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Uher R, Pavlova B, Najafi S, Adepalli N, Ross B, Howes Vallis E, Freeman K, Parker R, Propper L, Palaniyappan L. Antecedents of major depressive, bipolar, and psychotic disorders: A systematic review and meta-analysis of prospective studies. Neurosci Biobehav Rev 2024; 160:105625. [PMID: 38494121 DOI: 10.1016/j.neubiorev.2024.105625] [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: 12/31/2023] [Revised: 03/05/2024] [Accepted: 03/13/2024] [Indexed: 03/19/2024]
Abstract
Major depressive, bipolar, or psychotic disorders are preceded by earlier manifestations in behaviours and experiences. We present a synthesis of evidence on associations between person-level antecedents (behaviour, performance, psychopathology) in childhood, adolescence, or early adulthood and later onsets of major depressive disorder, bipolar disorder, or psychotic disorder based on prospective studies published up to September 16, 2022. We screened 11,342 records, identified 460 eligible publications, and extracted 570 risk ratios quantifying the relationships between 52 antecedents and onsets in 198 unique samples with prospective follow-up of 122,766 individuals from a mean age of 12.4 to a mean age of 24.8 for 1522,426 person years of follow-up. We completed meta-analyses of 12 antecedents with adequate data. Psychotic symptoms, depressive symptoms, anxiety, disruptive behaviors, affective lability, and sleep problems were transdiagnostic antecedents associated with onsets of depressive, bipolar, and psychotic disorders. Attention-deficit/hyperactivity and hypomanic symptoms specifically predicted bipolar disorder. While transdiagnostic and diagnosis-specific antecedents inform targeted prevention and help understand pathogenic mechanisms, extensive gaps in evidence indicate potential for improving early risk identification.
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Affiliation(s)
- Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
| | - Barbara Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Sara Najafi
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Nitya Adepalli
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Briana Ross
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Emily Howes Vallis
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Kathryn Freeman
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Robin Parker
- WK Kellogg Health Sciences Library, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lukas Propper
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Lena Palaniyappan
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Quebec, Montreal, Canada; Robarts Research Institute, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Canada
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Rakshe S, Valek R, Teichman R, Freeman K, DeFrancesco S, Carlson KF. Five Years of Extreme Risk Protection Orders in Oregon: A Descriptive Analysis. Psychol Rep 2024:332941241248599. [PMID: 38676327 DOI: 10.1177/00332941241248599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Extreme Risk Protection Order (ERPO) laws have received increasing attention as a tool to prevent firearm suicide and homicide, including mass shootings. However, important gaps remain in our understanding of ERPO usage and implementation. Using the Oregon Judicial Case Information Network database, we abstracted data from all ERPO petitions filed in Oregon from 2018 to 2022, the first five years after the law took effect (N = 649). ERPO petitions were filed in 29 of 36 counties (81%, range 0-105 per county, median 11), against respondents 17-96 years of age (median: 42). Of ERPOs filed, 78% were initially granted. While only 22% of respondents in initially-granted ERPOs requested a hearing, when a hearing was held, nearly half (44%) of ERPOs were dismissed. The majority of ERPO petitions were motivated by threats of harm to respondents and others (n = 327, 50%), followed by threats of harm to others-only (n = 220, 34%) or respondents-only (n = 81, 12%). During the 5-year period, 72 (11%) ERPO petitions cited threats of mass violence as a motivating factor, including 24 (4%) petitions citing threats to schools or college campuses. The majority of ERPOs were filed by law enforcement officers (60%), and these petitions were significantly more often granted than those filed by family/household members (96% vs. 67%, p < .0001). We also found evidence of important gaps in documentation, including of respondent race (unavailable for 191 respondents, 29%) and of weapon removal or disposition after the ERPO was granted (unavailable in 350 cases, 69%). This study of long-term patterns of ERPO petitions highlights trends in usage and suggests areas where improvement may be possible, with implications for other states that have adopted or are considering similar ERPO laws.
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Affiliation(s)
- Shauna Rakshe
- Oregon Health & Science University Knight Cancer Institute, Portland, OR, USA
| | - Rebecca Valek
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Rebecca Teichman
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Kathryn Freeman
- University of New Mexico Department of Emergency Medicine, Albuquerque, NM, USA
| | - Susan DeFrancesco
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Kathleen F Carlson
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
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Bonadonna G, Ramilijaona OM, Raharivololona BM, Andrianarimisa A, Razafindraibe H, Freeman K, Rasambainarivo F, Wroblewski EE, Milich KM. Response of diademed sifaka ( Propithecus diadema) to fosa ( Cryptoprocta ferox) predation in the Betampona Strict Nature Reserve, Madagascar. Ecol Evol 2024; 14:e11248. [PMID: 38601854 PMCID: PMC11004663 DOI: 10.1002/ece3.11248] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/20/2024] [Accepted: 03/27/2024] [Indexed: 04/12/2024] Open
Abstract
Large-bodied mammals living in fragmented habitats are at higher risk of extinction, and such risk can be influenced by ecological factors such as predator-prey system dynamics. These dynamics can be particularly complex for conservation management when one endangered species preys on another endangered species in an isolated or poor-quality habitat. Here we describe predation events observed over 19 months that involved two threatened species: the largest carnivore in Madagascar, the fosa (Cryptoprocta ferox), and three groups of diademed sifaka (Propithecus diadema) in the Betampona Strict Nature Reserve. This site is a 22 km2 low-altitude rainforest that is surrounded by agricultural land and isolated from larger forest corridors. We aim to (1) assess the behavioral changes of P. diadema in response to fosa attacks and identify any antipredator strategies that they adopted, and (2) quantify the frequency of fosa attacks and the predation impact on the sifaka population. We report five direct observations of fosa predation attempts (one successful), the discovery of a dead sifaka with evidence of fosa predation, and the disappearance of three individuals. We describe the observed attacks and compare the sifaka activity budgets and movement patterns before and after the events. To escape the predator, sifakas fled short distances, hid, and remained vigilant. The impact of predation, combined with low reproductive rates and potentially high inbreeding of this isolated diademed sifaka population, could affect the survival of this species in Betampona. Given the compounding effects of habitat isolation and high hunting pressure, community-specific conservation strategies should incorporate predator-prey dynamics via longitudinal monitoring of predator and prey population densities and quantifying the predation pressure between them.
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Affiliation(s)
- G. Bonadonna
- Department of AnthropologyWashington University in St. LouisSt. LouisMissouriUSA
| | - O. M. Ramilijaona
- Zoology and Animal Biodiversity, Faculty of SciencesUniversity of AntananarivoAntananarivoMadagascar
| | - B. M. Raharivololona
- Department of Anthropology and Sustainable Development, Faculty of SciencesUniversity of AntananarivoAntananarivoMadagascar
| | - A. Andrianarimisa
- Zoology and Animal Biodiversity, Faculty of SciencesUniversity of AntananarivoAntananarivoMadagascar
| | - H. Razafindraibe
- Zoology and Animal Biodiversity, Faculty of SciencesUniversity of AntananarivoAntananarivoMadagascar
| | - K. Freeman
- Madagascar Fauna and Flora GroupKalinkaUK
| | - F. Rasambainarivo
- Department of BiologyEast Carolina UniversityGreenvilleNorth CarolinaUSA
- Mahaliana Labs SARLAntananarivoMadagascar
| | - E. E. Wroblewski
- Department of AnthropologyWashington University in St. LouisSt. LouisMissouriUSA
| | - K. M. Milich
- Department of AnthropologyWashington University in St. LouisSt. LouisMissouriUSA
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Mazurka R, Vallis EH, Chen L, Freeman K, Langley R, Ross B, Arora S, Kahn M, Howard C, Liu D, Cumby J, Brennan ML, Hickcox SE, Bagnell AL, Propper L, Pavlova B, Uher R. Preferences for virtual versus in-person mental and physical healthcare in Canada: a descriptive study from a cohort of youth and their parents enriched for severe mental illness. BMJ Paediatr Open 2024; 8:e002197. [PMID: 38191204 PMCID: PMC10806455 DOI: 10.1136/bmjpo-2023-002197] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/21/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Virtual care may improve access to healthcare and may be well suited to digitally connected youth, but experts caution that privacy and technology barriers could perpetuate access inequities. Success of virtual care will depend on its alignment with patient preferences. However, information on preferences for virtual and in-person healthcare is missing, especially for youth. We sought to quantify preferences for and barriers to virtual versus in-person mental and physical healthcare in youth and their parents, including in vulnerable segments of the population such as families with a parent with severe mental illness (SMI). METHODS Participants were 219 youth and 326 parents from the Families Overcoming Risks and Building Opportunities for Wellbeing cohort from Canada, of which 61% of youth had at least one parent with SMI. Participants were interviewed about healthcare preferences and access to privacy/technology between October 2021 and December 2022. RESULTS Overall, youth reported a preference for in-person mental (66.6%) and physical healthcare (74.7%) versus virtual care or no preference, and to a somewhat lesser degree, so did their parents (48.0% and 53.9%). Half of participants reported privacy/technology barriers to virtual care, with privacy being the most common barrier. Preferences and barriers varied as a function of parent SMI status, socioeconomic status and rural residence. CONCLUSIONS The majority of youth and parents in this study prefer in-person healthcare, and the preference is stronger in youth and in vulnerable segments of the population. Lack of privacy may be a greater barrier to virtual care than access to technology.
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Affiliation(s)
- Raegan Mazurka
- Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Emily Howes Vallis
- Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Lucy Chen
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Ross Langley
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Briana Ross
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Swasti Arora
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Mica Kahn
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Cynthia Howard
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Dara Liu
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Jill Cumby
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | | | - Samuel E Hickcox
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Office of Addictions and Mental Health, Government of Nova Scotia, Halifax, Nova Scotia, Canada
| | - Alexa L Bagnell
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Lukas Propper
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Barbara Pavlova
- Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Rudolf Uher
- Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Sosero YL, Bandres-Ciga S, Ferwerda B, Tocino MTP, Belloso DR, Gómez-Garre P, Faouzi J, Taba P, Pavelka L, Marques TM, Gomes CPC, Kolodkin A, May P, Milanowski LM, Wszolek ZK, Uitti RJ, Heutink P, van Hilten JJ, Simon DK, Eberly S, Alvarez I, Krohn L, Yu E, Freeman K, Rudakou U, Ruskey JA, Asayesh F, Menéndez-Gonzàlez M, Pastor P, Ross OA, Krüger R, Corvol JC, Koks S, Mir P, De Bie RMA, Iwaki H, Gan-Or Z. Dopamine pathway and Parkinson's risk variants are associated with levodopa-induced dyskinesia. medRxiv 2023:2023.08.28.23294610. [PMID: 37790572 PMCID: PMC10543218 DOI: 10.1101/2023.08.28.23294610] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Levodopa-induced dyskinesia (LID) is a common adverse effect of levodopa, one of the main therapeutics used to treat the motor symptoms of Parkinson's disease (PD). Previous evidence suggests a connection between LID and a disruption of the dopaminergic system as well as genes implicated in PD, including GBA1 and LRRK2. Objectives To investigate the effects of genetic variants on risk and time to LID. Methods We performed a genome-wide association study (GWAS) and analyses focused on GBA1 and LRRK2 variants. We also calculated polygenic risk scores including risk variants for PD and variants in genes involved in the dopaminergic transmission pathway. To test the influence of genetics on LID risk we used logistic regression, and to examine its impact on time to LID we performed Cox regression including 1,612 PD patients with and 3,175 without LID. Results We found that GBA1 variants were associated with LID risk (OR=1.65, 95% CI=1.21-2.26, p=0.0017) and LRRK2 variants with reduced time to LID onset (HR=1.42, 95% CI=1.09-1.84, p=0.0098). The fourth quartile of the PD PRS was associated with increased LID risk (ORfourth_quartile=1.27, 95% CI=1.03-1.56, p=0.0210). The third and fourth dopamine pathway PRS quartiles were associated with a reduced time to development of LID (HRthird_quartile=1.38, 95% CI=1.07-1.79, p=0.0128; HRfourth_quartile=1.38, 95% CI=1.06-1.78, p=0.0147). Conclusions This study suggests that variants implicated in PD and in the dopaminergic transmission pathway play a role in the risk/time to develop LID. Further studies will be necessary to examine how these findings can inform clinical care.
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Affiliation(s)
- Yuri L Sosero
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Sara Bandres-Ciga
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes on Health, Bethesda, MD, USA
| | - Bart Ferwerda
- Department of Clinical Epidemiology and Biostatistics, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Maria T P Tocino
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Dìaz R Belloso
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Pilar Gómez-Garre
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Johann Faouzi
- Sorbonne Université, Paris Brain Institute - ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France
- CREST, ENSAI, Campus de Ker-Lann, 51 Rue Blaise Pascal - BP 37203 35172 Bruz Cedex, France
| | - Pille Taba
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu 50406, Estonia
| | - Lukas Pavelka
- Transversal Translational Medicine, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
- Centre Hospitalier de Luxembourg (CHL), Strassen, Luxembourg
| | - Tainà M Marques
- Transversal Translational Medicine, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Clarissa P C Gomes
- Translational Neuroscience, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Alexey Kolodkin
- Transversal Translational Medicine, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Patrick May
- Transversal Translational Medicine, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
- Centre Hospitalier de Luxembourg (CHL), Strassen, Luxembourg
| | - Lukasz M Milanowski
- Department of Neurology Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Zbigniew K Wszolek
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Ryan J Uitti
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | | | | | - David K Simon
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Shirley Eberly
- Department of Biostatistics and Computational Biology at the University of Rochester School of Medicine and Dentistry
| | - Ignacio Alvarez
- Department of Neurology, Hospital Universitari Mutua de Terrassa, Barcelona, Spain
| | - Lynne Krohn
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Eric Yu
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Kathryn Freeman
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Uladzislau Rudakou
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Jennifer A Ruskey
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Farnaz Asayesh
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Manuel Menéndez-Gonzàlez
- Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Calle Julián Clavería s/n, 33006 Oviedo, Spain
- Department of Neurology, Hospital Universitario Central de Asturias, Avenida Roma s/n, 33011 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Avenida Roma s/n, 33011 Oviedo, Spain
| | - Pau Pastor
- Department of Neurology, Hospital Universitari Mutua de Terrassa, Barcelona, Spain
- Unit of Neurodegenerative Diseases, Department of Neurology, University Hospital Germans Trias i Pujol and The Germans Trias i Pujol Research Institute (IGTP) Badalona, Barcelona, Spain
| | - Owen A Ross
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Rejko Krüger
- Transversal Translational Medicine, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
- Centre Hospitalier de Luxembourg (CHL), Strassen, Luxembourg
- Translational Neuroscience, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Jean-Christophe Corvol
- CREST, ENSAI, Campus de Ker-Lann, 51 Rue Blaise Pascal - BP 37203 35172 Bruz Cedex, France
| | - Sulev Koks
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Murdoch, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Australia
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - Rob M A De Bie
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Hirotaka Iwaki
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes on Health, Bethesda, MD, USA
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Data Tecnica International, Washington, District of Columbia, USA
| | - Ziv Gan-Or
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
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Hokamp JA, Freeman K, Harr KE. Analytical performance evaluation of two automated urine sediment analysers using two levels of commercially available quality control material. J Small Anim Pract 2023; 64:442-451. [PMID: 37019687 DOI: 10.1111/jsap.13608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 02/06/2023] [Accepted: 03/05/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVES Evaluate the in-clinic performance of point-of-care sediment analysers, Analyzer V (Vetscan SA, Abaxis) and Analyzer S (SediVue DX, IDEXX), using assayed, bilevel (2 concentrations) urine quality control material to determine if instrument specifications are acceptable for semi-quantitative clinical urine sediment analysis. MATERIALS AND METHODS Accuracy, precision and clinical utility of Analyzer V and Analyzer S measurements were evaluated using a bilevel, assayed quality control material in 23 veterinary practices. RESULTS Photomicrographs taken by the instruments facilitated manual review and quality assessment. Analyzer V and Analyzer S under-identified the presence of cystine crystals with 83 and 13% inaccuracy in the positive quality control material, respectively. Analyzer V and Analyzer S over-reported bacteria in the sterile quality control material with 82 and 94% specificity, respectively. Analyzer V and Analyzer S reported RBCs and WBCs within manufacturer specifications with excellent sensitivity (93 to 100%) and specificity (100%). CLINICAL SIGNIFICANCE Additional improvement is needed to better classify crystal types and reduce false positives for bacteria before clinical use. While normal samples can generally be trusted, a manual review of abnormal samples is required to ensure that clinically important urine components are correctly evaluated. Future studies should evaluate the performance of these instruments with species-specific urine sediment.
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Affiliation(s)
- J A Hokamp
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, 43210, USA
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Hokamp JA, Freeman K, Harr KE. Analytical performance evaluation of two automated urine chemistry analysers using two levels of commercially available quality control material. J Small Anim Pract 2023; 64:452-462. [PMID: 37129019 DOI: 10.1111/jsap.13620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 01/22/2023] [Accepted: 03/22/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Evaluate two point-of-care urine chemistry analysers, VetScan SA and VetLab UA using assayed, bilevel (two concentrations) urine quality control material to determine if performance is acceptable for semiquantitative clinical urine chemistry analysis. MATERIALS AND METHODS Normal and abnormal urine quality control material sent to 23 veterinary practices was evaluated three times by each clinic on in-clinic automated urinalysis instruments. Accuracy, precision and clinical utility were evaluated. RESULTS Normal urine quality control material: Results for blood, glucose, ketones and bilirubin were 100% accurate and precise for both analysers, and pH values were accurately acidic to neutral. However, pH from VetScan SA had clinically significant negative bias. Abnormal urine quality control material: VetScan SA: blood, microalbumin and bilirubin were 100% accurate; glucose, ketones, and protein demonstrated ≤10% inaccuracy; pH demonstrated 34% inaccuracy. VetLab UA: blood, ketones and bilirubin were 100% accurate; glucose and protein demonstrated ≤10% inaccuracy; pH was 100% accurately neutral to alkaline. CLINICAL SIGNIFICANCE VetScan SA had marked negative pH bias versus VetLab UA resulting in clinically significant, overly acidic results. Specific gravity, nitrite, and leukocyte test pads should not be used. Both instruments had excellent performance in normal quality control material. While blood, glucose, protein and bilirubin are correctly identified as present in abnormal quality control material, exact concentrations cannot be interpreted due to imprecision. Only semiquantitative results, not numerical values implying quantification, should be reported from urine test strips.
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Affiliation(s)
- J A Hokamp
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
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Krohn L, Heilbron K, Blauwendraat C, Reynolds RH, Yu E, Senkevich K, Rudakou U, Estiar MA, Gustavsson EK, Brolin K, Ruskey JA, Freeman K, Asayesh F, Chia R, Arnulf I, Hu MTM, Montplaisir JY, Gagnon JF, Desautels A, Dauvilliers Y, Gigli GL, Valente M, Janes F, Bernardini A, Högl B, Stefani A, Ibrahim A, Šonka K, Kemlink D, Oertel W, Janzen A, Plazzi G, Biscarini F, Antelmi E, Figorilli M, Puligheddu M, Mollenhauer B, Trenkwalder C, Sixel-Döring F, Cochen De Cock V, Monaca CC, Heidbreder A, Ferini-Strambi L, Dijkstra F, Viaene M, Abril B, Boeve BF, Scholz SW, Ryten M, Bandres-Ciga S, Noyce A, Cannon P, Pihlstrøm L, Nalls MA, Singleton AB, Rouleau GA, Postuma RB, Gan-Or Z. Genome-wide association study of REM sleep behavior disorder identifies polygenic risk and brain expression effects. Nat Commun 2022; 13:7496. [PMID: 36470867 PMCID: PMC9722930 DOI: 10.1038/s41467-022-34732-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 11/03/2022] [Indexed: 12/11/2022] Open
Abstract
Rapid-eye movement (REM) sleep behavior disorder (RBD), enactment of dreams during REM sleep, is an early clinical symptom of alpha-synucleinopathies and defines a more severe subtype. The genetic background of RBD and its underlying mechanisms are not well understood. Here, we perform a genome-wide association study of RBD, identifying five RBD risk loci near SNCA, GBA, TMEM175, INPP5F, and SCARB2. Expression analyses highlight SNCA-AS1 and potentially SCARB2 differential expression in different brain regions in RBD, with SNCA-AS1 further supported by colocalization analyses. Polygenic risk score, pathway analysis, and genetic correlations provide further insights into RBD genetics, highlighting RBD as a unique alpha-synucleinopathy subpopulation that will allow future early intervention.
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Affiliation(s)
- Lynne Krohn
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | | | - Cornelis Blauwendraat
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Regina H Reynolds
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- Great Ormond Street Institute of Child Health, Genetics and Genomic Medicine, University College London, London, UK
| | - Eric Yu
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Konstantin Senkevich
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Uladzislau Rudakou
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Mehrdad A Estiar
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Emil K Gustavsson
- Great Ormond Street Institute of Child Health, Genetics and Genomic Medicine, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
| | - Kajsa Brolin
- Lund University, Translational Neurogenetics Unit, Department of Experimental Medical Science, Lund, Sweden
| | - Jennifer A Ruskey
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Kathryn Freeman
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Farnaz Asayesh
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Ruth Chia
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Isabelle Arnulf
- Sleep Disorders Unit, Pitié Salpêtrière Hospital, APHP-Sorbonne, Paris Brain Insitute and Sorbonne University, Paris, France
| | - Michele T M Hu
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jacques Y Montplaisir
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Jean-François Gagnon
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Alex Desautels
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
- Department of Neurosciences, Université de Montréal, Montréal, QC, Canada
| | - Yves Dauvilliers
- National Reference Center for Narcolepsy, Sleep Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Institute Neuroscience Montpellier Inserm, Montpellier, France
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Francesco Janes
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
| | - Andrea Bernardini
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
| | - Birgit Högl
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Karel Šonka
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - David Kemlink
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Wolfgang Oertel
- Department of Neurology, Philipps-University, Marburg, Germany
| | - Annette Janzen
- Department of Neurology, Philipps-University, Marburg, Germany
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
- IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Francesco Biscarini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Elena Antelmi
- IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michela Figorilli
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Monica Puligheddu
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany
- Department of Neurology, University Medical Centre Goettingen, Goettingen, Germany
| | - Claudia Trenkwalder
- Paracelsus-Elena-Klinik, Kassel, Germany
- Department of Neurology, University Medical Centre Goettingen, Goettingen, Germany
| | - Friederike Sixel-Döring
- Department of Neurology, Philipps-University, Marburg, Germany
- Paracelsus-Elena-Klinik, Kassel, Germany
| | - Valérie Cochen De Cock
- Sleep and Neurology Unit, Beau Soleil Clinic, Montpellier, France
- EuroMov Digital Health in Motion, University of Montpellier IMT Mines Ales, Montpellier, France
| | - Christelle Charley Monaca
- University Lille North of France, Department of Clinical Neurophysiology and Sleep Center, CHU Lille, Lille, France
| | - Anna Heidbreder
- Institute of Sleep Medicine and Neuromuscular Disorders, University of Münster, Münster, Germany
| | - Luigi Ferini-Strambi
- Department of Neurological Sciences, Università Vita-Salute San Raffaele, Milan, Italy
| | - Femke Dijkstra
- Laboratory for Sleep Disorders, St. Dimpna Regional Hospital, Geel, Belgium
- Department of Neurology, St. Dimpna Regional Hospital, Geel, Belgium
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
| | - Mineke Viaene
- Laboratory for Sleep Disorders, St. Dimpna Regional Hospital, Geel, Belgium
- Department of Neurology, St. Dimpna Regional Hospital, Geel, Belgium
| | - Beatriz Abril
- Sleep disorder Unit, Carémeau Hospital, University Hospital of Nîmes, Nîmes, France
| | | | | | - Sonja W Scholz
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA
| | - Mina Ryten
- Great Ormond Street Institute of Child Health, Genetics and Genomic Medicine, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
| | - Sara Bandres-Ciga
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Alastair Noyce
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
- Department of Clinical and Movement Neurosciences, University College London, Institute of Neurology, London, UK
| | | | - Lasse Pihlstrøm
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Mike A Nalls
- Data Tecnica International, Glen Echo, MD, USA
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, MD, USA
| | - Andrew B Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, MD, USA
| | - Guy A Rouleau
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Ronald B Postuma
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Ziv Gan-Or
- Department of Human Genetics, McGill University, Montréal, QC, Canada.
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada.
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.
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Licata F, Mohanty NP, Crottini A, Andreone F, Harison RF, Randriamoria TM, Freeman K, Muller B, Birkinshaw C, Tilahimena A, Ficetola GF. Using public surveys to rapidly profile biological invasions in hard‐to‐monitor areas. Anim Conserv 2022. [DOI: 10.1111/acv.12835] [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: 11/26/2022]
Affiliation(s)
- F. Licata
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado, Campus de Vairão Universidade do Porto Vairão Portugal
- Departamento de Biologia, Faculdade de Ciências Universidade do Porto Porto Portugal
- BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO Campus de Vairão Vairão Portugal
| | - N. P. Mohanty
- Centre for Ecological Sciences Indian Institute of Science Bangalore India
- Centre for Invasion Biology, Department of Botany and Zoology Stellenbosch University Stellenbosch South Africa
| | - A. Crottini
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado, Campus de Vairão Universidade do Porto Vairão Portugal
- Departamento de Biologia, Faculdade de Ciências Universidade do Porto Porto Portugal
- BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO Campus de Vairão Vairão Portugal
| | - F. Andreone
- Museo Regionale di Scienze Naturali Torino Italy
| | - R. F. Harison
- Madagascar Fauna and Flora Group Toamasina Madagascar
- ISSEDD (Institut Supérieur de Science, Environnement et Développement Durable) Université de Toamasina Toamasina Madagascar
| | - T. M. Randriamoria
- Association Vahatra Antananarivo Madagascar
- Mention Zoologie et Biodiversité Animale, Domaine Sciences et Technologies Université d'Antananarivo Antananarivo Madagascar
| | - K. Freeman
- Madagascar Fauna and Flora Group Toamasina Madagascar
| | - B. Muller
- Madagascar Fauna and Flora Group Toamasina Madagascar
| | - C. Birkinshaw
- Missouri Botanical Garden – Madagascar Research and Conservation Program Antananarivo Madagascar
| | - A. Tilahimena
- Missouri Botanical Garden – Madagascar Research and Conservation Program Antananarivo Madagascar
| | - G. F. Ficetola
- Department of Environmental Science and Policy Università degli Studi di Milano Milan Italy
- CNRS, Laboratoire d'Écologie Alpine (LECA) Univ. Grenoble Alpes Grenoble France
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10
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Phillips ME, McGeeney LM, Griffin O, Freeman K, Dann S, Duggan SN. Training 1,200 dietitians: An evaluation of a training course for non-specialist dietitians on the management of pancreatic exocrine insufficiency. Clinical Nutrition Open Science 2022. [DOI: 10.1016/j.nutos.2022.07.002] [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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11
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Freeman K, Brown K, Miller L, Nissly T, Ricco J, Weinmann A. Knowledge Retention Using "Relay": A Novel Active-Learning Technique. PRiMER 2022; 6:12. [PMID: 35801197 PMCID: PMC9256294 DOI: 10.22454/primer.2022.586676] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Many residency programs utilize passive didactic lectures despite mixed evidence for knowledge retention. This prospective study investigated the efficacy of "relay," an active-learning technique, as measured by residents' knowledge retention and attitudes compared to traditional format. METHODS Faculty presented lectures to four family medicine residency programs on a randomized schedule. Lectures were followed by a 15-minute question-and-answer (Q&A) session or relay session. A relay is a collaborative, question-based game. The primary outcome was knowledge retention at 3 months, comparing Q&A to relay sessions as measured by a multiple-choice assessment. Responses were only included if a given resident completed knowledge assessments for both Q&A and relay sessions, to allow for intraresident adjustments, in addition to program, training year, and lecturer/topic. Secondary outcomes included residents' self-perceived knowledge and engagement as surveyed by an ordinal scale immediately following the learning session. RESULTS The primary analysis included 51 responses from 18 unique residents. The adjusted mean knowledge assessment score at 3 months was not statistically different after the relay sessions compared to Q&A (67% vs 60%, respectively; 7% difference, 95% CI: -4 to 18%, P=.20). For the secondary outcomes of learner attitudes (n=143 responses), learners reported greater engagement after the relay sessions compared to Q&A (51% vs 28% "very engaged"; overall P=.003), but self-perceived knowledge was not significantly different (overall P=.05, rounded down). CONCLUSIONS The relay technique did not show significant difference in 3-month knowledge retention, nor immediate self-perceived knowledge, despite greater learner self-perceived engagement.
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Affiliation(s)
| | - Kathryn Brown
- University of Minnesota Medical School, Minneapolis, MN
| | - Laura Miller
- University of Minnesota Medical School, Minneapolis, MN
| | - Tanner Nissly
- University of Minnesota Medical School, Minneapolis, MN
| | - Jason Ricco
- University of Minnesota Medical School, Minneapolis, MN
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Villalon N, Farzan N, Freeman K. Rate of bacteremia in the hemodialysis patient presenting to the emergency department with fever: a retrospective chart review. Int J Emerg Med 2018; 11:29. [PMID: 29802505 PMCID: PMC5970130 DOI: 10.1186/s12245-018-0188-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/15/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Infectious disease is the second most common cause of death in patients receiving hemodialysis (HD). When presenting to the emergency department (ED) with fever, it remains a diagnostic challenge to distinguish patients with potentially life-threatening bacterial infections from those with less significant causes of fever. The primary goal of this study was to determine the rate of bacteremia in HD patients presenting to the ED with fever. The secondary goal of this study was to identify any independent risk factors associated with bacteremia in the febrile HD patient. METHODS This is a retrospective medical record review of all HD patients who presented to the ED with either subjective fever as primary complaint or with a documented triage temperature of 38 °C or higher during the 3-year period between September 1, 2014, and September 1, 2017. Patient visits were included in the study if blood cultures were ordered in the ED. Data related to demographic information, clinical parameters, diagnostic test results in the ER, final diagnosis, and results of microbiology cultures were collected from each patient encounter. Univariate analysis was performed to identify risk factors associated with bacteremia. RESULTS We identified 353 patient visits from 138 unique patients that met inclusion criteria. Fifty-eight percent of these were women, and the average age was 54.6 years. The rate of bacteremia was 31.7%, and the main microorganisms isolated in blood culture were non-MRSA Staphylococcus aureus (40.7%), MRSA (13.3%), Pseudomonas aeruginosa (11.5%), and Enterobacter spp. (11.5%). Independent prognostic factors associated with bacteremia were use of dialysis catheter, prior history of bacteremia, and > 5% neutrophilic band cells (OR 6.55 [95% CI 3.96-10.8; p < 0.0001]; OR 8.87 [95% CI 5.32-14.8; p < 0.0001]; OR 3.32 [95% CI 1.90-5.80; p < 0.0001] respectively). CONCLUSION HD patients presenting to the ED with fever have high rates of bacteremia, with a significantly higher rate in patients using dialysis catheters or those with a history of bacteremia. Other clinical data available in the ED is minimally useful in predicting bacteremia.
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Affiliation(s)
- Nicholas Villalon
- Department of Emergency Medicine, Commonwealth Healthcare Corporation Hospital, Commonwealth of the Northern Mariana Islands 1 Navy Hill Dr. , Box 10002 PMB 4211, Saipan, MP, 96950, USA.
| | - Neda Farzan
- Department of Emergency Medicine, Commonwealth Healthcare Corporation Hospital, Commonwealth of the Northern Mariana Islands 1 Navy Hill Dr. , Box 10002 PMB 4211, Saipan, MP, 96950, USA
| | - Kathryn Freeman
- Department of Emergency Medicine, Commonwealth Healthcare Corporation Hospital, Commonwealth of the Northern Mariana Islands 1 Navy Hill Dr. , Box 10002 PMB 4211, Saipan, MP, 96950, USA
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Wiatrowski R, Martini L, Flanagan B, Freeman K, Sloan N. AANA Journal Course-Residual Neuromuscular Blockade: Evidence-Based Recommendations to Improve Patient Outcomes. AANA J 2018; 86:157-167. [PMID: 31573487] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Neuromuscular blocking drugs are administered to facilitate endotracheal intubation and induce paralysis to allow surgeons access to their anatomical target. Traditionally, qualitative measures; such as tactile observation of fade by a peripheral nerve stimulator, are used to assess the extent of the patient's recovery after receiving the neuromuscular blocking agent. Use of these qualitative measures; however, can contribute to high rates of residual neuromuscular blockade (RNMB), placing patients at risk of serious postoperative adverse events. Such adverse events include the need for tracheal reintubation, impaired oxygen and ventilation, increased risk of aspiration and pneumonia, pharyngeal dysfunction, and delayed discharge from the postanesthesia care unit. This problem of RNMB is exacerbated by the use of traditional drugs to reverse the neuromuscular blockade, such as the acetylcholinesterase inhibitor neostigmine. This course will examine the current limitations of qualitative neuromuscular monitoring, introduce the reader to acceleromyography, and outline the advantages of monitoring neuromuscular blockade during the perioperative period. In addition, this course will review the contemporary neuromuscular antagonists, including the newer neuromuscular antagonist sugammadex.
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Affiliation(s)
- Ryan Wiatrowski
- is a student registered nurse anesthetist at Virginia Commonwealth University in Richmond, Virginia. He earned his BSN at Georgetown University, Washington, DC, in 2013
| | - Laura Martini
- is a student registered nurse anesthetist at Virginia Commonwealth University. She earned her BSN at Villanova University, Villanova, Pennsylvania, in 2013
| | - Brandy Flanagan
- is a student registered nurse anesthetist at Virginia Commonwealth University. She earned her BSN at University of Nebraska Medical Center College of Nursing, Omaha, Nebraska, in 2009
| | - Kathryn Freeman
- is a student registered nurse anesthetist at Virginia Commonwealth University. She earned her BSN at George Mason University, Fairfax, Virginia, in 2010
| | - Naomi Sloan
- is a student registered nurse anesthetist at Virginia Commonwealth University. She earned her BSN at University of Kentucky, Lexington, Kentucky, in 2013
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Freeman K, Kirtz G, Hooijberg EH, Sick K, Leidinger EF. Breed related odds ratio and anatomic distribution of canine mast cell tumours in Austria. Tierarztl Prax Ausg K 2018; 42:367-73. [DOI: 10.15654/tpk-140165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/06/2014] [Indexed: 11/13/2022]
Abstract
SummaryObjective: An increased risk of mast cell tumours (MCT) in certain breeds has been described repeatedly in the literature. The incidence of MCTs for registered breeds in Austria, an estimate of the risk by means of the odds ratios based on breed as well as the anatomic localisation of MCTs were examined. Material and methods: In the first part of the study, the ranking of breeds in Austria based on 147,802 dogs with known breed (including mixed breed) was determined, based on those dogs included in the laboratory data base from 2000 to 2010. In the second part of the study, 476 dogs were identified with MCTs and analysed by age, sex, Patnaik grade of MCT and breed distribution. The odds ratios with confidence intervals were calculated for all breeds with skin tumours. Results: The age distribution showed a peak in the age group from 6.1 to 8.0 years; 70% of MCTs were localised to the head and trunk. No significant difference was found based on gender. The evaluation of the odds ratios showed that only four of the 20 of the most popular in Austria breeds (Boxer, Bernese Mountain Dog, Golden Retriever, Spaniel) had an increased risk; on the other hand, some breeds which have not been previously identified in the literature were indicated to have a significantly increased risk for MCT (e.g., Dogo Argentino, Tibetan Spaniel, Pyrenean Mountain Dog, Beauceron, and Austrian Smooth-haired Hound). Conclusion and clinical relevance: Because disease risk may influence the popularity of some currently rare breeds, consultation with breeders and owners regarding the identification of the breeds newly identified in this study as an increased risk for development of mast cell tumours is indicated.
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Iversen L, Dauden E, Segaert S, Freeman K, Magina S, Rigopoulos D, Thaci D. Reformulations of well-known active ingredients in the topical treatment of psoriasis vulgaris can improve clinical outcomes for patients. J Eur Acad Dermatol Venereol 2017; 31:1271-1284. [PMID: 28419600 DOI: 10.1111/jdv.14277] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 03/22/2017] [Indexed: 12/24/2022]
Abstract
Although the majority of patients with psoriasis vulgaris are treated exclusively with topical therapies, research to develop more effective topical therapies that are associated with higher patient satisfaction has lagged behind the development of systemic agents. The aim of this literature review was to determine whether there is documented evidence that applying an innovative approach to improving the formulation of active ingredients commonly used in the topical treatment of psoriasis can have a positive effect on clinical outcomes and patient-reported outcomes (PROs). The Embase and PubMed databases were searched for articles published between 2001 and 2016 that made direct head-to-head comparisons of different formulations of an active pharmaceutical ingredient (API), focusing on clinical outcomes and PROs. In total, 22 publications on APIs or API combinations met the eligibility criteria (19 head-to-head clinical trials, one pooled analysis, one health-economic modelling study and one systematic review). Significant clinical benefit associated with the use of a reformulated API over an older formulation was reported in three trials of clobetasol propionate, one trial of calcipotriol, three trials of betamethasone and five trials/pooled analyses of calcipotriol/calcipotriene + betamethasone dipropionate (Cal/BD) formulations. Significantly improved PROs associated with the use of a reformulated API over an older formulation were reported in three trials of clobetasol propionate, one trial of betamethasone valerate and two trials of Cal/BD formulations. These results demonstrate that the innovative reformulation of APIs used in the treatment of psoriasis can produce therapies that attain significantly improved clinical outcomes and PROs. This suggests that improvement in topical therapy for psoriasis need not only to be achieved by the identification of new targets and the development of new APIs, but that improvement in the vehicle used to deliver existing APIs has the potential to result in significant clinical and patient benefits.
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Affiliation(s)
- L Iversen
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - E Dauden
- Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain
| | - S Segaert
- Department of Dermatology, University Hospital Leuven, Leuven, Belgium
| | - K Freeman
- Bunny Hill Primary Care Centre, County Durham and Darlington NHS Foundation Trust & Sunderland Teaching Primary Care Trust, Sunderland, UK
| | - S Magina
- Department of Dermatology, CHSJoão, Porto, Portugal.,Department of Pharmacology and Therapeutics, Faculty of Medicine, Porto University, Porto, Portugal
| | - D Rigopoulos
- 2nd Department of Dermatology, University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - D Thaci
- Comprehensive Centre for Inflammation Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
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16
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Boostrom BO, Moore AS, DeRegis CJ, Robat C, Freeman K, Thamm DH. Canine Cutaneous Plasmacytosis: 21 Cases (2005-2015). J Vet Intern Med 2017; 31:1074-1080. [PMID: 28514049 PMCID: PMC5508321 DOI: 10.1111/jvim.14729] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 12/13/2016] [Revised: 02/04/2017] [Accepted: 04/06/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Cutaneous plasmacytosis (CP) is a syndrome of multiple cutaneous plasma cell tumors, in the absence of multiple myeloma. Although rare in both humans and dogs, treatment recommendations are usually extrapolated from multiple myeloma protocols. To date, no case series of CP have been described in the veterinary literature. HYPOTHESIS/OBJECTIVES To describe clinical presentation, determine treatment response rates and duration, and report overall survival of dogs with CP. ANIMALS Twenty-one client-owned dogs with CP. METHODS Medical records of 21 dogs with CP were reviewed. Diagnosis was based on histopathologic evaluation of at least 1 representative cutaneous or subcutaneous lesion in dogs with ≥3 lesions. Dogs with suspicion of multiple myeloma were excluded. RESULTS The most commonly affected breeds were the golden (5/21) and Labrador retriever (3/21). Fourteen of 21 dogs had >10 lesions, with some having >100. Lesions commonly were described as round, raised, pink-to-red, and variably alopecic or ulcerated. The most commonly used drug protocol was combined melphalan and prednisone, with an overall response rate (ORR) of 73.7% (14/19 dogs). Single-agent lomustine was associated with a similar ORR of 71.4% (5/7 dogs). For all treatments combined, the median progression-free interval after the first treatment was 153 days. The median survival time from the first treatment was 542 days. CONCLUSIONS AND CLINICAL IMPORTANCE Alkylating agents were effective in inducing remission of CP; corticosteroids, melphalan, and lomustine were the most commonly used drugs. Survival times were similar to those reported in dogs with multiple myeloma treated with alkylating agents.
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Affiliation(s)
- B O Boostrom
- Colorado State University Flint Animal Cancer Center, Fort Collins, CO
| | - A S Moore
- Veterinary Oncology Consultants, Lake Innes, NSW, Australia
| | - C J DeRegis
- Pieper Memorial Veterinary Center, Middletown, CT
| | - C Robat
- University of Wisconsin Veterinary Medical Teaching Hospital, Madison, WI
| | - K Freeman
- Veterinary Cancer and Surgery Specialists, Milwaukie, OR
| | - D H Thamm
- Colorado State University Flint Animal Cancer Center, Fort Collins, CO
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Stinton C, Taylor-Phillips S, Geppert J, Freeman K, Johnson S, Fraser H, Sutcliffe P, Clarke A. P24 Examining screening test accuracy in Tyrosinemia type 1: A comparison of rapid and systematic review Methods. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.123] [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: 11/03/2022]
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18
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Abstract
Trauma-induced coagulopathy (TIC) includes heterogeneous coagulopathic syndromes with different underlying causes, and treatment is challenged by limited diagnostic tests to discriminate between these entities in the acute setting. We provide an overview of progress in understanding the mechanisms of TIC and the context for several of the hypotheses that will be tested in 'TACTIC'. Although connected to ongoing clinical trials in trauma, TACTIC itself has no intent to conduct clinical trials. We do anticipate that 'early translation' of promising results will occur. Functions anticipated at this early translational level include: (i) basic science groundwork for future therapeutic candidates; (ii) development of acute coagulopathy scoring systems; (iii) coagulation factor composition-based computational analysis; (iv) characterization of novel analytes including tissue factor, polyphosphates, histones, meizothrombin and α-thrombin-antithrombin complexes, factor XIa, platelet and endothelial markers of activation, signatures of protein C activation and fibrinolysis markers; and (v) assessment of viscoelastic tests and new point-of-care methods.
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Affiliation(s)
- K G Mann
- Department of Biochemistry, University of Vermont, Colchester, VT, USA
| | - K Freeman
- Department of Surgery, University of Vermont, Burlington, VT, USA
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Pulikottil-Jacob R, Connock M, Kandala NB, Mistry H, Grove A, Freeman K, Costa M, Sutcliffe P, Clarke A. Cost effectiveness of total hip arthroplasty in osteoarthritis. Bone Joint J 2015; 97-B:449-57. [DOI: 10.1302/0301-620x.97b4.34242] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 11/05/2022]
Abstract
Many different designs of total hip arthroplasty (THA) with varying performance and cost are available. The identification of those which are the most cost-effective could allow significant cost-savings. We used an established Markov model to examine the cost effectiveness of five frequently used categories of THA which differed according to bearing surface and mode of fixation, using data from the National Joint Registry for England and Wales. Kaplan–Meier analyses of rates of revision for men and women were modelled with parametric distributions. Costs of devices were provided by the NHS Supply Chain and associated costs were taken from existing studies. Lifetime costs, lifetime quality-adjusted-life-years (QALYs) and the probability of a device being cost effective at a willingness to pay £20 000/QALY were included in the models. The differences in QALYs between different categories of implant were extremely small (< 0.0039 QALYs for men or women over the patient’s lifetime) and differences in cost were also marginal (£2500 to £3000 in the same time period). As a result, the probability of any particular device being the most cost effective was very sensitive to small, plausible changes in quality of life estimates and cost. Our results suggest that available evidence does not support recommending a particular device on cost effectiveness grounds alone. We would recommend that the choice of prosthesis should be determined by the rate of revision, local costs and the preferences of the surgeon and patient. Cite this article: Bone Joint J 2015;97-B:449–57.
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Affiliation(s)
| | - M. Connock
- University of Warwick, Coventry
CV4 7AL, UK
| | | | - H. Mistry
- University of Warwick, Coventry
CV4 7AL, UK
| | - A. Grove
- University of Warwick, Coventry
CV4 7AL, UK
| | - K. Freeman
- University of Warwick, Coventry
CV4 7AL, UK
| | - M. Costa
- University of Warwick, Coventry
CV4 7AL, UK
| | | | - A. Clarke
- University of Warwick, Coventry
CV4 7AL, UK
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Clarke A, Pulikottil-Jacob R, Grove A, Freeman K, Mistry H, Tsertsvadze A, Connock M, Court R, Ngianga-Bakwin K, Costa M, Sutcliffe P. OP75 NICE Hips: hip replacement interventions for osteoarthritis in the UK – a clinical and cost-effectiveness analysis. Br J Soc Med 2014. [DOI: 10.1136/jech-2014-204726.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Sutcliffe P, Connock M, Gurung T, Freeman K, Johnson S, Kandala NB, Grove A, Gurung B, Morrow S, Clarke A. Aspirin for prophylactic use in the primary prevention of cardiovascular disease and cancer: a systematic review and overview of reviews. Health Technol Assess 2014; 17:1-253. [PMID: 24074752 DOI: 10.3310/hta17430] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prophylactic aspirin has been considered to be beneficial in reducing the risks of heart disease and cancer. However, potential benefits must be balanced against the possible harm from side effects, such as bleeding and gastrointestinal (GI) symptoms. It is particularly important to know the risk of side effects when aspirin is used as primary prevention--that is when used by people as yet free of, but at risk of developing, cardiovascular disease (CVD) or cancer. In this report we aim to identify and re-analyse randomised controlled trials (RCTs), systematic reviews and meta-analyses to summarise the current scientific evidence with a focus on possible harms of prophylactic aspirin in primary prevention of CVD and cancer. OBJECTIVES To identify RCTs, systematic reviews and meta-analyses of RCTs of the prophylactic use of aspirin in primary prevention of CVD or cancer. To undertake a quality assessment of identified systematic reviews and meta-analyses using meta-analysis to investigate study-level effects on estimates of benefits and risks of adverse events; cumulative meta-analysis; exploratory multivariable meta-regression; and to quantify relative and absolute risks and benefits. METHODS We identified RCTs, meta-analyses and systematic reviews, and searched electronic bibliographic databases (from 2008 September 2012) including MEDLINE, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, NHS Centre for Reviews and Dissemination, and Science Citation Index. We limited searches to publications since 2008, based on timing of the most recent comprehensive systematic reviews. RESULTS In total, 2572 potentially relevant papers were identified and 27 met the inclusion criteria. Benefits of aspirin ranged from 6% reduction in relative risk (RR) for all-cause mortality [RR 0.94, 95% confidence interval (CI) 0.88 to 1.00] and 10% reduction in major cardiovascular events (MCEs) (RR 0.90, 95% CI 0.85 to 0.96) to a reduction in total coronary heart disease (CHD) of 15% (RR 0.85, 95% CI 0.69 to 1.06). Reported pooled odds ratios (ORs) for total cancer mortality ranged between 0.76 (95% CI 0.66 to 0.88) and 0.93 (95% CI 0.84 to 1.03). Inclusion of the Women's Health Study changed the estimated OR to 0.82 (95% CI 0.69 to 0.97). Aspirin reduced reported colorectal cancer (CRC) incidence (OR 0.66, 95% CI 0.90 to 1.02). However, including studies in which aspirin was given every other day raised the OR to 0.91 (95% CI 0.74 to 1.11). Reported cancer benefits appeared approximately 5 years from start of treatment. Calculation of absolute effects per 100,000 patient-years of follow-up showed reductions ranging from 33 to 46 deaths (all-cause mortality), 60-84 MCEs and 47-64 incidents of CHD and a possible avoidance of 34 deaths from CRC. Reported increased RRs of adverse events from aspirin use were 37% for GI bleeding (RR 1.37, 95% CI 1.15 to 1.62), between 54% (RR 1.54, 95% CI 1.30 to 1.82) and 62% (RR 1.62, 95% CI 1.31 to 2.00) for major bleeds, and between 32% (RR 1.32, 95% CI 1.00 to 1.74) and 38% (RR 1.38, 95% CI 1.01 to 1.82) for haemorrhagic stroke. Pooled estimates of increased RR for bleeding remained stable across trials conducted over several decades. Estimates of absolute rates of harm from aspirin use, per 100,000 patient-years of follow-up, were 99-178 for non-trivial bleeds, 46-49 for major bleeds, 68-117 for GI bleeds and 8-10 for haemorrhagic stroke. Meta-analyses aimed at judging risk of bleed according to sex and in individuals with diabetes were insufficiently powered for firm conclusions to be drawn. LIMITATIONS Searches were date limited to 2008 because of the intense interest that this subject has generated and the cataloguing of all primary research in so many previous systematic reviews. A further limitation was our potential over-reliance on study-level systematic reviews in which the person-years of follow-up were not accurately ascertainable. However, estimates of number of events averted or incurred through aspirin use calculated from data in study-level meta-analyses did not differ substantially from estimates based on individual patient data-level meta-analyses, for which person-years of follow-up were more accurate (although based on less-than-complete assemblies of currently available primary studies). CONCLUSIONS We have found that there is a fine balance between benefits and risks from regular aspirin use in primary prevention of CVD. Effects on cancer prevention have a long lead time and are at present reliant on post hoc analyses. All absolute effects are relatively small compared with the burden of these diseases. Several potentially relevant ongoing trials will be completed between 2013 and 2019, which may clarify the extent of benefit of aspirin in reducing cancer incidence and mortality. Future research considerations include expanding the use of IPD meta-analysis of RCTs by pooling data from available studies and investigating the impact of different dose regimens on cardiovascular and cancer outcomes. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- P Sutcliffe
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
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22
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Wager A, Thomas A, Sewatsky T, Boas S, O‘keefe M, Freeman K. Accuracy of Noninvasive and Invasive Point-of-Care Hemoglobin Measurement in the Emergency Department. Ann Emerg Med 2013. [DOI: 10.1016/j.annemergmed.2013.07.395] [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: 10/26/2022]
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23
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Sutcliffe P, Connock M, Gurung T, Freeman K, Johnson S, Kandala NB, Grove A, Gurung B, Morrow S, Stranges S. OP25 Benefits and Risks from Aspirin use in the Primary Prevention of Cardiovascular Disease and Cancer: A Systematic Review and Overview of Reviews of Randomised Trial Evidence. Br J Soc Med 2013. [DOI: 10.1136/jech-2013-203126.25] [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: 11/03/2022]
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24
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Trembizki E, Lahra MM, Stevens S, Freeman K, Hogg G, Lawrence A, Pearson J, Smith H, Sloots T, Whiley D. P2.032 A National Quality Assurance Survey: Low Neisseria Gonorrhoeae Misidentification Rates in Australia, 2012. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0297] [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: 11/03/2022]
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25
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Wetmore BA, Wambaugh JF, Ferguson SS, Sochaski MA, Rotroff DM, Freeman K, Clewell HJ, Dix DJ, Andersen ME, Houck KA, Allen B, Judson RS, Singh R, Kavlock RJ, Richard AM, Thomas RS. Response to "Accurate Risk-Based Chemical Screening * Relies on Robust Exposure Estimates". Toxicol Sci 2012. [DOI: 10.1093/toxsci/kfs144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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28
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Lui YW, Farinhas JM, Basalely AM, Hsu KA, Freeman K, Bello JA. Assessment of an introductory cervicocerebral catheter angiography learning program: a pilot study. AJNR Am J Neuroradiol 2012; 33:1041-5. [PMID: 22282448 DOI: 10.3174/ajnr.a2931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There is no standardized curriculum currently available at most institutions for establishing procedural competency in trainees performing cervicocerebral angiography. The purpose of this study was to evaluate a simple learning program to supplement the teaching of basic cervicocerebral angiography. MATERIALS AND METHODS An 11-session interactive curriculum was implemented covering anatomic, clinical, and radiographic topics for the novice cervicocerebral angiographer. The target learner was the neuroradiology fellow. Data were gathered regarding fellow comfort level on topics relating to cervicocerebral angiography by using a 5-point Likert scale. Improvement in scores on knowledge-based questions after completion of the curriculum was calculated (McNemar test). Trainee-perceived utility of the program was also recorded by using a 5-point Likert scale. Focus sessions were held at the completion of the curriculum to gather feedback regarding the strengths and weaknesses of the program from participants. RESULTS Ten subjects were enrolled in this pilot study for 3 years. Topics where participants reported a poor initial comfort level (4 or higher) included selection of injection rates and volumes and reformation of reverse-curve catheters. Trainees demonstrated a statistically significant change in the distribution of scores of 29.3% (49.4%-78.7% correct response rate, P < .0001). The average perceived utility was 1.5 (1 = most useful, 5 = least useful). CONCLUSIONS This simple learning program was a useful adjunct to the training of fellows in diagnostic cervicocerebral angiography, resulting in quantitative improvements in knowledge.
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Affiliation(s)
- Y W Lui
- Department of Radiology, NYU Langone Medical Center, New York 10016, USA.
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29
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Valentini M, Munari U, Saguner T, Freeman K, Pasetto S, Montalbán J, Grebel E. First results for the solar neighborhood of the Asiago Red Clump Survey. EPJ Web of Conferences 2012. [DOI: 10.1051/epjconf/20121905005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Goire N, Freeman K, Tapsall J, Lambert S, Nissen M, Sloots T, Whiley D. P3-S1.21 Non-culture based Neisseria gonorrhoeae antimicrobial resistance surveillance. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.421] [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: 11/04/2022]
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31
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Hurt AC, Lee RT, Leang SK, Cui L, Deng YM, Phuah SP, Caldwell N, Freeman K, Komadina N, Smith D, Speers D, Kelso A, Lin RT, Maurer-Stroh S, Barr IG. Increased detection in Australia and Singapore of a novel influenza A(H1N1)2009 variant with reduced oseltamivir and zanamivir sensitivity due to a S247N neuraminidase mutation. Euro Surveill 2011. [DOI: 10.2807/ese.16.23.19884-en] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A novel influenza A(H1N1)2009 variant with mildly reduced oseltamivir and zanamivir sensitivity has been detected in more than 10% of community specimens in Singapore and more than 30% of samples from northern Australia during the early months of 2011. The variant, which has also been detected in other regions of the Asia-Pacific, contains a S247N neuraminidase mutation. When combined with the H275Y mutation, as detected in an oseltamivir-treated patient, the dual S247N+H275Y mutant had extremely high oseltamivir resistance.
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Affiliation(s)
- A C Hurt
- World Health Organization Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia
| | - R T Lee
- Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), Singapore
| | - S K Leang
- World Health Organization Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia
| | - L Cui
- National Public Health Laboratory, Communicable Diseases Division Ministry of Health, Singapore
| | - Y M Deng
- World Health Organization Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia
| | - S P Phuah
- National Public Health Laboratory, Communicable Diseases Division Ministry of Health, Singapore
| | - N Caldwell
- World Health Organization Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia
| | - K Freeman
- Serology/Molecular Biology Department, Royal Darwin Hospital, Darwin, Australia
| | - N Komadina
- World Health Organization Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia
| | - D Smith
- PathWest Laboratory Medicine, Nedlands, Western Australia
| | - D Speers
- PathWest Laboratory Medicine, Nedlands, Western Australia
| | - A Kelso
- World Health Organization Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia
| | - R T Lin
- National Public Health Laboratory, Communicable Diseases Division Ministry of Health, Singapore
| | - S Maurer-Stroh
- School of Biological Sciences (SBS), Nanyang Technological University (NTU), Singapore
- National Public Health Laboratory, Communicable Diseases Division Ministry of Health, Singapore
- Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), Singapore
| | - I G Barr
- World Health Organization Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia
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Hurt AC, Lee RT, Leang SK, Cui L, Deng YM, Phuah SP, Caldwell N, Freeman K, Komadina N, Smith D, Speers D, Kelso A, Lin RT, Maurer-Stroh S, Barr IG. Increased detection in Australia and Singapore of a novel influenza A(H1N1)2009 variant with reduced oseltamivir and zanamivir sensitivity due to a S247N neuraminidase mutation. Euro Surveill 2011; 16:19884. [PMID: 21679678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
A novel influenza A(H1N1)2009 variant with mildly reduced oseltamivir and zanamivir sensitivity has been detected in more than 10% of community specimens in Singapore and more than 30% of samples from northern Australia during the early months of 2011. The variant, which has also been detected in other regions of the Asia-Pacific, contains a S247N neuraminidase mutation. When combined with the H275Y mutation, as detected in an oseltamivir-treated patient, the dual S247N+H275Y mutant had extremely high oseltamivir resistance.
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Affiliation(s)
- A C Hurt
- World Health Organization Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia.
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Jaradat H, Freeman K. SU-E-E-11: Results from the Tomotherapy Daily QA Using the Rotational Therapy Phantom. Med Phys 2011. [DOI: 10.1118/1.3611565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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34
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Hurt AC, Deng YM, Ernest J, Caldwell N, Leang L, Iannello P, Komadina N, Shaw R, Smith D, Dwyer DE, Tramontana AR, Lin RT, Freeman K, Kelso A, Barr IG. Oseltamivir-resistant influenza viruses circulating during the first year of the influenza A(H1N1) 2009 pandemic in the Asia-Pacific region, March 2009 to March 2010. Euro Surveill 2011; 16:19770. [PMID: 21262183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
During the first year of the influenza A(H1N1) 2009 pandemic, unprecedented amounts of the neuraminidase inhibitors, predominantly oseltamivir, were used in economically developed countries for the treatment and prophylaxis of patients prior to the availability of a pandemic vaccine. Due to concerns about the development of resistance, over 1,400 influenza A(H1N1) 2009 viruses isolated from the Asia-Pacific region during the first year of the pandemic (March 2009 to March 2010) were analysed by phenotypic and genotypic assays to determine their susceptibility to the neuraminidase inhibitors. Amongst viruses submitted to the World Health Organization Collaborating Centre for Reference and Research in Melbourne, Australia,oseltamivir resistance was detected in 1.3% of influenza A(H1N1) 2009 strains from Australia and 3.1% of strains from Singapore, but none was detected in specimens received from other countries in Oceania or south-east Asia, or in east Asia. The overall frequency of oseltamivir resistance in the Asia-Pacific region was 16 of 1,488 (1.1%). No zanamivir-resistant viruses were detected. Of the 16 oseltamivir-resistant isolates detected, nine were from immunocompromised individuals undergoing oseltamivir treatment and three were from immunocompetent individuals undergoing oseltamivir treatment. Importantly, four oseltamivir-resistant strains were from immunocompetent individuals who had not been treated with oseltamivir, demonstrating limited low-level community transmission of oseltamivir-resistant strains. Even with increased use of oseltamivir during the pandemic, the frequency of resistance has been low, with little evidence of community-wide spread of the resistant strains. Nevertheless, prudent use of the neuraminidase inhibitors remains necessary, as does continued monitoring for drug-resistant influenza viruses.
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Affiliation(s)
- A C Hurt
- WHO Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia.
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Hurt AC, Deng YM, Ernest J, Caldwell N, Leang L, Iannello P, Komadina N, Shaw R, Smith D, Dwyer DE, Tramontana AR, Lin RT, Freeman K, Kelso A, Barr IG. Oseltamivir-resistant influenza viruses circulating during the first year of the influenza A(H1N1)2009 pandemic in the Asia-Pacific region, March 2009 to March 2010. Euro Surveill 2011. [DOI: 10.2807/ese.16.03.19770-en] [Citation(s) in RCA: 28] [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] [Indexed: 11/20/2022] Open
Abstract
During the first year of the influenza A(H1N1)2009 pandemic, unprecedented amounts of the neuraminidase inhibitors, predominantly oseltamivir, were used in economically developed countries for the treatment and prophylaxis of patients prior to the availability of a pandemic vaccine. Due to concerns about the development of resistance, over 1,400 influenza A(H1N1)2009 viruses isolated from the Asia-Pacific region during the first year of the pandemic (March 2009 to March 2010) were analysed by phenotypic and genotypic assays to determine their susceptibility to the neuraminidase inhibitors. Amongst viruses submitted to the World Health Organization Collaborating Centre for Reference and Research in Melbourne, Australia, oseltamivir resistance was detected in 1.3% of influenza A(H1N1)2009 strains from Australia and 3.1% of strains from Singapore, but none was detected in specimens received from other countries in Oceania or south-east Asia, or in east Asia. The overall frequency of oseltamivir resistance in the Asia-Pacific region was 16 of 1,488 (1.1%). No zanamivir-resistant viruses were detected. Of the 16 oseltamivir-resistant isolates detected, nine were from immunocompromised individuals undergoing oseltamivir treatment and three were from immunocompetent individuals undergoing oseltamivir treatment. Importantly, four oseltamivir-resistant strains were from immunocompetent individuals who had not been treated with oseltamivir, demonstrating limited low-level community transmission of oseltamivir-resistant strains. Even with increased use of oseltamivir during the pandemic, the frequency of resistance has been low, with little evidence of community-wide spread of the resistant strains. Nevertheless, prudent use of the neuraminidase inhibitors remains necessary, as does continued monitoring for drug-resistant influenza viruses.
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Affiliation(s)
- A C Hurt
- WHO Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia
| | - Y M Deng
- WHO Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia
| | - J Ernest
- WHO Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia
| | - N Caldwell
- WHO Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia
| | - L Leang
- WHO Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia
| | - P Iannello
- WHO Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia
| | - N Komadina
- WHO Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia
| | - R Shaw
- WHO Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia
| | - D Smith
- PathWest Laboratories, Perth, Western Australia, Australia
| | - D E Dwyer
- Centre for Infectious Diseases and Microbiology, ICPMR, Westmead Hospital, New South Wales, Australia
| | | | - R T Lin
- National Public Health Laboratory, Communicable Diseases Division Ministry of Health, Singapore
| | - K Freeman
- Centre for Disease Control, Darwin, Australia
| | - A Kelso
- WHO Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia
| | - I G Barr
- WHO Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria, Australia
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Lei M, Clark C, Adams E, Freeman K, Jamieson C, Dabbs M, Jordan T, Whitaker S, Nisbet A, Guerrero Urbano T. CBCT Evaluation of Dose-Volume Changes in Contralateral Parotid Gland during Head and Neck IG-IMRT. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1129] [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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Phillips M, Haines M, Peck E, Lee H, Phillips B, Wein B, Bekenstein J, O'Grady J, Schoenberg M, Ogrocki P, Maddux B, Whitney C, Gould D, Riley D, Maciunas R, Espe-Pfeifer P, Arguello J, Taber S, Duff K, Fields A, Newby R, Weissgerber K, Epping A, Panepinto J, Scott P, Reesman J, Zabel A, Wodka E, Ferenc L, Comi A, Cohen N, Bigelow S, McCrea Jones L, Sandoval R, Vilar-Lopez R, Puente N, Hidalgo-Ruzante N, Bure A, Ojeda C, Puente A, Zolten A, Mallory L, Heyanka D, Golden C, McCue R, Heyanka D, Mackelprang J, Reuther B, Golden C, Odland A, Scarisbrick D, Heyanka D, Martin P, Golden C, Mazur-Mosiewicz A, Holcomb M, Dean R, Schneider J, Morgan D, Scott J, Leber W, Adams R, Marceaux J, Triebel K, Griffith H, Gifford K, Potter E, Webbe F, Barker W, Loewenstein D, Duara R, Gifford K, Mahaney T, Srinivasan V, Cummings T, Frankl M, Bayan R, Webbe F, Mulligan K, Duncan N, Greenaway M, Sakamoto M, Spiers M, Libon D, Pimontel M, Gavett B, Jefferson A, Nair A, Green R, Stern R, Mahaney T, Frankl M, Cummings T, Mulligan K, Webbe F, Lou K, Gavett B, Jefferson A, Nair A, Green R, Morere D, Gifford K, Ferro J, Ezrine G, Kiefel J, Hinton V, Greco S, Corradino G, Pantone J, MacLeod R, Stern R, Hart J, Lavach J, Pick L, Szymanski C, Ilardi D, Marcus D, Burns T, Mahle W, Jenkins P, Davis A, McDermott A, Pierson E, Freeman Floyd E, McIntosh D, Dixon F, Davis A, Boseck J, Berry K, Whited A, Gelder B, Davis A, Dodd J, Berry K, Boseck J, Koehn E, Gelder B, Riccio C, Kahn D, Perez E, Reynolds C, Scott M, Nguyen-Driver M, Ruchinskas R, Lennen D, Steiner R, Sikora D, Freeman K, Carboni J, Fong G, Fong G, Carboni J, Whigham K, O'Toole K, Schneider B, Burns T, Olivier T, Nemeth D, Whittington L, Moreau A, Webb N, Weimer M, Gontier J, Labrana J, Rioseco F, Lichtenberg P, Puente A, Puente A, Bure A, Buddin H, Teichner G, Golden C, Pacheco E, Chong J, Gold S, Mittenberg W, Miller A, Bruce J, Hancock L, Peterson S, Jacobson J, Guse E, Tyrer J, Lasater J, Fritz J, Lynch S, Yarger L, Bryant K, Zychowski L, Nippoldt-Baca L, Lehman C, Arffa S, Marceaux J, Dilks L, Arthur A, Myers B, Levy J, Blancett S, Martincin K, Thrasher A, Koushik N, McArthur S, Baird A, Foster P, Drago V, Yung R, Crucian G, Heilman K, Castellon S, Livers E, Oppenheim A, Carter C, Ganz P, San Miguel-Montes L, Escabi-Quiles Y, Allen D, Gavett B, Stern R, Nowinski C, Cantu R, Martukovich R, McKee A, Davis A, Roberds E, Lutz J, Williams R, Gupta A, Schoenberg M, Werz M, Maciunas R, Koubeissi M, Poreh A, Luders H, Barwick F, Arnett P, Morse C, Gonzalez-Heydrich J, Luna L, Rao S, McClendon J, Rotelle P, Waber D, Holland A, Boyer K, Faraone S, Whitney J, Guild D, Biederman J, Baerwald J, Ryan G, Baerwald J, Ryan G, Guerrero J, Carmona J, Parsons T, Rizzo A, Lance B, Courtney C, Baerwald J, Ryan G, Perna R, Jackson A, Luton L, O'Toole K, Harrison D, Alosco M, Emerson K, Hill B, Bauer L, Tremont G, Zychowski L, Yarger L, Kegel N, Arffa S, Crockett D, Hunt S, Parks R, Vernon-Wilkinsion R, Hietpas-Wilson T, Zartman A, Gordon S, Krueger K, VanBuren K, Yates A, Hilsabeck R, Campbell J, Riner B, Crowe S, Noggle C, Thompson J, Barisa M, Maulucci A, Noggle C, Thompson J, Barisa M, Maulucci A, Noggle C, Latham K, Thompson J, Barisa M, Maulucci A, Sumowski J, Chiaravalloti N, Lengenfelder J, DeLuca J, Iturriaga L, Henry G, Heilbronner R, Carmona J, Mittenberg W, Enders C, Stevens A, Dux M, Henry G, Heilbronner R, Mittenberg W, Enders C, Myers A, Arffa S, Holland A, Nippoldt-Baca L, Yarger L, Acocella-Stollerman J, Lee E, Peck E, Lee H, Khawaja S, Phillips B, Crockett A, Greve K, Comer C, Ord J, Etherton J, Bianchini K, Curtis K, Harrison A, Edwards M, Harrison A, Edwards M, Cottingham M, Goldberg H, Harrison D, Victor T, Perry L, Pazienza S, Boone K, Bowers T, Triebel K, Denney R, Halfaker D, Tussey C, Barber A, Martin P, Denney R, Deal W, Bailey C, Denney R, Marcopulos B, Schaefer L, Rabin L, Kakkanatt T, Popalzai A, Chantasi K, Heyanka D, Magyar Y, Cruz R, Weiss L, Schatz P, Gibney B, Lietner D, Koushik N, Brooks B, Iverson G, Horton A, Odland A, Reynolds C, Horton A, Reynolds C, Davis A, Finch W, Skierkiewicz A, Rothlisberg B, McIntosh D, Davis A, Finch W, Golden C, Chang M, McIntosh D, Rothlisberg B, Paulson S, Davis A, Starling J, Whited A, Chang M, Roberds E, Dodd J, Martin P, Goldstein G, DeFilippis N, Carlozzi N, Tulsky D, Kurkowski R, Browne K, Wortman K, Gershon R, Heyanka D, Odland A, Golden C, Rodriguez M, Myers A, West S, Golden C, Holster J, Bolanos J, Corsun-Ascher C, Golden C, Robbins J, Restrepo L, Prinzi L, Garcia J, Golden C, Holster J, Bolanos J, Garcia J, Golden C, Osgood J, Trice A, Ernst W, Mahaney T, Gifford K, Oelschlager J, Gurrea J, Tourgeman I, Odland A, Golden C, Tourgeman I, Gurrea J, Stack M, Boddy R, Demsky Y, Golden C, Judd T, Jurecska D, Holmes J, Aguerrevere L, Greve K, Capps D, Izquierdo R, Feldman C, Boddy R, Scarisbrick D, Rice J, Tourgeman I, Golden C, Scarisbrick D, Boddy R, Corsun-Ascher C, Heyanka D, Golden C, Woon F, Hedges D, Odland A, Heyanka D, Martin P, Golden C, Yamout K, Heinrichs R, Baade L, Soetaert D, Perle J, Odland A, Martin P, Golden C, Armstrong C, Bello D, Randall C, Allen D, McLaren T, Konopacki K, Peery S, Miranda F, Saleh M, Moise F, Mendoza J, Mak E, Gomez R, Mihaila E, Parrella M, White L, Harvey P, Marshall D, Gomez R, Keller J, Rogers E, Misa J, Che A, Tennakoon L, Schatzberg A, Sutton G, Allen D, Strauss G, Bello D, Armstrong C, Randall C, Duke L, Ross S, Randall C, Bello D, Armstrong C, Sutton G, Ringdahl E, Thaler N, McMurray J, Sanders L, Isaac H, Allen D, Rumble S, Klonoff P, Wilken J, Sullivan C, Fratto T, Sullivan A, McKenzie T, Ensley M, Saunders C, Quig M, Kane R, Simsarian J, Restrepo L, Rodriguez M, Robbins J, Morrow J, Golden C, Yung R, Sullivan W, Stringer K, Ferguson B, Drago V, Foster P, Lanting S, Brooks B, Iverson G, Horton A, Reynolds C, Scarisbrick D, Odland A, Perle J, Golden C, West S, Collins K, Frisch D, Golden C, Guerrero J, Baerwald J, Yung R, Sullivan W, Stringer K, Ferguson B, Drago V, Foster P, Mackelprang J, Heyanka D, Lennertz L, Morin I, Marker C, Collins M, Dodd J, Goldstein G, DeFilippis N, Holcomb M, Kimball T, Luther E, Belsher B, Botelho V, Reed R, Hernandez B, Noda A, Yesavage J, Kinoshita L, Kakos L, Gunstad J, Hughes J, Spitznagel M, Potter V, Stanek K, Szabo A, Waechter D, Josephson R, Rosneck J, Schofield H, Getz G, Magnuson S, Bryant K, Miller A, Martincin K, Pastel D, Poreh A, Davis J, Ramos C, Sherer C, Bertram D, Wall J, Bryant K, Poreh A, Magnuson S, Miller A, Martincin K, Pastel D, Gow C, Francis J, Olson L, Sautter S, Ord J, Capps D, Greve K, Bianchini K, Stettler T, Daniel M, Kleman V, Etchells M, Rabinowitz A, Barwick F, Arnett P, Proto D, Barker A, Gouvier W, Jones K, Williams J, Lockwood C, Mansoor Y, Homer-Smith E, Moses J, Stolberg P, Jones W, Krach S, Loe S, Mortimer J, Avirett E, Maricle D, Miller D, Avirett E, Mortimer J, Maricle D, Miller D, Avirett E, Mortimer J, Miller D, Maricle D, McGill C, Moneta L, Gioia G, Isquith P, Lazarus G, Puente A, Ahern D, Faust D, Bridges A, Ahern D, Faust D, Bridges A, Hobson V, Hall J, Harvey M, Spering C, Cullum M, Lacritz L, Massman P, Waring S, O'Bryant S, Frisch D, Morrow J, West S, Golden C, West S, Dougherty M, Rice J, Golden C, Morrow J, Frisch D, Pearlson J, Golden C, Thorgusen S, Watson J, Miller A, Kesner R, Levy J, Lambert A, Fazeli P, Marceaux J, Vance D, Marceaux J, Fazeli P, Vance D, Frankl M, Cummings T, Mahaney T, Webbe F, Spering C, Cooper J, Hobson V, O'Bryant S, Bolanos J, Holster J, Metoyer K, Garcia J, Golden C, Brown C, O'Toole K, Brown C, O'Toole K, Granader Y, Keller S, Bender H, Rathi S, Nass R, MacAllister W, Maehr A, Kiefel J, Bigras C, Slick D, Dewey L, Tao R, Motes M, Emslie G, Rypma B, Kahn D, Riccio C, Reynolds C, Eberle N, Mucci G, Chase A, Boyle M, Gallaway M, Bowyer S, Lajiness-O'Neill R, Gifford K, Mahaney T, Cohen R, Gorman P, Levin Allen S, O'Hara E, LeGoff D, Chute D, Barakat L, Laboy G, San Miguel-Montes L, Rios-Motta M, Pita-Garcia I, Van Horn H, Cuevas M, Ross P, Kinjo C, Basanez T, Patel S, Dinishak D, Zhou W, Ortega M, Zareie R, Lane B, Rosen A, Myers A, Domboski K, Ireland S, Mittenberg W, Mazur-Mosiewicz A, Holcomb M, Dean R, Myerson C, Katzen H, Mittel A, McClendon M, Guevara A, Nahab F, Gallo B, Levin B, Fay T, Brooks B, Sherman E, Szabo A, Gunstad J, Spitznagel M, McCaffery J, McGeary J, Paul R, Sweet L, Cohen R, Hancock L, Bruce J, Peterson S, Jacobson J, Tyrer J, Guse E, Lasater J, Fritz J, Lynch S, O'Rourke J, Queller S, Whitlock K, Beglinger L, Stout J, Duff K, Paulsen J, Kim M, Jang J, Chung J, Zukerman J, Miller S, Waterman G, Sadek J, Singer E, Heaton R, van Gorp W, Castellon S, Hinkin C, Yamout K, Baade L, Panos S, Becker B, Kim M, Foley J, Jang J, Chung J, Castellon S, Hinkin C, Kim M, Jang J, Foley J, Chung J, Miller S, Castellon S, Marcotte T, Hinkin C, Merrick E, Kazakov D, Duke L, Field R, Allen D, Mayfield J, Barney S, Thaler N, Allen D, Donohue B, Mayfield J, Mauro C, Shope C, Riber L, Dhami S, Citrome L, Tremeau F, Heyanka D, Corsun-Ascher C, Englebert N, Golden C, Block C, Sautter S, Stolberg P, Terranova J, Jones W, Allen D, Mayfield J, Ramanathan D, Medaglia J, Chiou K, Wardecker B, Slocomb J, Vesek J, Wang J, Hills E, Good D, Hillary F, Kimpton T, Kirshenbaum A, Madathil R, Trontel H, Hall S, Chiou K, Slocomb J, Ramanathan D, Medaglia J, Wardecker B, Vesek J, Wang J, Hills E, Good D, Hillary F, Salinas C, Tiedemann S, Webbe F, Williams C, Wood R, Ringdahl E, Thaler N, Hodges T, Mayfield J, Allen D, Kazakov D, Haderlie M, Terranova J, Martinez A, Allen D, Mayfield J, Medaglia J, Ramanathan D, Chiou K, Wardecker B, Franklin R, Genova H, Deluca J, Hillary F, Pastrana F, Wurst L, Zeiner H, Garcia A, Bender H, Rice J, West S, Dougherty M, Boddy R, Golden C, Tyrer J, Bruce J, Hancock L, Guse E, Jacobson J, Lynch S, Yung R, Sullivan W, Stringer K, Ferguson B, Drago V, Foster P, Scarisbrick D, Heyanka D, Frisch D, Golden C, Prinzi L, Morrow J, Robbins J, Golden C, Fallows R, Amin K, Virden T, Borgaro S, Hubel K, Miles G, Gomez R, Nazarian S, Mucci G, Moreno-Torres M, San Miguel-Montes L, Otero-Zeno T, Rios M, Douglas K, McGhee R, Sakamoto M, Spiers M, Vanderslice-Barr J, Elbin R, Covassin T, Kontos A, Larson E, Stiller-Ostrowski J, McLain M, Serina N, John S, Rautiola M, Waldstein S, Che A, Gomez R, Keller J, Tennakoon L, Marshall D, Rogers E, Misa J, Schatzberg A, Stiles M, Ericson R, Earleywine M, Ericson R, Earleywine M, Tourgeman I, Boddy R, Gurrea J, Buddin H, Golden C, Holcomb M, Mazur-Mosiewicz A, Dean R, Miele A, Lynch J, McCaffrey R, Miele A, Vanderslice-Barr J, Lynch J, McCaffrey R, Wershba R, Stevenson M, Thomas M, Sturgeon J, Youngjohn J, Morgan D, Bello D, Hollimon M, Schneider J, Edgington C, Scott J, Adams R, Morgan D, Bello D, Hollimon M, Schneider J, Edgington C, Scott J, Adams R, Heinrichs R, Baade L, Soetaert D, Barisa M, Noggle C, Thompson J, Barisa M, Noggle C, Thompson J, Barisa M, Noggle C, Thompson J, Pimental P, Riedl K, Kimsey M, Sartori A, Griffith H, Okonkwo O, Marson D, Bertisch H, Schaefer L, McKenzie S, Mittelman M, Hibbard M, Sherr R, Diller L, McTaggart A, Williams R, Troster A, Clark J, Owens T, O'Jile J, Schmitt A, Livingston R, Smernoff E, Galusha J, Piazza J, Gutierrez M, Yeager C, Hyer L, Vaughn E, LaPorte D, Schoenberg M, Werz M, Pedigo T, Lavach J, Hart J, Vyas S, Dorta N, Granader Y, Roberts E, Hill B, Musso M, Pella R, Barker A, Proto D, Gouvier W, Gibson K, Bowers T, Bowers T, Gibson K, Hinkle S, Barisa M, Noggle C, Thompson J, Thompson J, Noggle C, Barisa M, Maulucci A, Thompson J, Noggle C, Barisa M, Maulucci A, Thompson J, Noggle C, Barisa M, Maulucci A, Benitez A, Gunstad J, Spitznagel M, Szabo A, Rogers E, Gomez R, Keller J, Marshall D, Tennakoon L, Che A, Misa J, Schatzber A, Strauss G, Ringdahl E, Barney S, Jetha S, Duke L, Ross S, Watrous B, Allen D, Maucieri L, Noggle C, Barisa M, Thompson J, Maulucci A, Noggle C, Barisa M, Thompson J, Maulucci A, Noggle C, Barisa M, Thompson J, Maulucci A, Noggle C, Thompson J, Barisa M, Maulucci A, Noggle C, Thompson J, Barisa M, Maulucci A, Getz G, Dandridge A, Klein R, La Point S, Holcomb M, Mazur-Mosiewicz A, Dean R, Bailey C, Samples H, Broshek D, Barth J, Freeman J, Schatz P, Neidzwski K, Moser R, Reesman J, Suli-Moci E, Wells C, Moneta L, Dean P, Gioia G, Belsher B, Hutson L, Greenberg L, Sullivan C, Hull A, Poole J, Schatz P, Pardini J, Lovell M, Strauser E, Parish R, Carr W, Paggi M, Anderson-Barnes V, Kelly M, Hutson L, Loughlin J, Sullivan C, Kelley E, Poole J, Hutson L, Loughlin J, Sullivan C, Belsher B, Hull A, Greenberg L, Poole J, Carr W, Parish R, Paggi M, Anderson-Barnes V, Ahlers S, Roebuck Spencer T, O'Neill D, Carter J, Bleiberg J, Lange R, Brubacher J, Iverson G, Madler B, Heran M, MacKay A, Andolfatto G, Krol A, Mrazik M, Lebby P, Johnson W, Sweatt J, Turitz M, Greenawald K, Lesser S, Ormonde A, Lavach J, Hart J, Demakis G, Rimland C, Lengenfelder J, Sumowski J, Smith A, Chiaravalloti N, DeLuca J, Pierson E, Koehn E, Lajiness-O'Neill R, Hyer L, Yeager C, Manatan K, Sherman S, Atkinson M, Massey-Connolly S, Gugnani M, Stack R, Carson A, Mirza N, Johnson E, Lovell M, Perna R, Jackson A, Roy S, Zebeigly A, Larochette A, Bowie C, Harrison A, Nippoldt-Baca L, Bleil J, Arffa S, Thompson J, Noggle C, Mark B, Maulucci A, Umaki T, Denney R, Greenberg L, Hull A, Belsher B, Lee H, Sullivan C, Poole J, Abrigo E, Hurewitz F, Kounios J, Noggle C, Barisa M, Thompson J, Maulucci A, Greve K, Aguerrevere L, Bianchini K, Etherton J, Heinly M, Kontos A, Covassin T, Elbin R, Larson E, Stearne D, Johnson D, Gilliland K, Vincent A, Chafetz M, Herkov M, Morais H, Schwait A, Mangiameli L, Greenhill T. Grand Rounds. Arch Clin Neuropsychol 2009. [DOI: 10.1093/arclin/acp045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
OBJECTIVE To determine the effect of adenoidectomy and/or tonsillectomy ("adenotonsillectomy") upon growth and growth biomarkers, in the context of sleep disordered breathing (SDB). SDB in children, primarily due to adenotonsillar hypertrophy, increases the risk of growth failure. DESIGN Systematic review and meta-analysis. PubMed, ERIC and Cochrane Reviews databases from January 1980 to November 2007 were searched for studies reporting: pre/post-adenotonsillectomy height and weight changes as percentage increased or decreased, raw data, z scores or centiles, or: IGF-1 and/or IGFBP-3 serum-level changes as z scores or raw data. For anthropometrics, the meta-analysis included studies presenting z scores or centiles. SETTING Observational studies. PATIENTS Otherwise healthy children, not selected for obesity. MAIN OUTCOME MEASURES Pre/post-surgery changes in standardised height and weight, and IGF-1 and IGFBP-3. RESULTS Of 211 citations identified, 20 met systematic review criteria. SDB was an enrolment criterion in 13 of the studies, and one of several enrolment criteria in three. Meta-analysis findings for pre/post-surgery changes were: standardised height: 10 studies, 363 total children, pooled standardised mean differences (SMD) = 0.34 (95% CI 0.20 to 0.47); standardised weight: 11 studies, 390 total children, pooled SMD = 0.57 (95% CI 0.44 to 0.70); IGF-1: 7 studies, 177 total children, pooled SMD = 0.53 (95% CI 0.33 to 0.73); IGFBP-3: 7 studies, 177 total children, pooled SMD = 0.59 (95% CI 0.34 to 0.83). CONCLUSIONS Standardised height and weight, and IGF-1 and IGFBP-3 increased significantly after adenotonsillectomy. Findings suggest that primary care providers and specialists consider SDB secondary to adenotonsillar hypertrophy when screening, treating and referring children with growth failure.
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Affiliation(s)
- K A Bonuck
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Mazer, Bronx, NY 10461, USA.
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Blum J, Freeman K, Dart R. 130: Inconsistent Conflict of Interest Policies Across Peer-Reviewed Biomedical Journals. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.06.044] [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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Bobrow M, Heritage JE, Curnow RN, Freeman K. The Spatial Relationships of the Secondary Constriction Regions of the No. 9 Chromosomes in Human Interphase Nuclel. Clin Genet 2008. [DOI: 10.1111/j.1399-0004.1978.tb02149.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Freeman K, Gregory A, Turner A, Blasco P, Hogarth P, Hayflick S. Intellectual and adaptive behaviour functioning in pantothenate kinase-associated neurodegeneration. J Intellect Disabil Res 2007; 51:417-26. [PMID: 17493025 PMCID: PMC2099459 DOI: 10.1111/j.1365-2788.2006.00889.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Pantothenate kinase-associated neurodegeneration (PKAN), an extremely rare autosomal recessive disorder resulting in iron accumulation in the brain, has a diverse phenotypic expression. Based on limited case studies of one or two patients, intellectual impairment is considered part of PKAN. Investigations of cognitive functioning have utilized specific neuropsychological tests, without attention to general intellectual skills or adaptive behaviour. METHODS Sixteen individuals with PKAN completed measures of global intellectual functioning, and participants or care providers completed measures of adaptive behaviour skills and day-to-day functional limitations. Clinicians provided global ratings of condition severity. RESULTS Testing with standardized measures documented varied phenotypic expression, with general cognitive skills and adaptive behaviour ranging from high average to well below average. Age of disease onset correlated with measures of intellectual functioning, adaptive functioning and disease severity. CONCLUSIONS Findings support previously described clinical impressions of varied cognitive impairment and the association between age of onset and impairment. Further, they add important information regarding the natural history of the disease and suggest assessment strategies for use in treatment trials.
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Affiliation(s)
- K Freeman
- Child Development and Rehabilitation Center, Portland, OR, USA.
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BENNETT DAVIDP, Akerlof C, Alcock C, Allsman R, Axelrod T, Cook K, Freeman K, Griest K, Marshall S, Park HS, Perlmutter S, Peterson B, Quinn P, Rodgers A, Stubbs C, Sutherland W. The First Data from the MACHO Experiment. Ann N Y Acad Sci 2006; 688:612-8. [DOI: 10.1111/j.1749-6632.1993.tb43945.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Freeman K. Effects of Clinical Presentation and Initial Electrocardiogram on Time to Treatment in Emergency Department Patients with Hyperkalemia. Acad Emerg Med 2006. [DOI: 10.1197/j.aem.2006.03.469] [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: 11/10/2022]
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Lum G, Freeman K, Nguyen NL, Limnios EA, Tabrizi SN, Carter I, Chambers IW, Whiley DM, Sloots TP, Garland SM, Tapsall JW. A cluster of culture positive gonococcal infections but with false negative cppB gene based PCR. Sex Transm Infect 2005; 81:400-2. [PMID: 16199739 PMCID: PMC1745040 DOI: 10.1136/sti.2004.013805] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To describe the prevalence and characteristics of isolates of Neisseria gonorrhoeae grown from urine samples that produced negative results with nucleic acid amplification assays (NAA) targeting the cppB gene. METHODS An initial cluster of culture positive, but cppB gene based NAA negative, gonococcal infections was recognised. Urine samples and suspensions of gonococci isolated over 9 months in the Northern Territory of Australia were examined using cppB gene based and other non-cppB gene based NAA. The gonococcal isolates were phenotyped by determining the auxotype/serovar (A/S) class and genotyped by pulsed field gel electrophoresis (PFGE). RESULTS 14 (9.8%) of 143 gonococci isolated were of A/S class Pro(-/)Brpyut, indistinguishable on PFGE and negative in cppB gene based, but not other, NAA. CONCLUSIONS This cluster represents a temporal and geographic expansion of a gonococcal subtype lacking the cppB gene with consequent loss of sensitivity of NAA dependent on amplification of this target. Gonococci lacking the cppB gene have in the past been more commonly associated with the PAU-/PCU- auxotype, a gonococcal subtype hitherto infrequently encountered in Australia. NAA based on the cppB gene as a target may produce false positive as well as false negative NAA. This suggests that unless there is continuing comparison with culture to show their utility, cppB gene based NAA should be regarded as suboptimal for use either as a diagnostic or supplemental assay for diagnosis of gonorrhoea, and NAA with alternative amplification targets should be substituted.
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Affiliation(s)
- G Lum
- Department of Microbiology, Royal Darwin Hospital, Casuarina, Northern Territory, Australia
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Salt A, Freeman K, Prusa A, Ferret N, Buffolano W, Malm G, Schmidt D, Tan HK, Gilbert RE. Determinants of response to a parent questionnaire about development and behaviour in 3 year olds: European multicentre study of congenital toxoplasmosis. BMC Pediatr 2005; 5:21. [PMID: 15998464 PMCID: PMC1190190 DOI: 10.1186/1471-2431-5-21] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Accepted: 07/05/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to determine how response to a parent-completed postal questionnaire measuring development, behaviour, impairment, and parental concerns and anxiety, varies in different European centres. METHODS Prospective cohort study of 3 year old children, with and without congenital toxoplasmosis, who were identified by prenatal or neonatal screening for toxoplasmosis in 11 centres in 7 countries. Parents were mailed a questionnaire that comprised all or part of existing validated tools. We determined the effect of characteristics of the centre and child on response, age at questionnaire completion, and response to child drawing tasks. RESULTS The questionnaire took 21 minutes to complete on average. 67% (714/1058) of parents responded. Few parents (60/1058) refused to participate. The strongest determinants of response were the score for organisational attributes of the study centre (such as direct involvement in follow up and access to an address register), and infection with congenital toxoplasmosis. Age at completion was associated with study centre, presence of neurological abnormalities in early infancy, and duration of prenatal treatment. Completion rates for individual questions exceeded 92% except for child completed drawings of a man (70%), which were completed more by girls, older children, and in certain centres. CONCLUSION Differences in response across European centres were predominantly related to the organisation of follow up and access to correct addresses. The questionnaire was acceptable in all six countries and offers a low cost tool for assessing development, behaviour, and parental concerns and anxiety, in multinational studies.
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Affiliation(s)
- A Salt
- The Neurodisability Service, Great Ormond Street Hospital for Children and Institute of Child Health, London, UK
| | - K Freeman
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, New York, U.S.A
| | - A Prusa
- Department of Pediatrics, Division of Neonatology and Intensive Care, Medical University of Vienna, Austria
| | - N Ferret
- CHU de NICE, Service Parasitologie – Mycologie, Hopital L'Archet II, BP 3079, 06202 NICE Cedex 3
| | - W Buffolano
- Perinatal Infection Unit, Dept of Pediatrics, University of Naples Federico II, Naples, Italy
| | - G Malm
- Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - D Schmidt
- Department of Parasitology, Staten Seruminstitut, Copenhagen, Denmark
| | - HK Tan
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
| | - RE Gilbert
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
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Tapsall JW, Limnios EA, Nguyen NL, Carter I, Lum G, Freeman K, Tabrizi SN, Garland SM, Whiley DM, Sloots TP, Chambers IW. Cryptic-plasmid-free gonococci may contribute to failure of cppB gene-based assays to confirm results of BD ProbeTEC PCR for identification of Neisseria gonorrhoeae. J Clin Microbiol 2005; 43:2036-7. [PMID: 15815057 PMCID: PMC1081405 DOI: 10.1128/jcm.43.4.2036-2037.2005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Freeman K. Biphasic Defibrillation and Monophasic Defibrillation Produce Equivalent Clinical Outcomes. Acad Emerg Med 2005. [DOI: 10.1197/j.aem.2005.03.184] [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: 11/10/2022]
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Freeman K, Oakley L, Pollak A, Buffolano W, Petersen E, Semprini AE, Salt A, Gilbert R. Association between congenital toxoplasmosis and preterm birth, low birthweight and small for gestational age birth. BJOG 2005; 112:31-7. [PMID: 15663394 DOI: 10.1111/j.1471-0528.2004.00299.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the association between congenital toxoplasmosis and preterm birth, low birthweight and small for gestational age birth. DESIGN Multicentre prospective cohort study. SETTING Ten European centres offering prenatal screening for toxoplasmosis. POPULATION Deliveries after 23 weeks of gestation in 386 women with singleton pregnancies who seroconverted to toxoplasma infection before 20 weeks of gestation. Deliveries after 36 weeks in 234 women who seroconverted at 20 weeks or later, and tested positive before 37 weeks. METHODS Comparison of infected and uninfected births, adjusted for parity and country of birth. MAIN OUTCOME MEASURES Differences in gestational age at birth, birthweight and birthweight centile. RESULTS Infected babies were born or delivered earlier than uninfected babies: the mean difference for seroconverters before 20 weeks was -5.4 days (95% CI: -1.4, -9.4), and at 20 weeks or more, -2.6 days (95% CI: -0.5, -4.7). Congenital infection was associated with an increased risk of preterm delivery when seroconversion occurred before 20 weeks (OR 4.71; 95% CI: 2.03, 10.9). No significant differences were detected for birthweight or birthweight centile. CONCLUSION Babies with congenital toxoplasmosis were born earlier than uninfected babies but the mechanism leading to shorter length of gestation is unknown. Congenital infection could precipitate early delivery or prompt caesarean section or induction of delivery. We found no evidence for a significant association between congenital toxoplasmosis and reduced birthweight or small for gestational age birth.
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Affiliation(s)
- K Freeman
- Albert Einstein College of Medicine, Bronx, NY, USA
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Hammond A, Freeman K. The long-term outcomes from a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Clin Rehabil 2004; 18:520-8. [PMID: 15293486 DOI: 10.1191/0269215504cr766oa] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the long-term effects of joint protection on health status of people with early rheumatoid arthritis (RA). DESIGN A four-year follow-up of a randomized, controlled, assessor-blinded trial was conducted. SETTING Two rheumatology outpatient departments. PARTICIPANTS People with rheumatoid arthritis less than five years since diagnosis. INTERVENTIONS Two 8-hour interventions were originally compared: a standard arthritis education programme, including 2(1/2) hours of joint protection based on typical UK occupational therapy practice (plus 5(1/2) hours on RA, exercise, pain management, diet and foot care); and a joint protection programme, using educational-behavioural training. MAIN MEASURES Adherence to joint protection, pain, hand pain on activity, Arthritis Impact Measurement Scales 2 and Arthritis Self-efficacy were recorded at 0 and 4 years. RESULTS Sixty-five people attended the joint protection and 62 the standard programmes. Groups at entry were similar in age (51 years; 49 years), disease duration (21 months: 17.5 months) and use of nonsteroidal anti-inflammatory and disease-modifying drugs. At four years, the joint protection group continued to have significantly better: joint protection adherence (p=0.001); early morning stiffness (p=0.01); AIMS2 activities of daily living (ADL) scores (p=0.04) compared with the standard group. The joint protection group also had significantly fewer hand deformities: metacarpophalangeal (MCP) (p =0.02) and wrist joints (p=0.04). CONCLUSION Attending an educational-behavioural joint protection programme significantly improves joint protection adherence and maintains functional ability long term. This approach is more effective than standard methods of training and should be more widely adopted.
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Affiliation(s)
- A Hammond
- Rheumatology Department, Derbyshire Royal Infirmary, London Road, Derby DEI 2QY, UK.
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Abstract
OBJECTIVE To identify the effect of attending a cognitive-behavioural arthritis education programme on the health status of participants with newly diagnosed rheumatoid arthritis (RA) compared with a control group. DESIGN Randomized controlled trial. SETTING Hospital based. SUBJECTS Newly diagnosed with RA. INTERVENTION Participation in either a cognitive-behavioural arthritis education programme or a standard arthritis education programme (control group). Sessions for both groups lasted for 2 hours per week for four weeks. Subjects were examined at home by an assessor blinded to group allocation, prior to and three and six months following attendance. OUTCOME MEASURES The main outcome measure was the Physical Function subscale of the Arthritis Impact Measurement Scale Two. Other outcome measures included erythrocyte sedimentation rate (ESR), joint count scores, assessments of pain and psychological status. RESULTS Fifty-four subjects (mean time since diagnosis 4.5 months) took part. Baseline analysis revealed that the control group had significantly better levels of functional ability (U = 185; p = 0.009) and lower levels of helplessness (U = 168; p = 0.002) prior to intervention. This difference remained unchanged three months later. Six months following the intervention no significant differences were noted between the groups for any measure of health status. There were no significant changes in health status over time in either group. CONCLUSION Attending a cognitive-behavioural arthritis education programme had no significant effect on the health status of individuals newly diagnosed with RA. The move to early use of these programmes should be examined further, with a larger sample size and longer duration of follow-up.
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Affiliation(s)
- K Freeman
- Division of Physiotherapy Education, University of Nottingham, Nottingham City Hospital, Nottingham, UK.
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