlled trials was conducted to summarise research activity, as well as highlight future research directions, gaps and resources. Midwife-led trials will be reported elsewhere. AIM To quantify number, type and quality of nurse-led randomised controlled trials registered between 2000-2021. DESIGN A scoping review of RCTs. DATA SOURCES Medline, Emcare and Scopus were searched from 2000 to August 2021. ANZCTR, NHMRC, MRFF and HRC (NZ) registries were searched from inception to July 2021. REVIEW METHODS This review was informed by the JBI scoping review framework using the PRISMA-ScR. RESULTS Our search yielded 188 nurse-led publications and 279 registered randomised controlled trials. Multiple trials had the same nurse leaders. There were more registrations than publications. Publications were predominantly of high methodological quality; however, there was a reliance on active controls and blinding was low. Trial registrations indicate that universities and hospital/healthcare organisations were the major sources of funding, while publications indicate that Governments and the National Health and Medical Research Council were the main funding bodies. CONCLUSION A small number of high-quality, large-scale, nationally funded randomised controlled trials were identified, with a larger number of locally funded small trials. There was a disparity between the number of registered trials and those published. Additional infrastructure, funding and career frameworks are needed to enable nurses to design, conduct and publish clinical trials that inform the health system and improve health outcomes. RELEVANCE TO CLINICAL PRACTICE Research initiated and led by nurses has the potential to improve the health and well-being of individuals and communities, and current nurse-led research is of high methodological quality; however, there were very few nurse-led RCTs, conducted by a small pool of nurse researchers. This gap highlights the need for support in the design, conduct and publishing of nurse-led RCTs. PATIENT OR PUBLIC CONTRIBUTION This is a scoping review; therefore, patient or public contribution is not applicable.
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Affiliation(s)
- Marion Eckert
- Clinical and Health Sciences Unit, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
- Australasian Nursing and Midwifery Clinical Trials Network (ANMCTN), Adelaide, South Australia, Australia
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Kate Kennedy
- Clinical and Health Sciences Unit, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Kim Neylon
- Clinical and Health Sciences Unit, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Claire M Rickard
- Australasian Nursing and Midwifery Clinical Trials Network (ANMCTN), Adelaide, South Australia, Australia
- School of Nursing, Midwifery, and Social Work & Herston Infectious Diseases Institute, The University of Queensland & Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Samantha Keogh
- Australasian Nursing and Midwifery Clinical Trials Network (ANMCTN), Adelaide, South Australia, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Richard Gray
- Australasian Nursing and Midwifery Clinical Trials Network (ANMCTN), Adelaide, South Australia, Australia
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Sandy Middleton
- Australasian Nursing and Midwifery Clinical Trials Network (ANMCTN), Adelaide, South Australia, Australia
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, New South Wales, Australia
| | - Caroline Homer
- Australasian Nursing and Midwifery Clinical Trials Network (ANMCTN), Adelaide, South Australia, Australia
- Maternal, Newborn and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Lisa Whitehead
- Australasian Nursing and Midwifery Clinical Trials Network (ANMCTN), Adelaide, South Australia, Australia
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Greg Sharplin
- Clinical and Health Sciences Unit, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
- Australasian Nursing and Midwifery Clinical Trials Network (ANMCTN), Adelaide, South Australia, Australia
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Ramsey I, Kennedy K, Sharplin G, Eckert M, Peters MDJ. Culturally safe, appropriate, and high-quality breast cancer screening for transgender people: A scoping review. Int J Transgend Health 2023; 24:174-194. [PMID: 37114110 PMCID: PMC10128429 DOI: 10.1080/26895269.2022.2155289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Background There is a recognized need for evidence to inform breast cancer screening guidelines and services for transgender people, who face barriers to accessing appropriate and inclusive health care. Aims This review summarized evidence for breast cancer risk and screening guidelines in transgender individuals, including the potential impact of gender-affirming hormone therapy (GAHT); factors that may influence screening decision-making and behaviors; and considerations for providing culturally safe, high-quality screening services. Methods A protocol was developed based on the Joanna Briggs Institute scoping review methodology. Searches were performed in Medline, Emcare, Embase, Scopus, and the Cochrane Library for articles reporting information on the provision of culturally safe, high-quality breast cancer screening services for transgender people. Results We identified 57 sources for inclusion: 13 cross-sectional studies, 6 case reports, 2 case series, 28 review or opinion articles, 6 systematic reviews, 1 qualitative study, and 1 book chapter. Evidence on rates of breast cancer screening among transgender people and the association between GAHT and breast cancer risk was inconclusive. Factors negatively associated with cancer screening behaviors included socioeconomic barriers, stigma, and lack of health provider awareness of transgender health issues. Breast cancer screening recommendations varied and were generally based on expert opinion due to the lack of clear evidence. Considerations for providing culturally safe care to transgender people were identified and mapped to the areas of workplace policies and procedures, patient information, clinic environment, professional conduct, communication, and knowledge and competency. Discussion Screening recommendations for transgender individuals are complicated by the lack of robust epidemiological data and clear understanding of the role GAHT may play in breast cancer pathogenesis. Guidelines have been developed based on expert opinion and are subsequently not uniform or evidence based. Further work is required to clarify and consolidate recommendations.
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Affiliation(s)
- Imogen Ramsey
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Kate Kennedy
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Greg Sharplin
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Micah D. J. Peters
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
- Faculty of Health and Medical Sciences, Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
- The Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence, Adelaide, Australia
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Hall DE, Youk A, Allsup K, Kennedy K, Byard TD, Dhupar R, Chu D, Rahman AM, Wilson M, Cahalin LP, Afilalo J, Forman DE. Preoperative Rehabilitation Is Feasible in the Weeks Prior to Surgery and Significantly Improves Functional Performance. J Frailty Aging 2023; 12:267-276. [PMID: 38008976 PMCID: PMC10683858 DOI: 10.14283/jfa.2022.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
BACKGROUND Frailty is a multidimensional state of increased vulnerability. Frail patients are at increased risk for poor surgical outcomes. Prior research demonstrates that rehabilitation strategies deployed after surgery improve outcomes by building strength. OBJECTIVES Examine the feasibility and impact of a novel, multi-faceted prehabilitation intervention for frail patients before surgery. DESIGN Single arm clinical trial. SETTING Veterans Affairs hospital. PARTICIPANTS Patients preparing for major abdominal, urological, thoracic, or cardiac surgery with frailty identified as a Risk Analysis Index≥30. INTERVENTION Prehabilitation started in a supervised setting to establish safety and then transitioned to home-based exercise with weekly telephone coaching by exercise physiologists. Prehabilitation included (a)strength and coordination training; (b)respiratory muscle training (IMT); (c)aerobic conditioning; and (d)nutritional coaching and supplementation. Prehabilitation length was tailored to the 4-6 week time lag typically preceding each participant's normally scheduled surgery. MEASUREMENTS Functional performance and patient surveys were assessed at baseline, every other week during prehabilitation, and then 30 and 90 days after surgery. Within-person changes were estimated using linear mixed models. RESULTS 43 patients completed baseline assessments; 36(84%) completed a median 5(range 3-10) weeks of prehabilitation before surgery; 32(74%) were retained through 90-day follow-up. Baseline function was relatively low. Exercise logs show participants completed 94% of supervised exercise, 78% of prescribed IMT and 74% of home-based exercise. Between baseline and day of surgery, timed-up-and-go decreased 2.3 seconds, gait speed increased 0.1 meters/second, six-minute walk test increased 41.7 meters, and the time to complete 5 chair rises decreased 1.6 seconds(all P≤0.007). Maximum and mean inspiratory and expiratory pressures increased 4.5, 7.3, 14.1 and 13.5 centimeters of water, respectively(all P≤0.041). CONCLUSIONS Prehabilitation is feasible before major surgery and achieves clinically meaningful improvements in functional performance that may impact postoperative outcomes and recovery. These data support rationale for a larger trial powered to detect differences in postoperative outcomes.
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Affiliation(s)
- D E Hall
- Daniel E Hall, UPMC Presbyterian Hospital, Suite F12, 200 Lothrop St, Pittsburgh, PA 15213, P:412.647.0421|F:412.647.1448,
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Becker F, Marcantonio F, Datta S, Wichterich C, Cizmas L, Surber J, Kennedy K, Bowles E. Tracking the source of contaminant lead in children's blood. Environ Res 2022; 212:113307. [PMID: 35447155 DOI: 10.1016/j.envres.2022.113307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/09/2022] [Accepted: 04/10/2022] [Indexed: 06/14/2023]
Abstract
Pb isotope ratios are used for apportioning the sources of Pb in the blood of children (ages 1-6) screened for high blood Pb levels (>5 μg/dL) surrounding urban areas of Kansas City, MO. We compared Pb isotope ratios measured in the child's blood with those of the most likely sources of Pb in that child's home environment. The environmental sources sampled consisted of topsoils, paints, occupational sources (e.g., oil rig workers' uniforms, mechanics' clothes), indoor air filters, dusts, and dietary sources (e.g., spices). Blood lead levels (BLL) ranged from 2.9 to 12.7 μg/dL in children from the five homes participating in this study. Measurements of 206Pb/204Pb, 207Pb/204Pb and 208Pb/204Pb isotope ratios were made by multi-collector ICP-MS. Comparison of the Pb isotope ratios in home environment samples versus those in the child's blood in each home allowed the identification of possible sources of a child's Pb exposure in three homes. In five homes investigated, children's blood Pb levels were most likely to be derived from dusts inside, and topsoil outside, the homes, or a mixture thereof. In one case, blood Pb was derived from turmeric spice and, in another, the Pb was derived from paint. It is not always possible to directly link high BLLs to the environmental sources collected when Pb isotope ratios of the environmental samples did not overlap with those of the blood.
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Affiliation(s)
- F Becker
- Department of Geology and Geophysics, Texas A&M University, College Station, TX, USA
| | - F Marcantonio
- Department of Geology and Geophysics, Texas A&M University, College Station, TX, USA.
| | - S Datta
- Department of Earth and Planetary Sciences, University of Texas, San Antonio, TX, USA
| | - C Wichterich
- Department of Geology and Geophysics, Texas A&M University, College Station, TX, USA
| | - L Cizmas
- School of Public Health, Texas A&M University, College Station, TX, USA
| | - J Surber
- Department of Geology, Kansas State University, Manhattan, KS, USA
| | - K Kennedy
- Children's Mercy Kansas City Environmental Health Program, Kansas City, MO, USA
| | - E Bowles
- Children's Mercy Kansas City Environmental Health Program, Kansas City, MO, USA
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Krause D, Sharrah K, Gross A, Bowers D, Mulkerin D, Brandt N, Kennedy K, Austin A, Begue A, Bell R, Raczyk C, Pickard T, Kubal T, Johnson D, Jeffries K, Dest V, Randall R, Sugalski J, Zecha G. Measuring Advanced Practice Provider Productivity at the National Comprehensive Cancer Network’s Member Institutions. J Adv Pract Oncol 2022; 13:507-513. [PMID: 35910498 PMCID: PMC9328455 DOI: 10.6004/jadpro.2022.13.5.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: The utilization of advanced practice providers (APPs) in oncology has been growing over the last decade; however, there is no standard method for assessing an APP's contributions to oncology care. Methods: The NCCN Best Practices Committee (BPC) created an APP Workgroup to develop recommendations to support the roles of APPs at NCCN Member Institutions. The Workgroup conducted surveys to understand how NCCN centers measure productivity. This article will review the survey results and provide recommendations for measuring APP productivity. Results: Although 54% of responding centers indicated they utilize relative value units (RVU) targets for independent APP visits, 88% of APPs are either unsure or do not believe RVUs are an effective measurement of overall productivity. Relative value units do not reflect non-billable hours, and APPs perform a significant number of non-billable tasks that are important to oncology practices. Sixty-six percent of APPs believe that measuring disease-based team productivity is a more reasonable assessment of APP productivity than measuring productivity at the individual level. Conclusion: Our recommendation for cancer centers is to focus on the value that APPs provide to overall care delivery. Advanced practice provider productivity metrics should consider not only the number of patients seen by APPs, but also the high quality and thorough care delivered that contributes to the overall care of the patient and practice. Advanced practice providers can help improve access to care, deliver improved outcomes, and increase patient and provider satisfaction. Reducing the focus on RVUs, accounting for important non-RVU–generating activities, and incorporating quality and team metrics will provide a better overall picture of APP productivity.
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Affiliation(s)
- Diana Krause
- From National Comprehensive Cancer Network (NCCN), Plymouth Meeting, Pennsylvania
| | - Karen Sharrah
- City of Hope National Medical Center, Duarte, California
| | - Anne Gross
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Daniel Mulkerin
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Nancy Brandt
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Kate Kennedy
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Annie Austin
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Aaron Begue
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rose Bell
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Cheryl Raczyk
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Todd Pickard
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Vanna Dest
- Yale Cancer Center/Smilow Cancer Hospital, New Haven, Connecticut
| | - Rory Randall
- University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Jessica Sugalski
- From National Comprehensive Cancer Network (NCCN), Plymouth Meeting, Pennsylvania
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Kennedy K, Fish J, Forsythe D, Ramsey I, Adelson P. COVID-19 front door screening implementation: experiences of staff conducting screening. AUST J ADV NURS 2021. [DOI: 10.37464/2020.384.430] [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]
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Peters MDJ, Ramsey I, Kennedy K, Sharplin G, Eckert M. Culturally safe, high-quality breast cancer screening for transgender people: A scoping review protocol. J Adv Nurs 2021; 78:276-281. [PMID: 34816475 DOI: 10.1111/jan.15094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022]
Abstract
AIM To develop evidence-based recommendations for provision of culturally safe, high-quality services for breast cancer screening for transgender people. DESIGN The scoping review will follow the JBI methodological guidance for scoping reviews. METHODS A search using MEDLINE (PubMed), Embase (Ovid), Scopus, the Cochrane Library, including the Cochrane Methodology Register, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and the World Health Organization, Australia Government Department of Health and Google Scholar will be undertaken. The review will include people of any age and ethnicity defined in the source of evidence as transgender. The review will include individuals who have used gender-affirming interventions or not and sources of evidence that report information relevant to the provision of culturally safe, high-quality breast cancer screening services for transgender people. English language sources of evidence published from database inception with information from any country will be eligible for inclusion. Sources will be screened for inclusion by three independent reviewers. Results will be extracted using a purpose-built tool and presented in relation to the review questions and objective in the final report using tables, figures and corresponding narrative. Project funding was approved by the Australian Government Department of Health in June 2020. DISCUSSION There are a range of factors that impact on the equity of health access and outcomes for people who are not cisgender. Transgender people are at risk of breast cancer but there is relatively little evidence about how their risks may or may not differ substantially from cis-gendered individuals and little guidance for health providers to ensure inclusive, culturally safe, high-quality breast cancer screening services for both transgender males, transgender females and gender diverse people who may not identify as male or as female. IMPACT It is important to provide culturally safe, high-quality services for breast cancer screening for transgender people.
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Affiliation(s)
- Micah D J Peters
- UniSA Clinical & Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia.,Faculty of Health and Medical Sciences, Adelaide Nursing School, University of Adelaide, Adelaide, Australia.,The Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence, Adelaide, Australia
| | - Imogen Ramsey
- UniSA Clinical & Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
| | - Kate Kennedy
- UniSA Clinical & Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
| | - Greg Sharplin
- UniSA Clinical & Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
| | - Marion Eckert
- UniSA Clinical & Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
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Austin A, Jeffries K, Krause D, Sugalski J, Sharrah K, Gross A, Bowers D, Mulkerin D, Brandt N, Begue A, Bell R, Raczyk C, Pickard T, Johnson D, Dest V, Randall R, Zecha G, Kennedy K. A Study of Advanced Practice Provider Staffing Models and Professional Development Opportunities at National Comprehensive Cancer Network Member Institutions. J Adv Pract Oncol 2021; 12:717-724. [PMID: 34671501 PMCID: PMC8504930 DOI: 10.6004/jadpro.2021.12.7.5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The National Comprehensive Cancer Network (NCCN) Best Practices Committee created an Advanced Practice Provider (APP) Workgroup to develop recommendations to support APP roles at NCCN Member Institutions. Methods The Workgroup conducted three surveys to understand APP program structure, staffing models, and professional development opportunities at NCCN Member Institutions. Results The total number of new and follow-up visits a 1.0 APP full-time equivalent conducts per week in shared and independent visits ranged from 11 to 97, with an average of 40 visits per week (n = 39). The type of visits APPs conduct include follow-up shared (47.2%), follow-up independent (46%), new shared (6.5%), and new independent visits (0.5%). Seventy-two percent of respondents utilize a mixed model visit type, with 15% utilizing only independent visits and 13% utilizing only shared visits (n = 39). Of the 95% of centers with APP leads, 100% indicated that leads carry administrative and clinical responsibilities (n = 20); however, results varied with respect to how this time is allocated. Professional development opportunities offered included posters, papers, and presentations (84%), leadership development (57%), research opportunities (52%), writing book chapters (19%), and other professional development activities (12%; n = 422). Twenty percent of APPs indicated that protected time to engage in development opportunities should be offered. Conclusion As evidenced by the variability of the survey results, the field would benefit from developing standards for APPs. There is a lack of information regarding leadership structures to help support APPs, and additional research is needed. Additionally, centers should continuously assess the career-long opportunities needed to maximize the value of oncology APPs.
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Affiliation(s)
- Annie Austin
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | | | - Diana Krause
- National Comprehensive Cancer Network (NCCN), Plymouth Meeting, Pennsylvania
| | - Jessica Sugalski
- National Comprehensive Cancer Network (NCCN), Plymouth Meeting, Pennsylvania
| | - Karen Sharrah
- City of Hope National Medical Center, Duarte, California
| | - Anne Gross
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Daniel Mulkerin
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Nancy Brandt
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Aaron Begue
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rose Bell
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Cheryl Raczyk
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | | | - Vanna Dest
- Yale Cancer Center/Smilow Cancer Hospital, New Haven, Connecticut
| | - Rory Randall
- University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | | | - Kate Kennedy
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
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Abstract
Abstract
Background
The COVID-19 pandemic accelerated adoption of a telehealth model to replace outpatient visits. We studied quality indicators and clinical outcomes associated with virtual visits in comparison to in-person ambulatory visits for patients with atrial fibrillation (AF) seen by electrophysiology providers.
Methods
Quality indicators and outcomes for patients with primary diagnosis of AF seen by electrophysiology providers (6 physicians and 4 nurse practitioners) for the 12 week period of March 22–June 13, 2020 were compared with those from the 12 week period of March 24–June 15, 2019.
Result
We identified 2340 clinic visits for AF (1081 in 2019 and 1259 in 2020). Telehealth was not used in 2019, and was used in 90.5% of the 2020 visits. On multivariate analysis during 120 days following each encounter, there was no difference in hospital admissions between 2019 and 2020 (OR 0.89; 95% CI 0.69–1.14; p=0.3624), and there was trend towards lower emergency department visits in 2020 compared with 2019 (OR 0.77; 95% CI 0.6–1; p=0.0509). There were 36 deaths at 120 days, mortality was similar in 2020 as compared with 2019 (OR 1.5; 95% CI 0.74–3.03; p=0.2601). There was no difference in completed procedures including permanent pacemakers, cardiac resynchronization therapy devices, implantable cardioverter-defibrillators and catheter ablations. There was a significant difference in anticoagulant (OR 0.71; 95% CI 0.52–0.99; p=0.0412) and antiarrhythmic (OR 0.78; 95% CI 0.61–0.99; p=0.0384) dose adjustment or new prescriptions in 2019 compared with 2020.
Conclusion
Telehealth was associated with similar intermediate-term clinical outcomes when compared to traditional ambulatory encounters. However, adjusting or providing new prescriptions for anticoagulant or anti-arrhythmic medications was more common with in-person than with virtual visits.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Shatla
- University of Missouri Kansas City, Internal Medicine, kansas, United States of America
| | - Y Sammour
- University of Missouri Kansas City, Internal Medicine, kansas, United States of America
| | - K Kennedy
- St. Luke's Mid America Heart Institute, Kansas City, United States of America
| | - A P Wimmer
- St. Luke's Mid America Heart Institute, Kansas City, United States of America
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Al-Shahi Salman R, Keerie C, Stephen J, Lewis S, Norrie J, Dennis MS, Newby DE, Wardlaw JM, Lip GY, Parry-Jones A, White PM, Baigent C, Lasserson D, Oliver C, O'Mahony F, Amoils S, Bamford J, Armitage J, Emberson J, Rinkel GJ, Lowe G, Innes K, Adamczuk K, Dinsmore L, Drever J, Milne G, Walker A, Hutchison A, Williams C, Fraser R, Anderson R, Covil K, Stewart K, Rees J, Hall P, Bullen A, Stoddart A, Moullaali TJ, Palmer J, Sakka E, Perthen J, Lyttle N, Samarasekera N, MacRaild A, Burgess S, Teasdale J, Coakley M, Taylor P, Blair G, Whiteley W, Shenkin S, Clancy U, Macleod M, Sutherland R, Moullaali T, Barugh A, Lerpiniere C, Moreton F, Fethers N, Anjum T, Krishnan M, Slade P, Storton S, Williams M, Davies C, Connor L, Gainard G, Murphy C, Barber M, Esson D, Choulerton J, Shaw L, Lucas S, Hierons S, Avis J, Stone A, Gbadamoshi L, Costa T, Pearce L, Harkness K, Richards E, Howe J, Kamara C, Lindert R, Ali A, Rehan J, Chapman S, Edwards M, Bathula R, Cohen D, Devine J, Mpelembue M, Yesupatham P, Chhabra S, Adewetan G, Ballantine R, Brooks D, Smith G, Rogers G, Marsden S, Clark S, Wilkinson A, Brown E, Stephenson L, Nyo K, Abraham A, Pai Y, Shim G, Baliga V, Nair A, Robinson M, Hawksworth C, Greig J, Alam I, Nortcliffe T, Ramiz R, Shaw R, Parry-Jones A, Lee S, Marsden T, Perez J, Birleson E, Yadava R, Sangombe M, Stafford S, Hughes T, Knibbs L, Morse B, Schwarz S, Jelley B, White S, Richard B, Lawson H, Moseley S, Tayler M, Edwards M, Triscott C, Wallace R, Hall A, Dell A, Rashed K, Board S, Buckley C, Tanate A, Pitt-Kerby T, Beesley K, Perry J, Hellyer C, Guyler P, Menon N, Tysoe S, Prabakaran R, Cooper M, Rajapakse A, Wynter I, Smith S, Weir N, Boxall C, Yates H, Smith S, Crawford P, Marigold J, Smith F, Harvey J, Evans S, Baldwin L, Hammond S, Mudd P, Bowring A, Keenan S, Thorpe K, Haque M, Taaffe J, Temple N, Peachey T, Wells K, Haines F, Butterworth-Cowin N, Horne Z, Licenik R, Boughton H, England T, Hedstrom A, Menezes B, Davies R, Johnson V, Whittingham-Jones S, Werring D, Obarey S, Watchurst C, Ashton A, Feerick S, Francia N, Banaras A, Epstein D, Marinescu M, Williams A, Robinson A, Humphries F, Anwar I, Annamalai A, Crawford S, Collins V, Shepherd L, Siddle E, Penge J, Epstein D, Qureshi S, Krishnamurthy V, Papavasileiou V, Waugh D, Veraque E, Douglas N, Khan N, Ramachandran S, Sommerville P, Rudd A, Kullane S, Bhalla A, Birns J, Ahmed R, Gibbons M, Klamerus E, Cendreda B, Muir K, Day N, Welch A, Smith W, Elliot J, Eltawil S, Mahmood A, Hatherley K, Mitchell S, Bains H, Quinn L, Teal R, Gbinigie I, Harston G, Mathieson P, Ford G, Schulz U, Kennedy J, Nagaratnam K, Bangalore K, Bhupathiraju N, Wharton C, Fotherby K, Nasar A, Stevens A, Willberry A, Evans R, Rai B, Blake C, Thavanesan K, Hann G, Changuion T, Nix S, Whiting A, Dharmasiri M, Mallon L, Keltos M, Smyth N, Eglinton C, Duffy J, Tone E, Sykes L, Porter E, Fitton C, Kirkineziadis N, Cluckie G, Kennedy K, Trippier S, Williams R, Hayter E, Rackie J, Patel B, Rita G, Blight A, Jones V, Zhang L, Choy L, Pereira A, Clarke B, Al-Hussayni S, Dixon L, Young A, Bergin A, Broughton D, Raghunathan S, Jackson B, Appleton J, Wilkes G, Buck A, Richardson C, Clarke J, Fleming L, Squires G, Law Z, Hutchinson C, Cvoro V, Couser M, McGregor A, McAuley S, Pound S, Cochrane P, Holmes C, Murphy P, Devitt N, Osborn M, Steele A, Guthrie LB, Smith E, Hewitt J, Chaston N, Myint M, Smith A, Fairlie L, Davis M, Atkinson B, Woodward S, Hogg V, Fawcett M, Finlay L, Dixit A, Cameron E, Keegan B, Kelly J, Concannon D, Dutta D, Ward D, Glass J, O'Connell S, Ngeh J, O'Kelly A, Williams E, Ragab S, Jenkinson D, Dube J, Gleave L, Leggett J, Kissoon N, Southern L, Naghotra U, Bokhari M, McClelland B, Adie K, Mate A, Harrington F, James A, Swanson E, Chant T, Naccache M, Coutts A, Courtauld G, Whurr S, Webber S, Shead E, Luder R, Bhargava M, Murali E, Cuenoud L, Pasco K, Speirs O, Chapman L, Inskip L, Kavanagh L, Srinivasan M, Motherwell N, Mukherjee I, Tonks L, Donaldson D, Button H, Wilcox R, Hurford F, Logan R, Taylor A, Arden T, Carpenter M, Datta P, Zahoor T, Jackson L, Needle A, Stanners A, Ghouri I, Exley D, Akhtar S, Brooke H, Beadle S, O'Brien E, Francis J, McGee J, Amis E, Mitchell J, Finlay S, Sinha D, Manoczki C, King S, Tarka J, Choudhary S, Premaruban J, Sutton D, Kumar P, Culmsee C, Winckley C, Davies H, Thatcher H, Vasileiadis E, Aweid B, Holden M, Mason C, Hlaing T, Madzamba G, Ingram T, Linforth M, Cullen C, Thomas N, France J, Saulat A, Bhaskaran B, Fitzell P, Horan K, Manyoni C, Garfield-Smith J, Griffin H, Atkins S, Redome J, Muddegowda G, Maguire H, Barry A, Abano N, Varquez R, Hiden J, Lyjko S, Remegoso A, Finney K, Butler A, Strecker M, MaCleod MJ, Irvine J, Nelson S, Guzmangutierrez G, Furnace J, Taylor V, Ramadan H, Storton K, Hassan S, Abdus Sami E, Bellfield R, Stewart K, Quinn O, Patterson C, Emsley H, Gregary B, Ahmed S, Patel S, Raj S, Sultan S, Wright F, Langhorne P, Graham R, Quinn T, McArthur K. Effects of oral anticoagulation for atrial fibrillation after spontaneous intracranial haemorrhage in the UK: a randomised, open-label, assessor-masked, pilot-phase, non-inferiority trial. Lancet Neurol 2021; 20:842-853. [PMID: 34487722 DOI: 10.1016/s1474-4422(21)00264-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Oral anticoagulation reduces the rate of systemic embolism for patients with atrial fibrillation by two-thirds, but its benefits for patients with previous intracranial haemorrhage are uncertain. In the Start or STop Anticoagulants Randomised Trial (SoSTART), we aimed to establish whether starting is non-inferior to avoiding oral anticoagulation for survivors of intracranial haemorrhage who have atrial fibrillation. METHODS SoSTART was a prospective, randomised, open-label, assessor-masked, parallel-group, pilot phase trial done at 67 hospitals in the UK. We recruited adults (aged ≥18 years) who had survived at least 24 h after symptomatic spontaneous intracranial haemorrhage, had atrial fibrillation, and had a CHA2DS2-VASc score of at least 2. Web-based computerised randomisation incorporating a minimisation algorithm allocated participants (1:1) to start or avoid long-term (≥1 year) full treatment dose open-label oral anticoagulation. The participants assigned to start oral anticoagulation received either a direct oral anticoagulant or vitamin K antagonist, and the group assigned to avoid oral anticoagulation received standard clinical practice (antiplatelet agent or no antithrombotic agent). The primary outcome was recurrent symptomatic spontaneous intracranial haemorrhage, and was adjudicated by an individual masked to treatment allocation. All outcomes were ascertained for at least 1 year after randomisation and assessed in the intention-to-treat population of all randomly assigned participants, using Cox proportional hazards regression adjusted for minimisation covariates. We planned a sample size of 190 participants (one-sided p=0·025, power 90%, allowing for non-adherence) based on a non-inferiority margin of 12% (or adjusted hazard ratio [HR] of 3·2). This trial is registered with ClinicalTrials.gov (NCT03153150) and is complete. FINDINGS Between March 29, 2018, and Feb 27, 2020, consent was obtained at 61 sites for 218 participants, of whom 203 were randomly assigned at a median of 115 days (IQR 49-265) after intracranial haemorrhage onset. 101 were assigned to start and 102 to avoid oral anticoagulation. Participants were followed up for median of 1·2 years (IQR 0·97-1·95; completeness 97·2%). Starting oral anticoagulation was not non-inferior to avoiding oral anticoagulation: eight (8%) of 101 in the start group versus four (4%) of 102 in the avoid group had intracranial haemorrhage recurrences (adjusted HR 2·42 [95% CI 0·72-8·09]; p=0·152). Serious adverse events occurred in 17 (17%) participants in the start group and 15 (15%) in the avoid group. 22 (22%) patients in the start group and 11 (11%) patients in the avoid group died during the study. INTERPRETATION Whether starting oral anticoagulation was non-inferior to avoiding it for people with atrial fibrillation after intracranial haemorrhage was inconclusive, although rates of recurrent intracranial haemorrhage were lower than expected. In view of weak evidence from analyses of three composite secondary outcomes, the possibility that oral anticoagulation might be superior for preventing symptomatic major vascular events should be investigated in adequately powered randomised trials. FUNDING British Heart Foundation, Medical Research Council, Chest Heart & Stroke Scotland.
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Marques E, Kennedy K, Nishimura K, Giroux D, Cilento V, Fang W, Ugalde P. OA11.03 Oncologic Outcomes of Patients with Resected T3N0M0 Non-small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Furqan M, Malhotra J, Liu L, Wang H, Pasquinelli M, Sisel E, Kennedy K, Shergill A, Feldman L. FP04.04 A Phase Ib/II Study of Imprime PGG and Pembrolizumab in Pretreated Patients With Advanced Stage Non-Small Cell Lung Cancer: BTCRC-LUN15-017. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.218] [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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Sisel E, Furqan M, Malhotra J, Shergill A, Kennedy K, Liu L, Pasquinelli M, Feldman L. P77.05 Phase II Study of Imprime PGG and Pembrolizumab in Stage IV NSCLC After Progression on First-Line Therapy: BTCRC-LUN15-017. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lima F, Kennedy K, Parulkar A, Sheikh W, Sharma E, Chu A. Hospital readmissions after catheter ablation for atrial fibrillation among patients with heart failure in the United States. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Catheter ablation for atrial fibrillation may improve quality of life and long-term mortality among patients with heart failure.
Purpose
The rates of hospital readmission after catheter ablation for atrial fibrillation among patients with an established diagnosis of heart failure are largely unknown. We aimed to assess the rates and causes of 30-day readmission among patients with heart failure undergoing catheter ablation vs. medical therapy for atrial fibrillation in the United States.
Methods
The 2016 Nationwide Readmissions Database was screened for patients with diagnosis of heart failure and atrial fibrillation using the 10th Revision of International Classification of Diseases codes. Patients undergoing catheter ablation for atrial fibrillation were grouped separately from those treated medically for atrial fibrillation. Thirty-day readmissions were assessed for both groups.
Results
The analytical cohort included 749,776 (national estimate of 1,421,673) patients with heart failure and atrial fibrillation. This included 2,204 patients that underwent catheter ablation. Patients treated with catheter ablation had lower 30-day readmissions compared to the medical therapy group (16.8% vs 20.1%, p<0.001). Fifty-five percent of all readmissions among the catheter ablation cohort were related to cardiac events. Heart failure exacerbation (40%) and arrhythmia (36%) were the most common cardiac causes for readmission after catheter ablation (Figure).
Conclusions
In a contemporary nationwide analysis of patients with heart failure and atrial fibrillation, compared to medical therapy those treated with catheter ablation for atrial fibrillation had fewer 30-day readmissions after index hospital discharge. The most common cause for readmission among patients treated with catheter ablation was heart failure exacerbation and arrhythmia.
Causes of readmission
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- F Lima
- Brown University, Providence, United States of America
| | - K Kennedy
- St. Luke's Mid America Heart Institute, Kansas City, United States of America
| | - A Parulkar
- Brown University, Providence, United States of America
| | - W Sheikh
- Brown University, Providence, United States of America
| | - E Sharma
- Brown University, Providence, United States of America
| | - A Chu
- Brown University, Providence, United States of America
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Hofmeyer A, Taylor R, Kennedy K. Knowledge for nurses to better care for themselves so they can better care for others during the Covid-19 pandemic and beyond. Nurse Educ Today 2020; 94:104503. [PMID: 32980179 PMCID: PMC7295457 DOI: 10.1016/j.nedt.2020.104503] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/09/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Anne Hofmeyer
- Anglia Ruskin University, UK; Rosemary Bryant AO Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia; UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, Australia.
| | - Ruth Taylor
- University of Aberdeen, King's College, Aberdeen AB24 3FX, United Kingdom.
| | - Kate Kennedy
- Rosemary Bryant AO Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia; UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, Australia.
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Hofmeyer A, Taylor R, Kennedy K. Fostering compassion and reducing burnout: How can health system leaders respond in the Covid-19 pandemic and beyond? Nurse Educ Today 2020; 94:104502. [PMID: 32980180 PMCID: PMC7295512 DOI: 10.1016/j.nedt.2020.104502] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/09/2020] [Indexed: 05/13/2023]
Affiliation(s)
- Anne Hofmeyer
- Anglia Ruskin University, UK; Rosemary Bryant AO Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia; UniSA Clinical and Health Sciences, University of South Australia, GPOBox 2471, Adelaide, Australia.
| | - Ruth Taylor
- University of Aberdeen, King's College, Aberdeen AB24 3FX, United Kingdom.
| | - Kate Kennedy
- Rosemary Bryant AO Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia; UniSA Clinical and Health Sciences, University of South Australia, GPOBox 2471, Adelaide, Australia.
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Marnie C, Peters MD, Forsythe D, Kennedy K, Sharplin G, Eckert M, Chiarella M, Vernon R. Recency of Practice and the Maintenance of Professional Competence for Nurses and Midwives: A Scoping Review Protocol. J Law Med 2020; 27:1008-1013. [PMID: 32880416] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Australian and international nursing regulators have specific requirements for continuing competence and the professional, safe practice of nurses and midwives. Requirements can dictate duration of practice, time away from/recency of practice, revalidation policies, and time between study program completion and practice commencement. Requirements vary between contexts and are periodically updated. To identify and examine Australian and international evidence for best regulatory practices relating to recency and the maintenance of professional competence among nurses and midwives, a scoping review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be undertaken. This protocol details the scope, inclusion criteria, and methodology that will guide the scoping review, which will inform an update to the Nursing and Midwifery Board of Australia's Registration Standard: Recency of Practice.
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Affiliation(s)
- Casey Marnie
- Research Assistant, Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia
| | - Micah Dj Peters
- Research Fellow, Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia; Core Staff Member, Centre for Evidence-based Practice South Australia (CEPSA): a Joanna Briggs Institute Centre of Excellence, Adelaide, Australia; Adjunct Lecturer, Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Deborah Forsythe
- Research Assistant, Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia
| | - Kate Kennedy
- Research Projects Coordinator, Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia
| | - Greg Sharplin
- Research and Strategy Manager, Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia
| | - Marion Eckert
- Professor of Cancer Nursing, University of South Australia; Director, Rosemary Bryant AO Research Centre; Chair, Cancer Care Research Group, UniSA Clinical & Health Sciences
| | - Mary Chiarella
- Professor Emeritus, Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales
| | - Rachael Vernon
- Associate Professor, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia; Dean of Programs (Nursing & Midwifery), UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia
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Johnson W, Bloschichak A, Biniek J, Kennedy K, Kurowski D. Bench‐Marking the Prices Paid By Commercial Insurers for Professional Services. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- W. Johnson
- Health Care Cost Institute Washington DC United States
| | | | - J.F. Biniek
- Health Care Cost Institute Washington DC United States
| | - K. Kennedy
- Health Care Cost Institute Washington DC United States
| | - D. Kurowski
- Health Care Cost Institute Washington DC United States
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Kennedy K, Cal R, Casey R, Lopez C, Adelfio A, Molloy B, Wall AM, Holton TA, Khaldi N. The anti-ageing effects of a natural peptide discovered by artificial intelligence. Int J Cosmet Sci 2020; 42:388-398. [PMID: 32453870 DOI: 10.1111/ics.12635] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/08/2020] [Accepted: 05/20/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE As skin ages, impaired extracellular matrix (ECM) protein synthesis and increased action of degradative enzymes manifest as atrophy, wrinkling and laxity. There is mounting evidence for the functional role of exogenous peptides across many areas, including in offsetting the effects of cutaneous ageing. Here, using an artificial intelligence (AI) approach, we identified peptide RTE62G (pep_RTE62G), a naturally occurring, unmodified peptide with ECM stimulatory properties. The AI-predicted anti-ageing properties of pep_RTE62G were then validated through in vitro, ex vivo and proof of concept clinical testing. METHODS A deep learning approach was applied to unlock pep_RTE62G from a plant source, Pisum sativum (pea). Cell culture assays of human dermal fibroblasts (HDFs) and keratinocytes (HaCaTs) were subsequently used to evaluate the in vitro effect of pep_RTE62G. Distinct activities such as cell proliferation and ECM protein production properties were determined by ELISA assays. Cell migration was assessed using a wound healing assay, while ECM protein synthesis and gene expression were analysed, respectively, by immunofluorescence microscopy and PCR. Immunohistochemistry of human skin explants was employed to further investigate the induction of ECM proteins by pep_RTE62G ex vivo. Finally, the clinical effect of pep_RTE626 was evaluated in a proof of concept 28-day pilot study. RESULTS In vitro testing confirmed that pep_RTE62G is an effective multi-functional anti-ageing ingredient. In HaCaTs, pep_RTE62G treatment significantly increases both cellular proliferation and migration. Similarly, in HDFs, pep_RTE62G consistently induced the neosynthesis of ECM protein elastin and collagen, effects that are upheld in human skin explants. Lastly, in our proof of concept clinical study, application of pep_RTE626 over 28 days demonstrated anti-wrinkle and collagen stimulatory potential. CONCLUSION pep_RTE62G represents a natural, unmodified peptide with AI-predicted and experimentally validated anti-ageing properties. Our results affirm the utility of AI in the discovery of novel, functional topical ingredients.
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Affiliation(s)
- K Kennedy
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - R Cal
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - R Casey
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - C Lopez
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - A Adelfio
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - B Molloy
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - A M Wall
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - T A Holton
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - N Khaldi
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
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Lehenbauer K, Qarajeh R, Shatla I, Singh A, Patel K, Peri-Okonny P, Kennedy K, Torres N, Myadam R, Sperry B, Saeed I, Thompson R, McGhie A, Bateman T. Multimodality Imaging: Coronary Calcium Scoring And Myocardial Blood Flow Reserve To Predict Underlying Multivessel Coronary Artery Disease. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hofmeyer A, Kennedy K, Taylor R. Contesting the term ‘compassion fatigue’: Integrating findings from social neuroscience and self-care research. Collegian 2020. [DOI: 10.1016/j.colegn.2019.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Ali H, Ehsan A, Kennedy K, Riley P, Seo A, Bajaj N, Singh A, Sellke F, Levine D, Kiernan M, Yousefzai R. The Cost and Length of Stay Associated with Biventricular Assist Devices in the United States (2009-2015). J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Rogers PL, Staruszkiewicz W, Adams A, Atienza B, Berg RJ, Chin H, DesJardins C, Gilgan M, Hansen LB, Hummer W, Jahncke M, Jester E, Kennedy K, Krzynowek J, McLachlan D, Mowdy D, Newton RT, Personeau JC, Rorberg JA, Shum G, Thomas TS, Wagner R, Whitby C, Yuen G. Gas Chromatographic Method for Putrescine and Cadaverine in Canned Tuna and Mahimahi and Fluorometric Method for Histamine (Minor Modification of AOAC Official Method 977.13): Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/80.3.591] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A collaborative study was conducted to test a modification to the AOAC fluorometric method for histamine (AOAC® Official Method 977.13) that substitutes 75% methanol as the extracting solvent. All other steps remain unchanged. The extracts prepared with 75% methanol were also used to collaboratively test a gas chromatographic (GC) method for determination of putrescine and cadaverine in seafood. In the GC method, the extracted diamines are converted to fluorinated derivatives, the reaction mixtures are passed through solid-phase extraction columns, and the derivatives are quantitated by electron capture GC after separation on an OV-225 column. Fourteen laboratories using the GC method for putrescine and cadaverine and 16 laboratories using the fluorometric method for histamine analyzed 14 canned tuna and raw mahimahi (including blind duplicates and a spike) containing 0.2-2.6 ppm putrescine, 0.6-9.1 ppm cadaverine, and 0.6-154 ppm histamine. At the 5 ppm level, recoveries ranged from 71 to 102% for putrescine and 77 to 112% for cadaverine; the respective repeatability relative standard deviations (RSDr) were 5.2 and 15%, and the respective reproducibility relative standard deviations (RSDR) were 8.8 and 18%. At the 50 ppm level, histamine recoveries ranged from 84 to 125%, RSDr was 3.6%, and RSDR was 9.4%. The GC method for determination of putrescine in canned tuna and cadaverine in canned tuna and mahimahi has been adopted first action by AOAC INTERNATIONAL, and the AOAC Official Method 977.13, Histamine in Seafood, Fluorometric Method, has been modified
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Affiliation(s)
- Patricia L Rogers
- U.S. Food and Drug Administration, Office of Seafood, 200 C St, SW, Washington, DC 20204
| | - Walter Staruszkiewicz
- U.S. Food and Drug Administration, Office of Seafood, 200 C St, SW, Washington, DC 20204
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Kennedy K, Adelson P, Fleet J, Steen M, McKellar L, Eckert M, Peters MDJ. Shared decision aids in pregnancy care: A scoping review. Midwifery 2019; 81:102589. [PMID: 31790856 DOI: 10.1016/j.midw.2019.102589] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/11/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Shared decision making in pregnancy, labour, and birth is vital to woman-centred care and despite strong evidence for the effectiveness of shared decision making in pregnancy care, practical uptake has been slow. DESIGN AND AIM This scoping review aimed to identify and describe effective and appropriate shared decision aids designed to be provided to women in the antenatal period to assist them in making informed decisions for both pregnancy and birth. Two questions guided the enquiry: (i) what shared decision aids for pregnancy and perinatal care are of appropriate quality and feasibility for application in Australia? (ii) which of these decision aids have been shown to be effective and appropriate for Aboriginal and Torres Strait Islander peoples, culturally diverse women, or those with low literacy? METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) was used to conduct the review. Five key databases and selected grey literature sources were examined. English language evidence from Australia, Europe, Canada, United Kingdom, New Zealand, and United States of America produced from 2009 was eligible for inclusion, checked against apriori inclusion criteria, and assessed for quality and usability using the International Patient Decision Aid Standards. RESULTS From a total of 5,209 search results, 35 sources of evidence reporting on 27 decision aids were included following title/abstract and full-text review. Most of the decision aids concerned decisions around birth (52%, n = 14) or antenatal screening 37% (n = 10). The quality of the decision aids was moderate to high, with most communicating risks, benefits, and choice pathways via a mix of Likert-style scales, quizzes, and pictures or graphs. Use of decision aids resulted in significant reductions in decisional conflict and increased knowledge. The format of decision aids appeared to have no effect on these outcomes, indicating that paper-based are as effective as video- or audio-based decision aids. Eleven decision aids were suitable for low literacy or low health literacy women, and six were either developed for culturally diverse groups or have been translated into other languages. No decision aids found were specific to Aboriginal and Torres Strait Islander peoples. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The 27 decision aids are readily adoptable into westernised healthcare settings and can be used by midwives or multidisciplinary teams in conjunction with women. Decision aids are designed to support women, and families to arrive at informed choices and supplement the decision-making process rather than to replace consumer-healthcare professional interaction. If given before an appointment, high quality decision aids can increase a woman's familiarity with medical terminology, options for care, and an insight into personal values, thereby decreasing decisional conflict and increasing knowledge.
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Affiliation(s)
- Kate Kennedy
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Australia. GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Pamela Adelson
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Australia. GPO Box 2471, Adelaide, SA 5001, Australia; Mothers, Babies and Families: Health Research Group, Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Australia
| | - Julie Fleet
- Mothers, Babies and Families: Health Research Group, Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Australia
| | - Mary Steen
- Mothers, Babies and Families: Health Research Group, Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Australia
| | - Lois McKellar
- Mothers, Babies and Families: Health Research Group, Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Australia. GPO Box 2471, Adelaide, SA 5001, Australia
| | - Micah D J Peters
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Australia. GPO Box 2471, Adelaide, SA 5001, Australia
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Sharplin G, Adelson P, Kennedy K, Williams N, Hewlett R, Wood J, Bonner R, Dabars E, Eckert M. Establishing and Sustaining a Culture of Evidence-Based Practice: An Evaluation of Barriers and Facilitators to Implementing the Best Practice Spotlight Organization Program in the Australian Healthcare Context. Healthcare (Basel) 2019; 7:healthcare7040142. [PMID: 31726668 PMCID: PMC6956050 DOI: 10.3390/healthcare7040142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/22/2019] [Accepted: 11/05/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Nurses and midwives are central to the implementation and delivery of quality care through evidence-based practice (EBP). However, implementation of EBP in nursing and midwifery is under-researched with few examples of systematic and sustained change. The Registered Nurses Association of Ontario’s Best-Practice Spotlight Organization (BPSO) Program was adopted in South Australia as a framework to systematically implement EBP in two diverse and complex healthcare settings. Methods: The study was a post-implementation, mixed-method evaluation conducted at two healthcare settings in Adelaide, South Australia utilizing qualitative and quantitative data. Proctor’s implementation evaluation framework guided the evaluation design. Information sources included; interviews, focus groups, questionnaires, and document review. Results: Clinical and executive staff (n = 109 participants) from a broad range of stakeholder groups participated in the interviews, focus groups, and returned questionnaires. A number of facilitators directly affecting program implementation were identified; these pertained to embedding continuity into the program’s implementation and delivery, a robust governance structure, and executive sponsorship. Barriers to implementation were also identified. These barriers pertained to organizational or workforce challenges; staff turnover and movement (e.g., secondment), insufficient staff to allow people to attend training, and a lack of organizational commitment to the program, especially at an executive level. As a result of successful implementation, it was observed that over three years, the BPSO program positively influenced the uptake and implementation of EBP by clinicians and the organizations into which they were introduced. Conclusions: The BPSO model can be translocated to new healthcare systems and has the potential to act as a mechanism for establishing and sustaining EBP change. This study was the first to apply an implementation evaluation framework to the BPSO program, which allowed for structured analysis of facilitating or impeding factors that affected implementation success. The findings have important implications for other health systems looking to translocate the same or similar EBP programs, as well as contributing to the growing body of implementation evaluation literature.
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Affiliation(s)
- Greg Sharplin
- Rosemary Bryant AO Research Centre, Division of Health Sciences, University of South Australia, Adelaide 5000, Australia; (P.A.); (K.K.); (M.E.)
- Correspondence: ; Tel.: +61-8-8302-2846
| | - Pam Adelson
- Rosemary Bryant AO Research Centre, Division of Health Sciences, University of South Australia, Adelaide 5000, Australia; (P.A.); (K.K.); (M.E.)
| | - Kate Kennedy
- Rosemary Bryant AO Research Centre, Division of Health Sciences, University of South Australia, Adelaide 5000, Australia; (P.A.); (K.K.); (M.E.)
| | - Nicola Williams
- Australian Nursing and Midwifery Federation (SA Branch), Ridleyton SA 5008, Australia; (N.W.); (R.H.); (J.W.); (R.B.); (E.D.)
| | - Roslyn Hewlett
- Australian Nursing and Midwifery Federation (SA Branch), Ridleyton SA 5008, Australia; (N.W.); (R.H.); (J.W.); (R.B.); (E.D.)
| | - Jackie Wood
- Australian Nursing and Midwifery Federation (SA Branch), Ridleyton SA 5008, Australia; (N.W.); (R.H.); (J.W.); (R.B.); (E.D.)
| | - Rob Bonner
- Australian Nursing and Midwifery Federation (SA Branch), Ridleyton SA 5008, Australia; (N.W.); (R.H.); (J.W.); (R.B.); (E.D.)
| | - Elizabeth Dabars
- Australian Nursing and Midwifery Federation (SA Branch), Ridleyton SA 5008, Australia; (N.W.); (R.H.); (J.W.); (R.B.); (E.D.)
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, Division of Health Sciences, University of South Australia, Adelaide 5000, Australia; (P.A.); (K.K.); (M.E.)
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Keighley C, Chen SCA, Marriott D, Pope A, Chapman B, Kennedy K, Bak N, Underwood N, Wilson HL, McDonald K, Darvall J, Halliday C, Kidd S, Nguyen Q, Hajkowicz K, Sorrell TC, Van Hal S, Slavin MA. Candidaemia and a risk predictive model for overall mortality: a prospective multicentre study. BMC Infect Dis 2019; 19:445. [PMID: 31113382 PMCID: PMC6528341 DOI: 10.1186/s12879-019-4065-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/02/2019] [Indexed: 01/21/2023] Open
Abstract
Background Candidaemia is associated with high mortality. Variables associated with mortality have been published previously, but not developed into a risk predictive model for mortality. We sought to describe the current epidemiology of candidaemia in Australia, analyse predictors of 30-day all-cause mortality, and develop and validate a mortality risk predictive model. Methods Adults with candidaemia were studied prospectively over 12 months at eight institutions. Clinical and laboratory variables at time of blood culture-positivity were subject to multivariate analysis for association with 30-day all-cause mortality. A predictive score for mortality was examined by area under receiver operator characteristic curves and a historical data set was used for validation. Results The median age of 133 patients with candidaemia was 62 years; 76 (57%) were male and 57 (43%) were female. Co-morbidities included underlying haematologic malignancy (n = 20; 15%), and solid organ malignancy in (n = 25; 19%); 55 (41%) were in an intensive care unit (ICU). Non-albicans Candida spp. accounted for 61% of cases (81/133). All-cause 30-day mortality was 31%. A gastrointestinal or unknown source was associated with higher overall mortality than an intravascular or urologic source (p < 0.01). A risk predictive score based on age > 65 years, ICU admission, chronic organ dysfunction, preceding surgery within 30 days, haematological malignancy, source of candidaemia and antibiotic therapy for ≥10 days stratified patients into < 20% or ≥ 20% predicted mortality. The model retained accuracy when validated against a historical dataset (n = 741). Conclusions Mortality in patients with candidaemia remains high. A simple mortality risk predictive score stratifying patients with candidaemia into < 20% and ≥ 20% 30-day mortality is presented. This model uses information available at time of candidaemia diagnosis is easy to incorporate into decision support systems. Further validation of this model is warranted. Electronic supplementary material The online version of this article (10.1186/s12879-019-4065-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Keighley
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, Darcy Rd, 3rd Level, ICPMR Building, Westmead, Sydney, New South Wales, 2145, Australia. .,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia. .,Department of Infectious Diseases, Westmead Hospital, Westmead, Sydney, NSW, Australia.
| | - S C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, Darcy Rd, 3rd Level, ICPMR Building, Westmead, Sydney, New South Wales, 2145, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - D Marriott
- Department of Microbiology and Infectious Diseases, St. Vincent's Hospital, Sydney, NSW, Australia
| | - A Pope
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,School of Mathematics and Statistics, University of NSW, Sydney, NSW, Australia
| | - B Chapman
- Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - K Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - N Bak
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - N Underwood
- Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - H L Wilson
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - K McDonald
- Department of Microbiology and Infectious Diseases, St. Vincent's Hospital, Sydney, NSW, Australia
| | - J Darvall
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - C Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, Darcy Rd, 3rd Level, ICPMR Building, Westmead, Sydney, New South Wales, 2145, Australia
| | - S Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, SA, Australia
| | - Q Nguyen
- National Centre for Clinical Excellence on Emerging Drugs of Concern (NCCRED), National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - K Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - T C Sorrell
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases, Westmead Hospital, Westmead, Sydney, NSW, Australia.,Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - S Van Hal
- Department of Infectious Diseases and Microbiology, New South Wales Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - M A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, National Centre for Infections in Cancer, Melbourne, VIC, Australia
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Grandin E, Gulati G, Kennedy K, Cabezas F, Birati E, Rame J, Atluri P, Pagani F, Kirklin J, Naftel D, Kormos R, Teuteberg J, Kiernan M. Post-Implant Phosphodiesterase-5 Inhibitor Use is Associated with Increased Rates of Late Right Heart Failure after LVAD: An INTERMACS Analysis. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Heaney C, Fernandez H, Lima B, Taylor J, Vuthoori R, Navarro J, Davidson K, Jelcic Y, Majure D, Kennedy K, Stevens G, Maybaum S. Subjective Assessment Underestimates Frailty in Patients with Heart Failure Referred for Advanced Therapies. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Navarro J, Miller E, Heaney C, Vuthoori R, Majure D, Lin K, Wang P, Kennedy K, Fernandez H, Lima B, Maybaum S. Reduction in Plasma Macrophage Migration Inhibitory Factor and Angiopoietin-2 Levels during Venoarterial Extracorporeal Membrane Oxygenation Support. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Dennis M, Mead G, Forbes J, Graham C, Hackett M, Hankey GJ, House A, Lewis S, Lundström E, Sandercock P, Innes K, Williams C, Drever J, Mcgrath A, Deary A, Fraser R, Anderson R, Walker P, Perry D, Mcgill C, Buchanan D, Chun Y, Dinsmore L, Maschauer E, Barugh A, Mikhail S, Blair G, Hoeritzauer I, Scott M, Fraser G, Lawrence K, Shaw A, Williamson J, Burgess D, Macleod M, Morales D, Sullivan F, Brady M, French R, Van Wijck F, Watkins C, Proudfoot F, Skwarski J, Mcgowan D, Murphy R, Burgess S, Rutherford W, Mccormick K, Buchan R, Macraild A, Paulton R, Fazal A, Taylor P, Parakramawansha R, Hunter N, Perry J, Bamford J, Waugh D, Veraque E, Bedford C, Kambafwile M, Idrovo L, Makawa L, Smalley P, Randall M, Thirugnana-Chandran T, Hassan A, Vowden R, Jackson J, Bhalla A, Rudd A, Tam CK, Birns J, Gibbs C, Lee Carbon L, Cattermole E, Marks K, Cape A, Hurley L, Kullane S, Smyth N, Eglinton C, Wilson J, Giallombardo E, Frith A, Reidy P, Pitt M, Sykes L, Dellafera D, Croome V, Kerwood L, Hancevic M, Narh C, Merritt C, Duffy J, Cooke D, Willson J, Ali A, Naqvi A, Kamara C, Bowler H, Bell S, Jackson T, Harkness K, Stocks K, Duty S, Doyle C, Dunn G, Endean K, Claydon F, Richards E, Howe J, Lindert R, Majid A, Dakin K, Maatouk A, Barron L, Meegada M, Rana P, Nair A, Brighouse-Johnson C, Greig J, Kyu M, Prasad S, Robinson M, Alam I, Mclean B, Greenhalgh L, Ahmed Z, Roffe C, Brammer S, Beardmore C, Finney K, Barry A, Hollinshead P, Grocott J, Maguire H, Natarajan I, Chembala J, Sanyal R, Lijko S, Abano N, Remegoso A, Ferdinand P, Stevens S, Varquez R, Causley C, Butler A, Whitmore P, Stephen C, Carpio R, Hiden J, Muddegowda G, Denic H, Sword J, Curwen R, James M, Mudd P, Hall F, Cageao J, Keenan S, Roughan C, Kingwell H, Hemsley A, Lohan C, Davenport S, Bowring A, Chapter T, Hough M, Strain D, Gupwell K, Miller K, Goff A, Cusack E, Todd S, Partridge R, Jennings G, Thorpe K, Stephenson J, Littlewood K, Barber M, Brodie F, Marshall S, Esson D, Coburn I, Mcinnes C, Ross F, Bowie E, Barcroft H, Withers V, Miller L, Willcoxson P, Donninson M, Evans R, Daniel D, Coyle J, Keeling M, Wanklyn P, Elliott M, Wightman J, Iveson E, Dyer N, Porteous AM, Haritakis M, Ward M, Doughty L, Carr L, O Neill M, Anazodo C, Wood P, Cottrell P, Donne C, Rodriguez R, Mir R, Westmoreland J, Bell J, Emms C, Wright L, Clark Brown P, Bamford E, Stanners A, Carpenter M, Datta P, Davey R, Needle A, Eastwood MJ, Razik FZ, Ghouri I, Bateman G, Archer J, Balasubramanian V, Bowers R, Ball J, Benton L, Jackson L, Ellam J, Norton K, Guyler P, Dowling T, Tysoe S, Harman P, Kundu A, Omodunbi O, Loganathan T, Chandler S, Noor S, Siddiqui A, Siddiqui A, Kunhunny S, Sinha D, Sheppard M, Rashmi S, France E, Orath Prabakaran R, Wilson L, Ropun A, Kelavkar S, Ng KX, Kamuriwo L, Shah S, Mangion D, Constantin C, De Michele Hock L, Hardwick A, Borley J, Markova S, Netherton K, Lawrence T, Fletcher J, Spencer R, Palmer H, Cullen C, Hamill D, Durairaj R, Mellor Z, Fluskey T, Wood D, Keeling A, Hankin V, Peters J, Shackcloth D, Hlaing T, Tangney R, Ewing J, Harrison M, Stevenson S, Sutton V, Soliman M, Hindle J, Watson E, Hewitt C, Borley J, Butler S, Wahishi I, Arif S, Fields A, Sharma J, Brown R, Taylor C, Bell S, Leach S, Patterson C, Khan S, Wilson H, Price J, Ramadan H, Maguire S, Bellfield R, Hooley M, Hamid U, Gaba W, Ghulam R, Masters L, Quinn O, Sekaran L, Tate M, Mohammed N, Bharaj K, Justin F, Pattni R, Alwis L, Sethuraman S, Robinson R, Eldridge L, Mintias S, Chauhan M, Tam CK, Palmones J, Holmes C, Guthrie LB, Osborn M, Ball L, Caine S, Steele A, Murphy P, Devitt N, Leonard J, Patel R, Penwarden I, Dodd E, Holloway A, Baker P, Clarke S, Williams S, Dow L, Wynn-Williams R, Kennedy J, Teal R, Schulz U, Ford G, Mathieson P, Reckless I, Deveciana A, Mccann P, Cluckie G, Howell G, Ayer J, Moynihan B, Ghatala R, Clarke B, Cloud G, Patel B, Khan U, Al-Samarrai N, Trippier S, Chopra N, Adedoyin T, Watson F, Jones V, Zhang L, Choy L, Williams R, Clarke N, Blight A, Kennedy K, Dainty A, Selvarajah J, Kalladka D, Cheripelli B, Smith W, Moreton F, Welch A, Huang X, Douglas E, Lush A, Day N, El Tawil S, Montgomery K, Hamilton H, Ritchie D, Ramachandra S, Mcleish K, Thavanesan K, Loganathan S, Roberts J, Cox C, Orr S, Hogan A, Tiwari D, Hann G, Longland B, David O, Bell J, Ovington C, Rogers E, Bower R, Keltos M, Cohen D, Devine J, Alwis L, Southworth L, Burgess L, Lang M, Badiani B, Guo F, Oshodi A, Owoyele E, Epie N, David A, Mpelembue M, Bathula R, Abdul-Saheb M, Chamberlain A, Sudkeo V, Rashed K, Wood D, Williams-Yesson B, Board J, De Bruijn S, Buckley C, Board S, Allison J, Keeling E, Duckett T, Donaldson D, Vickers C, Barron C, Balian L, Wilson J, Edwards A, England T, Hedstrom A, Bedford E, Harper M, Melikyan E, Abbott W, Subramanian K, Goldsworthy M, Srinivasan M, Yeomans A, Donaldson D, Hurford F, Chapman R, Shahzad S, David O, Motherwell N, Tonks L, Young R, Ghani U, Mukherjee I, Dutta D, Obaid M, Brown P, Davis F, Ward D, Turfrey J, Cartwright B, Topia B, Spurway J, Collins K, Bakawala R, Hughes C, Oconnell S, Hill L, Chatterjee K, Webster T, Haider S, Rushworth P, Macleod F, Nallasivan A, Perkins C, Burns E, Leason S, Carter T, Seagrave S, Sami E, Armstrong L, Naqvi SN, Hassan M, Parkinson S, Mawer S, Darnbrook G, Booth C, Hairsine B, Smith M, Williamson S, Farquhar F, Esisi B, Cassidy T, Mankin G, Mcclelland B, Bokhari M, Sproates D, Epstein E, Hurdowar S, Blackburn R, Sukhdeep N, Razak S, Osman K, Hashmi A, Upton N, Harrington F, Courtauld G, Schofield C, Lucas L, Adie K, Bond K, Mate A, Skewes J, James A, Brodie C, Johnson M, Allsop L, Driver E, Harris K, Drake M, Ellis S, Maund B, Thomas E, Moore K, Burn M, Hamilton A, Mahalingam S, Misra A, Reid F, Benford A, Hilton D, Hazell L, Ofori K, Thomas AL, Mathew M, Dayal S, Burn I, Fotherby K, Jennings-Preece K, Willberry A, Morgan D, Butler D, Sahota G, Kauldhar K, Ahmad N, Stevens A, Das S, Bruce D, Pai Y, Nyo K, Stephenson L, Nendick R, Rogers G, Dhakal M, Dima S, Brown E, Clayton S, Gamble P, Naeem M, Hayman R, Burnip R, Earnshaw P, Hargroves D, Ransom B, Rudenko H, Balogun I, Griffiths K, Mears K, Webb T, Cowie L, Hammond T, Thomson A, Ceccarelli D, Chattha N, Beranova E, Verrion A, Gillian A, Schumacher N, Bahk A, Walker S, Cvoro V, Mccormick K, Chapman N, Pound S, Cain R, Mcauley S, Couser M, Simpson M, Tachtatzis A, Ullah K, Sims D, Jones R, Smith J, Tongue R, Willmot M, Sutton C, Littleton E, Khaira J, Maiden S, Cunningham J, Green C, Chin YM, Bates M, Ahlquist K, Kane I, Breeds J, Sargent T, Latter L, Pitt Ford A, Gainsborough N, Levett T, Thompson P, Barbon E, Dunne A, Hervey S, Ragab S, Sandell T, Dickson C, Dube J, Power S, Evans N, Wadams B, Elitova S, Aubrey B, Garcia T, Mcilmoyle J, Jeffs C, Dickinson C, Ahmed A, Kumar S, Frudd J, Armer C, Potter A, Donaldson S, Howard J, Jones K, Dhar S, Collas D, Sundayi S, Denham L, Oza D, Walker E, Cunningham J, Bhandari M, Ispoglou S, Evans R, Sharobeem K, Walton E, Shanu S, Hayes A, Howard-Brown J, Billingham S, Weir N, Pressly V, Wood E, Sykes L, Howard G, Burton H, Crawford P, Egerton S, Evans S, Hakkak J, Andrews J, Lampard R, Allen C, Walters A, Said R, Marigold JR, Tsang SM, Creeden R, Cox C, Smith S, Gartrell I, Smith F, Jenkins C, Pryor J, Hedges A, Price F, Moseley L, Mercer L, Hughes C, Mcgowan D, Azim A, White J, Krasinska-Chavez M, Chaplin S, Curtis J, Singh D, Imam J, Nicolson A, Alam S, Whitworth S, Wood L, Warburton E, Kelly S, Mcgee J, Markus H, Chandrasena D, Hayden D, Sesay J, Hayhoe H, Bolton M, Macdonald J, Mitchell J, Farron C, Amis E, Day D, Culbert A, Espanol A, Hannon N, Handley D, Finlay S, Crisp S, Whitehead L, Francis J, Oconnell J, Osborne E, Beard R, Krishnamurthy R, Mokoena L, Sattar N, Myint M, Edwards M, Smith A, Corrigan P, Byrne A, Blackburn J, Mcghee C, Smart A, Macleod M, Donaldson F, Copeland C, Wilson J, Scott R, Fitzsimmons P, Lopez P, Wilkinson M, Manoj A, Cox P, Trainor L, Fletcher G, Denny L, Kavanagh K, Allsop H, Emsley H, Sultan S, Mcloughlin A, Walmsley B, Hough L, Ahmed S, Doyle D, Gregary B, Raj S, Nagaratnam K, Mannava N, Haque N, Shields N, Preston K, Mason G, Short K, Lumsdale G, Uitenbosch G, Sukys U, Valentine S, Jarrett D, Dodsworth K, Wands M, Khan N, Tandy J, Watkinson C, Golding W, Butler R, Williams M, Davies Y, Yip K, James C, Suttling A, Maney A, Gamble GE, Hague A, Charles B, Blane S, Duran B, Lambert C, Stagg K, Whiting R, Homan JE, Brown S, Hussain M, Harvey M, Graham L, Foote L, Lane C, Kemp L(J, Rowe J, Durman H, Foot J, Brotherton L, Hunt N, Pawley C, Whitcher A, Sutton P, Mcdonald S, Pak D, Wiltshire A, Jagger J, Metcalf AK, Healey GL, Balami J, Self CM, Crofts M, Chakrabarti A, Hmu C, Ravenhill G, Grimmer C, Soe T, Keshet-Price J, Langley M, Potter I, Tam PL, Macleod MJ, Cooper P, Christie M, Irvine J, Annison F, Christie D, Meneses C, Johnson A, Joyson A, Nelson S, Taylor V, Reid J, Clarke R, Furnace J, Gow H, Abousleiman Y, Beadling T, Collins S, Jones S, Purcell J, Bloom S, Goshawk S, Landicho M, Sangaralingham S, Begum Y, Mutton S, Munuswamy Vaiyapuri E, Allen J, Lowe J, Hughes M, Wiggam I, Cuddy S, Tauro S, Wells B, Mohd Nor A, Eglinton C, Persad N, Kalita M, Weatherby S, Brown C, Pace A, Lashley D, Marner M, Weinling M, Wilmshurst N, Waugh D, Mucha A, Shah A, Baker J, Westcott J, Cowan R, Vasileiadis E, Mumani S, Parry A, Mason C, Holden M, Petrides K, Nishiyama T, Mehta H, Krishnan M, Lynne D, Thomas L, Lynda C, Hughes C, Clements C, Williams R, Anjum T, Sharon S, Tucker S, Jones P, Colwill D, Thompson Jones H, Chadha D, Fairweather M, Walstow D, Fong R, Johnston S, Almadenboyle C, Ross S, Carson S, Nair P, Tenbruck E, Stirling M, Pusalkar A, Beadle H, Chan K, Dangri P, Asokanathan A, Rana A, Gohil S, Massyn M, Aruldoss P, Cook A, Crabtree K, Dabbagh S, Black T, Clarke C, Mead D, Fennelly R, Anthony A, Nardone L, Dimartino V, Tribbeck M, Broughton D, Tryambake D, Dixon L, Skotnicka A, Thompson J, Whitehouse S, Sigsworth A, Wong J, Annamalai A, Pagan J, Affley B, Sunderland C, Goldenberg L, Khan A, Wilkinson P, Nari R, Abbott L, Young E, Shakhon A, Lock S, Stewart J, Pereira R, Dsouza M, Dunn S, Mckenna AM, Cron N, Kidd M, Hull G, Bunworth K, Drummond G, Mahawish K, Hayes N, Connell L, Simpson J, Penney H, Punekar S, Nevinson J, Wareing W, Ward J, Greenwood R, Austin D, Banaras A, Hogan C, Corbett T, Oji N, Elliott E, Brezitski M, Passeron N, Howaniec L, Watchurst C, Patel K, Erande R, Shah R, Sengupta N, Metiu M, Gonzalez C, Funnell S, Margalef J, Peters G, Chadbourn I, Sivakumar R, Saksena R, Ketley-O'donel J, Needle R, Chinery E, Wright A, Cook S, Ngeh J, Proeschel H, Cook P, Ashcroft P, Sharpe S, Jones S, Jenkinson D, Kelly D, Bray H, Gunathilagan G, Griffiths K, Mears K, Gillian A, Jones S, Tilbey S, Abubakar S, Beranova E, Vassallo J, Leonard D, Orrell L, Hasan A, Khan A, Qamar S, Graham S, Hewitt E, Awolesi J, Haque M, Kent A, Bradshaw E, Cooper M, Wynter I, Rajapakse A, Janbieh J, Nasar AM, Wade L, Otter L, Haigh S, Burgoyne JR, Boulton R, Boulton A, Rayessa R, Clarkson E, Rhian H, Fleming A, Mitchelson K, Lowthorpe V, Abdul-Hamid A, Jones P, Duggan C, Hynes A, Nurse E, Raza SA, Jones S, Pallikona U, Edwards B, Morgan G, Dennett K, Tench H, Loosley R, Trugeon-Smith T, Jones R, Williams R, Robson D, Mavinamane S, Meenakshisundaram S, Ranga L, Dealing S, Hill A, Hargreaves M, Smith T, Bate J, Harrison L, Kirthivasan R, Cannon E, Topliffe J, Keskeys R, Williams S, Mcneela F, Cairns F, James T, Lyle A, Shah S, Zachariah G, Fergey L, Smolen S, Cooper L, Bohannan E, Omer S, Amlani S, Hunter N, Hawkes-Blackburn M, Gulli G, Peacocke A, Amero J, Burova M, Speirs O, Levy S, Francis L, Holland S, Brotheridge S, Lyon H, Hare C, Jackson S, Stephenson L, Al Hussayni S, Featherstone J, Bwalya A, Singh A, Goorah MN, Walford J, Bell A, Kelly C, Rusk D, Sutton D, Patel F, Duberley S, Hayes K, Hunt L, El Nour A, Cottrell P, Westmoreland J, Honour S, Box C, Wood P, Haritakis M, Dyer S, Brown L, Elliott K, Temlett E, Paterson J, Furness R, Young S, Orugun E, Brewer C, Thornthwaite S, Crowther H, Glover R, Sein M, Haque K, Gibson E, Wong S, Rotchell K, Burton K, Brookes L, Bailey L, Leonard D, Lindley C, Murray A, Waltho K, Holland M, Kumar P, Harlekar P, Booth L, Culmsee C, Drew J, Khan M, Mackenzie N, Thomas C, Ritchie J, Barker J, Haley M, Cotterill D, Lane L, Little C, Simmons D, Saunders G, Dymond H, Kidd S, Warinton R, Neves-Silva Y, Nevajda B, Villaruel M, Umasankar U, Patel S, Man A, Christmas N, Rangasamy R, Ladner R, Butt G, Alvares W, Gadi N, Power M, Wroath B, Dynan K, Wilson D, Crothers S, Leonard C, Hagan S, Douris G, Vahidassr D, Thompson A, Gallen B, Mckenna S, Edwards C, Mcgoldrick C, Bhattad M, Kawafi K, Morse D, Jacob P, Turner L, Saravanan N, Johnson L, Humphrey S, Namushi R, Patel R, Mclaughlin J, Omahony P, Osikominu E, Orefo C, Mcdonald C, Jones V, Makanju E, Khan T, Appiatse G, Stone H, Augustin M, Wardale A, Salehin M, Bailey D, Garcia-Alen L, Kalathil L, Tinsley S, Jones T, Amor K, Ritchings A, Margerum E, Horton J, Miller R, Gautam N, Meir J, Jones A, Putteril J, Lepore M, Makanju E, Gallifent R, Arundell LL, Mcredmond C, Goulding A, Nadarajan V, Laurence J, Fung Lo S, Melander S, Nicholas P, Woodford E, Mckenzie G, Le V, Crause J, Luder R, Bhargava M, Shah R, Bhome G, Johnson VV, Chesser D, Bridger H, Murali E, Scott J, Morrison S, Burns A, Graham J, Duffy M, Ali K, Sargent T, Pitcher E, Gaylard J, Newman J, Punnoose S, Besley S, Purohit K, Rees A, Davy M, Chohan O, Khan MF, Walker R, Murray V, Bent C, Oakley S, Blight A, Peixoto C, Jones S, Livingstone G, Butler F, Bradfield S, Gordon L, Schmit J, Wijewardane A, Edmunds T, Wills R, Medcalf C, Argandona L, Cuenoud L, Hassan H, Erumere E, Ocallaghan A, Gompertz P, Redjep O, Auld G, Howaniec L, Song A, Tarkas T, Kabash H, Hungwe R. Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial. Lancet 2019; 393:265-274. [PMID: 30528472 PMCID: PMC6336936 DOI: 10.1016/s0140-6736(18)32823-x] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 10/24/2018] [Accepted: 10/29/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. METHODS FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. FINDINGS Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839-1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26-6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38-2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. INTERPRETATION Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. FUNDING UK Stroke Association and NIHR Health Technology Assessment Programme.
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Kennedy K, Applebaum B, Bowblis J. WILL SHE STAY OR WILL SHE GO? FACILITY-LEVEL IMPACTS ON NURSE AIDES’ RETENTION AND TURNOVER RATES IN OHIO NURSING HOMES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Kennedy
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University
| | - B Applebaum
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University
| | - J Bowblis
- Department of Economics and Scripps Gerontology Center
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Kennedy K, Hua C, Nelson M. MOVING BEYOND PLANS FOR EMERGENCY PREPAREDNESS: ORGANIZATIONAL RESILIENCE IN RESIDENTIAL CARE FACILITIES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Kennedy
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University
| | | | - M Nelson
- Scripps Gerontology Center, Miami University
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Capucilli P, Kennedy K, Kazatsky A, Cianferoni A, Spergel J. A SQUEEZABLE CASE OF ANAPHYLAXIS. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kennedy K, Ruffner M, Muir A. MULTIPHASIC TREATMENT MODALITY FOR PEDIATRIC EOSINOPHILIC GASTROENTERITIS, A SINGLE CENTER EXPERIENCE. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.191] [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: 11/28/2022]
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Levin M, Silberstein SD, Gilbert R, Lucas S, Munsie L, Garrelts A, Kennedy K, Everman N, Pearlman E. Basic Considerations for the Use of Monoclonal Antibodies in Migraine. Headache 2018; 58:1689-1696. [PMID: 30426478 PMCID: PMC6283065 DOI: 10.1111/head.13439] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Migraine impacts more than 36 million people in the United States and 1 billion people worldwide. Despite the increasing availability of acute and preventive therapies, there is still tremendous unmet need. Potential treatments in development include monoclonal antibodies (mAbs). Appropriate use of these “biologic” treatments will necessitate an understanding of the aspects that distinguish them from traditional medications. AIM Many drug classes are prescribed for migraine treatment, but all have limitations. Recently, calcitonin gene-related peptide (CGRP) activity has shown a significant promise as a target for preventive therapy. In this review, we provide an overview of the potential role of CGRP mAbs in migraine, with a focus on their design, pharmacokinetics, safety, and immunogenicity. CONCLUSIONS The CGRP mAbs are an innovative new therapy for migraine and address the need for effective and tolerable preventive options. MAbs, including those that target CGRP or its receptor, bind to a target with high specificity and affinity and lead to few off-target adverse effects, although mechanism-based adverse reactions may occur. Unlike other therapeutic antibodies used to treat neurologic disease, CGRP mAbs do not have a target within the immune system and have been designed to avoid altering the immune system. The safety and efficacy of mAbs against CGRP or its receptors are being investigated in clinical development programs, and the first of these therapies has received regulatory approval in the United States.
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Affiliation(s)
| | | | | | - Sylvia Lucas
- University of Washington School of MedicineSeattleWAUSA
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Cafone J, Kennedy K, Corry J, Lee J. A COMMON THERAPY FOR ALLERGIC REACTION YET A RARELY SUSPECTED CAUSE OF HYPERSENSITIVITY. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sigurdson S, Biagi J, Langley H, Kennedy K, Mahmud A. Integration of Ongoing Quality Assurance Measures in Colorectal Cancer Survivorship Care Plans. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1334] [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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Noor Z, Goldman J, Lawler W, Melancon D, Telivala B, Braiteh F, Dicarlo B, Kennedy K, Martinez D, Adams B, Wang X, Jones B, Garon E. P2.13-39 A Phase Ib Trial of the HSP90 Inhibitor AUY922 in Combination with Pemetrexed in Metastatic Non-Squamous, Non-Small Cell Lung Cancer Patients. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mahony C, Vandermolen K, Otto-Bruc A, Naciff J, Kennedy K, Daston G. In vitro alternatives for assessing human safety of botanical mixtures. Toxicol Lett 2018. [DOI: 10.1016/j.toxlet.2018.06.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Izuma K, Kennedy K, Fitzjohn A, Sedikides C, Shibata K. Neural activity in the reward-related brain regions predicts implicit self-esteem: A novel validity test of psychological measures using neuroimaging. J Pers Soc Psychol 2018; 114:343-357. [DOI: 10.1037/pspa0000114] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bell A, Conway N, Courtney J, Kennedy K, Raubenheimer Z, Rice N, Kevans D, Donohoe CL, Reynolds JV. Point Prevalence of Adult Intestinal Failure in Republic Of Ireland. Ir Med J 2018; 111:688. [PMID: 29952437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Parenteral Nutrition (PN) is a life-saving treatment used for patients with Intestinal Failure (IF). PN is complex and demands highly specialised care to avoid serious complications in the home setting. All tertiary centres in the Republic of Ireland (ROI) were contacted to assess the prevalence of IF requiring PN and complications, over a one year period. Sixty-seven patients were treated across 15 centres: a period prevalence of 14.6 and 9.6 patients per million for long-term PN and home PN respectively. Three-quarters of patients experienced at least one major complication with 18% mortality rate over the study period. There were 2.86 admissions per HPN patient, each lasting mean 13.4 days. One-third experienced catheter-related infections. There was a reduced length of stay during emergency re-admissions in high volume centres (mean 31 v 43 days, p=0.17). The establishment of a National Centre for IF/HPN in ROI is integral to reducing PN-associated complications.
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Affiliation(s)
- A Bell
- School of Medicine, Trinity College Dublin
| | - N Conway
- School of Medicine, Trinity College Dublin
| | - J Courtney
- School of Medicine, Trinity College Dublin
| | - K Kennedy
- School of Medicine, Trinity College Dublin
| | | | - N Rice
- Irish Society for Clinical Nutrition and Metabolism (IrSPEN)
| | - D Kevans
- Dept of Gastroenterology, St James' Hospital, Dublin 8
| | - C L Donohoe
- Dept of Surgery, St James' Hospital, Dublin 8
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Kennedy K, DeFelice M, Abraham S. P328 History of milk or soy protein intolerance in infancy in patients with eosinophilic esophagitis. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.219] [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: 11/15/2022]
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Berndt A, Murray CM, Kennedy K, Stanley MJ, Gilbert-Hunt S. Effectiveness of distance learning strategies for continuing professional development (CPD) for rural allied health practitioners: a systematic review. BMC Med Educ 2017; 17:117. [PMID: 28701199 PMCID: PMC5506644 DOI: 10.1186/s12909-017-0949-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/26/2017] [Indexed: 05/06/2023]
Abstract
BACKGROUND Allied health professionals working in rural areas face unique challenges, often with limited access to resources. Accessing continuing professional development is one of those challenges and is related to retention of workforce. Effectiveness of distance learning strategies for continuing professional development in rural allied healthcare workers has not been evaluated. METHODS We searched 17 databases and the grey literature up to September 2016 following the PRISMA guidelines. Any primary studies were included that focussed on allied health and distance delivery regardless of education topic or study design. Two independent reviewers extracted data and critically appraised the selected studies. RESULTS The search returned 5257 results. With removal of duplicate references, we reviewed 3964 article titles and abstracts; n = 206 appeared potentially eligible and were scrutinised via full text screening; n = 14 were included. Studies were published between 1997 and 2016, were of varied methodological quality and were predominantly from Australia, USA and Canada with a focus on satisfaction of learners with the delivery method or on measures of educational outcomes. Technologies used to deliver distance education included video conference, teleconference, web based platforms and virtual reality. Early papers tended to focus more on the technology characteristics than educational outcomes. Some studies compared technology based delivery to face to face modes and found satisfaction and learning outcomes to be on par. Only three studies reported on practice change following the educational intervention and, despite a suggestion there is a link between the constructs, none measured the relationship between access to continuing professional development and workforce retention. CONCLUSION Technology based options of delivery have a high utility, however the complex inter-relatedness of time, use, travel, location, costs, interactivity, learning outcomes and educational design suggest a need for more sophisticated consideration by educational providers. TRIAL REGISTRATION Registration with PROSPERO 30 June 2016: CRD42016041588 .
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Affiliation(s)
- Angela Berndt
- University of South Australia, School of Health Sciences, Adelaide, Australia
| | - Carolyn M. Murray
- University of South Australia, School of Health Sciences, Adelaide, Australia
| | - Kate Kennedy
- University of South Australia, School of Health Sciences, Adelaide, Australia
| | - Mandy J. Stanley
- University of South Australia, School of Health Sciences, Adelaide, Australia
| | - Susan Gilbert-Hunt
- University of South Australia, School of Health Sciences, Adelaide, Australia
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Kinsley C, Kennedy K, Crolla A. A combined reed bed/freezing bed technology for septage treatment and reuse in cold climate regions. Water Sci Technol 2017; 76:286-293. [PMID: 28726695 DOI: 10.2166/wst.2017.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A combined reed bed-freezing bed (RB-FB) technology was effective at treating septage under Canadian climatic conditions over a 5-year period with average loading rates of 82-104 kg TS/m2/y. Varying hydraulic and solid loading rates as well as the increasing sludge cake with time had little to no effect on treatment efficiency, with almost complete removal of organic matter, solids, heavy metals and nutrients. Filtrate concentrations varied significantly between the freeze-thaw and growing seasons for many parameters, although the differences were not important from a treatment or reuse perspective with filtrate quality similar to a low to medium strength domestic wastewater. The potential to reuse the filtrate as a source of irrigation water will depend upon local regulations. The dewatered sludge cake consistently met biosolids land application standards in terms of pathogen and metals content, with Escherichia coli numbers declining with time as sludge cake depth increased. A combined RB-FB technology can provide a cost-effective solution for septage management in northern rural communities with potential for beneficial reuse of both the filtrate and dewatered sludge cake.
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Affiliation(s)
- C Kinsley
- Department of Civil Engineering, University of Ottawa, 161 Louis Pasteur, Ottawa, Ontario, Canada K1N 6N5 E-mail: ; Ontario Rural Wastewater Centre, Université de Guelph - Campus d'Alfred, 31 St. Paul St., Alfred, Ontario, Canada K0B1A0
| | - K Kennedy
- Department of Civil Engineering, University of Ottawa, 161 Louis Pasteur, Ottawa, Ontario, Canada K1N 6N5 E-mail:
| | - A Crolla
- Ontario Rural Wastewater Centre, Université de Guelph - Campus d'Alfred, 31 St. Paul St., Alfred, Ontario, Canada K0B1A0
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Grandin E, Mooney D, Kennedy K, Kiernan M, Kociol R, Teuteberg J, Pagani F, Gaffey A, Atluri P, Birati E, Myers S, Naftel D, Oliveira G, Simpson K, Yeh R, Kirklin J, Kormos R, Rame J. The Duration of Inotropic Support and Survival After Left Ventricular Assist Device. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Biswas C, Chen SCA, Halliday C, Kennedy K, Playford EG, Marriott DJ, Slavin MA, Sorrell TC, Sintchenko V. Identification of genetic markers of resistance to echinocandins, azoles and 5-fluorocytosine in Candida glabrata by next-generation sequencing: a feasibility study. Clin Microbiol Infect 2017; 23:676.e7-676.e10. [PMID: 28344162 DOI: 10.1016/j.cmi.2017.03.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/03/2017] [Accepted: 03/18/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Multi-antifungal drug resistance in Candida glabrata is increasing. We examined the feasibility of next-generation sequencing (NGS) to investigate the presence of antifungal drug resistance markers in C. glabrata. METHODS The antifungal susceptibility of 12 clinical isolates and one ATCC strain of C. glabrata was determined using the Sensititre YeastOne® YO10 assay. These included three isolate pairs where the second isolate of each pair had developed a rise in drug MICs. Single nucleotide polymorphisms (SNPs) in genes known to be linked to echinocandin, azole and 5-fluorocytosine resistance were analysed in all isolates through NGS. RESULTS High-quality non-synonymous SNPs in antifungal resistance genes such as FKS1, FKS2, CgCDR1, CgPDR1 and FCY2 were identified. For two of three isolate pairs, there was a >60-fold rise in MICs to all echinocandins in the second isolate from each pair; one echinocandin-resistant isolate harboured a mutation in FKS1 (S629P) and the other in FKS2 (S663P). Of the third pair, both the 5-fluorocytosine-susceptible, and resistant isolates had a mutation in FCY2 (A237T). SNPs in CgPDR1 were found in pan-azole-resistant isolates. SNPs in other genes linked to azole resistance (CgCDR1, ERG9 and CgFLR1) were present in both azole-susceptible and azole-resistant isolates. SNPs were also identified in Candida adhesin genes EPA1, EPA6, PWP2 and PWP5 but their presence was not associated with higher drug MICs. CONCLUSIONS Genome-wide analysis of antifungal resistance markers was feasible and simultaneously revealed mutation patterns of genes implicated in resistance to different antifungal drug classes.
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Affiliation(s)
- C Biswas
- Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Sydney, Australia; Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Sydney, Australia.
| | - S C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Sydney, Australia; Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Sydney, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
| | - C Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Sydney, Australia
| | - K Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, Australia
| | - E G Playford
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - D J Marriott
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, Australia
| | - M A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - T C Sorrell
- Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Sydney, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
| | - V Sintchenko
- Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Sydney, Australia; Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Sydney, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
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Wolf S, Morris J, Kennedy K, Lawn M, Mcloughlin T, Feane K, Uprichard J, Weaver A, Allard S, Green L. The impact of providing blood to the scene of an accident on transfusion laboratory practice. Transfus Med 2017; 28:56-59. [PMID: 28295747 DOI: 10.1111/tme.12397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 01/07/2017] [Accepted: 02/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Haemorrhage is the leading cause of mortality during trauma. In 2012, London's Air Ambulance introduced Blood on Board (BOB), transfusing group O red cells (RBC) to trauma patients at the scene. OBJECTIVES This study assessed the impact of BOB on the number of mixed field samples received by the laboratory, the number of group O RBC transfused to non-group O patients and the ratio of RBC to fresh frozen plasma (FFP) transfused in the initial 24 h. METHODS Three major trauma centres collected data on patients for whom the major haemorrhage protocol was activated between August 2008 and February 2012 pre-BOB and March 2012 and December 2013 post-BOB. RESULTS A total of 233 trauma patients were identified pre-BOB and 119 post-BOB. There was no significant difference in the percentage of group O units transfused to non-group O patients (75 vs 82%, P = 0·21) or the RBC : FFP ratio (pre-BOB mean 1·6 [interquartile range (IQR) 1·0-2·0]; post-BOB mean 1·7 [IQR 1·1-2·2], P = 0·24). There was no significant difference in the percentage of mixed field samples received (23% vs 27%, P = 0·3). CONCLUSION The introduction of BOB did not change the proportion of group O RBC transfused or the RBC : FFP ratio; however, the proportion of acceptable samples decreased. This is largely due to an increase in blood samples not received from the post-BOB cohort, which we believe is probably due to patients who died at the scene. We have introduced robust systems to indicate reasons for not obtaining samples.
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Affiliation(s)
- S Wolf
- Department of Hematology, Barts Health NHS Trust, London, UK
| | - J Morris
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - K Kennedy
- Department of Hematology, Barts Health NHS Trust, London, UK
| | - M Lawn
- Kings College Hospital, London, UK
| | - T Mcloughlin
- Department of Hematology, Barts Health NHS Trust, London, UK
| | - K Feane
- St George's Healthcare NHS Trust, London, UK
| | - J Uprichard
- St George's Healthcare NHS Trust, London, UK
| | - A Weaver
- Department of Hematology, Barts Health NHS Trust, London, UK
| | - S Allard
- Department of Hematology, Barts Health NHS Trust, London, UK.,NHS Blood and Transplant, London, UK
| | - L Green
- Department of Hematology, Barts Health NHS Trust, London, UK.,Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,NHS Blood and Transplant, London, UK
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Kennedy K, Cunningham-Rundles C, Morsheimer M. O011 Immunoglobulin management approaches in American patients with common variable immune deficiency and autoimmunity. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.371] [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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50
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Fewtrell MS, Kennedy K, Ahluwalia JS, Nicholl R, Lucas A, Burton P. Predictors of expressed breast milk volume in mothers expressing milk for their preterm infant. Arch Dis Child Fetal Neonatal Ed 2016; 101:F502-F506. [PMID: 26936878 DOI: 10.1136/archdischild-2015-308321] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 09/21/2015] [Accepted: 02/10/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND An understanding of predictors of breast milk production may enable the provision of better advice and support to mothers with preterm infants who may need to express milk for long periods. OBJECTIVE To investigate factors predicting the amount of milk expressed by mothers for their preterm infant (1) during the first 10 days and (2) during the infant's whole hospital stay. METHODS 62 mothers with preterm infants <34 weeks who participated in a randomised trial comparing two breast pumps completed 10-day diaries including weight of milk expressed and questionnaires giving their opinion of the breast pump; 47 mothers provided data on milk expression up to the infant's hospital discharge. RESULTS Significant predictors of 10-day milk weight in multivariate models were the number of episodes of 'breast feeding' (17 g (95% CI 8 to 26, p=0.001) increase per episode), the use of double versus single pumping (109 (31-186, p=0.007) g/day more) and the number of complete daily records (17 (1-33, p=0.04) g increase/day). Significant multivariate predictors of total milk production were double versus single pumping (491 (55) mL/day vs 266 (44) mL/day), expressing 500 mL/day by day 10 (525 (53) mL/day vs 232 (43) mL/day) and a higher score for breast pump 'comfort' (best=489 (39) mL/day, middle=335 (57) mL/day, worst=311 (78) mL/day). CONCLUSIONS These results suggest that relatively simple, modifiable factors can favourably impact milk production in the neonatal intensive care unit setting and emphasise the importance of double pumping, early establishment of milk production and design features of the breast pump that promote comfort. TRIAL REGISTRATION NUMBER NCT00887991.
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Affiliation(s)
- M S Fewtrell
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - K Kennedy
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - J S Ahluwalia
- Neonatal Intensive Care Unit, Addenbrookes Hospital, Cambridge, UK
| | - R Nicholl
- Neonatal Intensive Care Unit (NICU), Northwick Park Hospital, Harrow, Middlesex, UK
| | - A Lucas
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - P Burton
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
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