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Baniel CC, Johnston L, Jackson C, Arai S, Hiniker SM, Hoppe RT, Binkley MS. Low Dose Splenic Radiotherapy for Myeloproliferative Neoplasms prior to Allogeneic Hematopoietic Stem Cell Transplant. Int J Radiat Oncol Biol Phys 2023; 117:e458. [PMID: 37785467 DOI: 10.1016/j.ijrobp.2023.06.1651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Myeloproliferative neoplasms including primary and secondary myelofibrosis (MF) are a rare spectrum of chronic myeloproliferative disorders in which nearly 90% of patients experience splenomegaly. Importantly, splenic radiotherapy (SRT) may be used in combination with allogeneic stem cell transplant (alloSCT) to improve symptoms related to splenomegaly, though there currently is no consensus SRT dose/fractionation protocol reported in the literature for use in combination with alloSCT. We sought to report our institutional experience utilizing low dose SRT prior to alloSCT in the post-Jakafi era. MATERIALS/METHODS We performed a retrospective review of all patients diagnosed with MF at our institution from 2017-2022 who received reduced intensity alloHCT. Patients who underwent total lymphoid or body irradiation were excluded. Descriptive demographic and clinical characteristics of patients were summarized by means, medians, standard deviations, ranges and proportions as appropriate. RESULTS We identified 39 patients with MF who underwent reduced intensity conditioning (RIC) consisting of fludarabine/melphalan in preparation for alloHCT (median age 64.5, 12/16 males, median follow up 21 months). 16 patients with Jakafi-resistant splenomegaly completed low dose SRT prior to transplant (median spleen size: 24.5cm) with a median dose of 5Gy delivered in 5 fractions. 3D conformal therapy was used for all patients. All patients completed the planned total radiation course without treatment break or dose limiting acute toxicity. Thrombocytopenia was the most reported toxicity (CTCAE v5.0; 2 patients experienced grade 1, 1 patient experienced grade 2). No patients experienced grade 3 or higher acute cytopenias nor required transfusion during radiotherapy. All patients successfully received alloHCT a median of 7 days (range: 2-11) after the completion of SRT with a 94% (15/16) engraftment rate. Median neutrophil recovery (ANC > 500 × 3 days) time was 18 days (range: 13-31); median length of hospital stay was 23 days (range: 20-129). Overall survival was 75% in the SRT cohort (12/16, 2 with persistent disease, 2 due to other causes). Symptom burden data was available for 14/16 patients; 79% (11/14) of patients reported improvement in symptoms associated with splenomegaly or reduction in splenic size on physical examination. CONCLUSION In the largest reported experience of a low dose SRT only cohort to date, we observe low dose SRT is feasible, safe in combination with alloHCT with high engraftment rates, and may reduce symptoms related to splenomegaly thereby improving patient quality of life without compromising transplant related outcomes. A prospective study validating this protocol is currently underway.
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Affiliation(s)
- C C Baniel
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | - S Arai
- Stanford University, Stanford, CA
| | - S M Hiniker
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - R T Hoppe
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M S Binkley
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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Werner‐Seidler A, Li SH, Spanos S, Johnston L, O'Dea B, Torok M, Ritterband L, Newby JM, Mackinnon AJ, Christensen H. The effects of a sleep-focused smartphone application on insomnia and depressive symptoms: a randomised controlled trial and mediation analysis. J Child Psychol Psychiatry 2023; 64:1324-1335. [PMID: 36991537 PMCID: PMC10952387 DOI: 10.1111/jcpp.13795] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Rates of depression are increasing among adolescents. A novel way to reduce depression is by improving sleep. We evaluated whether an app-based intervention for insomnia improved sleep and depression, and whether changes in insomnia mediated changes in depression. METHODS We conducted a 2-arm single-blind randomised controlled trial at the Black Dog Institute in Australia. Adolescents 12-16 years experiencing insomnia symptoms were randomly allocated to receive Sleep Ninja, an app-delivered cognitive behavioural therapy program for insomnia, or to an active control group involving weekly text message sleep tips. Assessments took place at baseline, 6 weeks (post-intervention) and 14 weeks (post-baseline). Co-primary outcomes were symptoms of insomnia and depression at post-intervention (primary endpoint). Intent-to-treat analyses were conducted. The trial is registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12619001462178. RESULTS Between October 25, 2019, and September 6, 2020, 264 participants were randomised to receive Sleep Ninja (n = 131) or to the control group (n = 133). Relative to the control group, those allocated to the intervention reported a greater reduction in insomnia symptoms at 6 weeks (95% CI: -2.96 to -0.41, d = .41) and 14 weeks (95% CI: -3.34 to -0.19, d = .39), and a greater reduction in depression symptoms at 6 weeks (95% CI: -3.46 to -0.56, d = .28) but not 14 weeks (p < 1). Change in insomnia mediated change in depression. No adverse events were reported. CONCLUSIONS An app-delivered program for insomnia could be a practical, non-stigmatising and scalable way to reduce symptoms of insomnia and depression among adolescents experiencing difficulties getting enough good quality sleep.
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Affiliation(s)
- Aliza Werner‐Seidler
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia
| | - Sophie H. Li
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia
| | - Samantha Spanos
- Australian Institute of Health InnovationMacquarie UniversitySydneyNSWAustralia
| | - Lara Johnston
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
| | - Bridianne O'Dea
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
| | - Michelle Torok
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
| | - Lee Ritterband
- School of MedicineUniversity of VirginiaCharlottesvilleVAUSA
| | - Jill M. Newby
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia
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Alkhedhairi SAA, Aba Alkhayl FF, Ismail AD, Rozendaal A, German M, MacLean B, Johnston L, Miller A, Hunter A, Macgregor L, Combet E, Quinn T, Gray S. The effects of krill oil supplementation on skeletal muscle function and size in older adults: a randomised controlled trial. Clin Nutr 2022; 41:1228-1235. [DOI: 10.1016/j.clnu.2022.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
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Francia C, Johnston L, Justo R, Manoy S, Cassimatis J, Fraser J. Latent Rheumatic Heart Disease Progression in Children and Youths Living in Endemic Regions: A Global Systematic Review. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.478] [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: 10/16/2022]
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Beames JR, Johnston L, O'Dea B, Torok M, Christensen H, Boydell KM, Werner-Seidler A. Factors That Help and Hinder the Implementation of Digital Depression Prevention Programs: School-Based Cross-sectional Study. J Med Internet Res 2021; 23:e26223. [PMID: 34448701 PMCID: PMC8433863 DOI: 10.2196/26223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/17/2021] [Accepted: 05/04/2021] [Indexed: 12/20/2022] Open
Abstract
Background Digital prevention programs that are delivered in a school environment can inoculate young people against depression. However, little is known about the school-based factors that help and hinder the implementation of these programs. Staff members are integral for supporting mental health programs in schools and are likely to have a wealth of expertise and knowledge about the factors that affect implementation. Objective The primary objective of this study was to explore the barriers and facilitators to implementing a digital depression prevention program in Australian secondary schools with teachers, counselors, and principals. The secondary objective was to explore variations in these factors across different school contexts, including the school type (government or nongovernment), location (capital city, regional/or rural areas), and socioeconomic status (SES) (low, medium, high). Methods This quantitative cross-sectional survey study assessed the barriers and facilitators to implementing a hypothetical digital prevention program in Australian schools. The survey was taken by 97 teachers (average age 38.3 years), 93 counselors (average age 39.5 years), and 11 principals (average age 50.9 years) across Australia between November 2017 and July 2018. Results A range of barriers and facilitators relating to logistics and resources, staff support, and program factors were endorsed by the surveyed staff. Consistent with prior research, common barriers included a lack of time and resources (ie, staff and rooms). These barriers were particularly evident in government, rural/regional, and low socioeconomic schools. Other barriers were specific to digital delivery, including privacy issues and a lack of clarity around staff roles and responsibilities. Facilitators included upskilling staff through training, embedding the program into the curriculum, and other program factors including universal delivery, screening of students’ mental health, and clear referral pathways. Knowledge about the program efficacy was also perceived as important by a large proportion of the respondents. Conclusions The digital depression prevention program was perceived as suitable for use within different schools in Australia, although certain factors need to be considered to enable effective implementation. Logistics and resources, support, and program factors were identified as particularly important for school-based implementation. To maximize the effectiveness in delivering digital programs, implementation may need to be tailored to the staff roles and school types.
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Affiliation(s)
- Joanne R Beames
- Black Dog Institute, University of New South Wales, Randwick, Australia
| | - Lara Johnston
- Black Dog Institute, University of New South Wales, Randwick, Australia
| | - Bridianne O'Dea
- Black Dog Institute, University of New South Wales, Randwick, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Randwick, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Randwick, Australia
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Sapa H, Johnston L, Casaus A. Holistic radiographic interpretation. Br Dent J 2021; 230:625-626. [PMID: 34050275 DOI: 10.1038/s41415-021-3101-1] [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: 11/09/2022]
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Shah A, Stanworth SJ, Lee A, Johnston L, Docherty AB. Prevalence, management and outcomes associated with anaemia in ICU survivors: a retrospective study. Anaesthesia 2021; 76:1421-1423. [PMID: 33789355 DOI: 10.1111/anae.15461] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 12/12/2022]
Affiliation(s)
- A Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - S J Stanworth
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - A Lee
- Royal Berkshire Hospital NHS Foundation Trust, Reading, UK
| | - L Johnston
- University of Edinburgh Medical School, Edinburgh, UK
| | - A B Docherty
- The Usher Institute, University of Edinburgh, Edinburgh, UK
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Hockley J, Johnston L, Watson J, Shenkin SD. 102 Online Supportive Conversations & Reflection Sessions [OSCARS] with Care Home Staff Following A Resident’s Death: Improving Coping Mechanisms, Team Cohesion and Communication. Age Ageing 2021. [PMCID: PMC7989628 DOI: 10.1093/ageing/afab030.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction COVID-19 Trauma Guidance suggests opportunities for structured, time-limited discussions about challenging experiences should be offered. It is unknown if such discussions can be effectively delivered online by palliative care specialists to support care home (CH) staff in relation to death/dying. Funded by Scotland’s Chief Scientist Office COVID-19 “rapid research” fund, online OSCaRS is being piloted. Methods Fortnightly OSCaRS delivered to small groups of CH staff via a secure online platform in three local CHs over 10 weeks. Sessions are digitally recorded. The shortened version of the Chesney coping self-efficacy questionnaire is completed by all staff pre/post. Additional post-study questions asked of OSCaRS participants and in-depth staff interviews will be undertaken (n = 10). Thematic analysis of the recorded sessions and interviews will be undertaken and related to the staff questionnaire and context of each CH. Results New learning on the feasibility and acceptability of providing OSCaRS to frontline staff. The benefit of OSCaRS to CH staff coping mechanisms, team cohesion and communicaton with relatives during the COVID-19 pandemic will be presented. Initial results show that OSCaRS are feasible, valued by all care home staff and support staff in coping with the challenges of COVID-19/. Key Conclusions The analysis will inform future practice, and an Implementation Guide for OSCaRS in CHs will be produced. Key learning on the potential for online support in relation to death/dying during the pandemic and beyond will contribute to future education, training and staff wellbeing resources. It will also inform the role of such sessions in developing individual coping mechanisms and team working alongside communication with relatives during lockdown.
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Affiliation(s)
- J Hockley
- University of Edinburgh; Edinburgh Napier University; University of Edinburgh; University of Edinburgh
| | - L Johnston
- University of Edinburgh; Edinburgh Napier University; University of Edinburgh; University of Edinburgh
| | - J Watson
- University of Edinburgh; Edinburgh Napier University; University of Edinburgh; University of Edinburgh
| | - S D Shenkin
- University of Edinburgh; Edinburgh Napier University; University of Edinburgh; University of Edinburgh
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Johnston L, Malcolm C, Rambabu L, Hockley J, Shenkin SD. 101 Avoiding Burnout of the Care Home Workforce During the COVID-19 Pandemic and Beyond: Sharing National Learning and Local Initiatives. Age Ageing 2021. [PMCID: PMC7989615 DOI: 10.1093/ageing/afab030.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction COVID-19 in care homes has heightened the risk of staff burnout, undermining already problematic staff retention and low morale. There has been an associated proliferation of resources and online initiatives to support frontline workers, however, few of these are directly targeted at the care home workforce. Care home workers are highly skilled in caring for people with complex needs, but have very variable levels of formal training, and just over half of care homes in Scotland include registered nurses. This project will rapidly collate existing resources and identify, direct from care home workers, their best practice, initiatives, and resources used to support resilience and retention during this pandemic and moving forward. Methods 1) Rapid review of care home specific evidence and resources (including published research and social media); 2) Online survey of Enabling Research in Care Homes (ENRICH) members across Scotland (n = 55); 3) Case studies within six care homes to identify what is working well and what is not in terms of promoting resilience and emotional support. Results The rapid review has identified a wide range of resources directed at supporting staff working in care homes; the survey and case studies will provide data on the key learning and resources that have supported staff, and outline the challenges identified. There are many resources available but staff do not access these. The role of the care home manager is key. Key conclusions This comprehensive review of resources and initiatives will make a valuable contribution to policy and practice designed to reduce burnout and foster retention not just in care homes but more widely across health and social care.
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Affiliation(s)
- L Johnston
- Edinburgh Napier University; Edinburgh Napier University; University of Edinburgh; University of Edinburgh; University of Edinburgh
| | - C Malcolm
- Edinburgh Napier University; Edinburgh Napier University; University of Edinburgh; University of Edinburgh; University of Edinburgh
| | - L Rambabu
- Edinburgh Napier University; Edinburgh Napier University; University of Edinburgh; University of Edinburgh; University of Edinburgh
| | - J Hockley
- Edinburgh Napier University; Edinburgh Napier University; University of Edinburgh; University of Edinburgh; University of Edinburgh
| | - S D Shenkin
- Edinburgh Napier University; Edinburgh Napier University; University of Edinburgh; University of Edinburgh; University of Edinburgh
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Johnston L, Mackay B, King T, Krockenberger MB, Malik R, Tebb A. Abdominal cryptococcosis in dogs and cats: 38 cases (2000-2018). J Small Anim Pract 2020; 62:19-27. [PMID: 33107069 DOI: 10.1111/jsap.13232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 06/05/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To report the clinical presentation, laboratory and imaging findings, treatment and outcome of abdominal cryptococcosis in dogs and cats in Australia. MATERIALS AND METHODS Canine and feline cases from Australia were retrospectively identified (2000 to 2018) via laboratory and referral centre searches for abdominal cryptococcosis diagnosed by cytology (needle aspirates) or histopathology (biopsy or necropsy) of abdominal organs/tissues. Signalment, presenting complaints, clinical signs, laboratory findings, medical imaging, latex cryptococcal antigen agglutination test (LCAT) titres, treatment and outcome data was collected. RESULTS Thirty-eight cases were included (35 dogs, three cats) in the study. Median age of presentation was 2 years for dogs and 6 years for cats. Common presenting complaints included vomiting (23/38), lethargy (19/38) and inappetence/anorexia (15/38). Abdominal ultrasound (25/38 cases) revealed mesenteric and intestinal lesions in most of the cases. On surgical exploration, seven cases had an intestinal lesion associated with an intussusception. Nineteen cases had a pre-treatment LCAT performed, with a median initial titre of 1:2048 (range 1:2 to 65,536). Twenty-four cases (23 dogs, one cat) received treatment, either medical, surgical or both. Median survival time for cases with combined medical and surgical treatment, surgical treatment alone or medical treatment alone was 730, 140 and 561 days, respectively. Eleven remain alive at the time of follow up. CLINICAL SIGNIFICANCE Abdominal cryptococcosis although rare should be a considered as a diagnostic possibility in an especially young dog presenting with gastro-intestinal signs. Older dogs can also present with this condition and should not be euthanised based on imaging alone due to the likenesses with neoplasia. With appropriate treatment and monitoring many dogs may have a prolonged survival period and some may be cured.
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Affiliation(s)
- L Johnston
- Department of Internal Medicine, Veterinary Specialist Services, Carrara, 4211, Australia
| | - B Mackay
- Department of Internal Medicine, Veterinary Specialist Services, Carrara, 4211, Australia
| | - T King
- Department of Internal Medicine, Veterinary Specialist Services, Carrara, 4211, Australia
| | - M B Krockenberger
- Sydney School of Veterinary Science, The University of Sydney, Sydney, 2006, Australia
| | - R Malik
- Centre for Veterinary Education, The University of Sydney, Sydney, 2006, Australia.,School of Animal and Veterinary Science, Charles Sturt University, Wagga Wagga, 2678, Australia
| | - A Tebb
- Western Australian Veterinary Emergency and Speciality, Success, 6164, Australia
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Johnston L, Leister E, Singer L. Severe metabolic acidosis due to acetazolamide intoxication in a dog. Aust Vet J 2020; 99:11-14. [PMID: 33025586 DOI: 10.1111/avj.13027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 12/01/2022]
Abstract
CASE REPORT This case report describes the clinical signs and case management of a 1-year-old neutered male Siberian Husky that accidentally ingested 635 mg/kg of oral acetazolamide (a carbonic anhydrase inhibitor). The dog presented with severe tachypnoea due to the development of hyperchloraemic metabolic acidosis and associated hypokalaemia that persisted for 7 days. Clinical and biochemical changes resolved with intravenous and subsequent oral supplementation of sodium bicarbonate and potassium. Complete recovery occurred within 9 days of presentation. CONCLUSION To the authors' knowledge, this is the first case that reports overdosage of an oral carbonic anhydrase inhibitor in a dog and subsequent recovery with adequate supplementation and supportive care.
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Affiliation(s)
- L Johnston
- Internal Medicine, Veterinary Specialist Services, Eastlake Street, Carrara, Queensland, 4211, Australia
| | - E Leister
- Emergency and Critical care, Pet ICU, Lexington Road, Underwood, Queensland, 4119, Australia
| | - L Singer
- Internal Medicine, Veterinary Specialist Services, Eastlake Street, Carrara, Queensland, 4211, Australia
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Kumar D, Vachharajani AJ, Wertheimer F, Vergales B, Glass K, Dannaway D, Winter L, Delaney H, Ganster A, Arnold J, Urban A, Johnston L, Bruno C, Gray MM, Sawyer T. Boot camps in neonatal-perinatal medicine fellowship programs: A national survey. J Neonatal Perinatal Med 2020; 12:231-237. [PMID: 30829620 DOI: 10.3233/npm-18117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Simulation is widely used in graduate medical education. A prior survey showed that 80% of Neonatal-Perinatal Medicine (NPM) fellowship programs in the U.S. use simulation. There are multiple ways to provide simulation-based education. One such method is through intensive simulation-based education sessions held at the beginning of a training program, common called 'boot camps'. The aim of this study was to describe the use of simulation-based boot camps in NPM fellowship programs. METHODS Survey study of Accreditation Council for Graduate Medical Education (ACGME) accredited NPM fellowships in the U.S. RESULTS Fifty-nine of 98 programs (60%) responded. Thirty six (61%) participated in 1st year fellow boot camps, which focused on procedural skills and newborn resuscitation. Nearly half of programs participated in regional boot camps. Most boot camps were one or two days long. Eleven programs (19%) held 2nd or 3rd year fellow boot camps, which focused on advanced resuscitation and communication. Barriers included lack of faculty protected time (57%), funding (39%), and lack of faculty experience (31%). CONCLUSIONS A majority of ACGME accredited NPM fellowships participate in 1st year fellows' boot camps. Many participate in regional boot camps. A few programs have 2nd or 3rd year fellow boot camps. Lack of time, funding, and faculty experience were common barriers.
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Affiliation(s)
- D Kumar
- Department of Pediatrics, Division of Neonatology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA
| | - A J Vachharajani
- Department of Pediatrics, Division of Newborn Medicine, Washington University in St. Louis and St. Louis Children's Hospital, St. Louis, MO, USA
| | - F Wertheimer
- Department of Pediatrics, Division of Neonatology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - B Vergales
- Department of Pediatrics, Division of Neonatology, University of Virginia Health System, Charlottesville, VA, USA
| | - K Glass
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - D Dannaway
- Department of Pediatrics, Section of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - L Winter
- Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - H Delaney
- Department of Pediatrics, Division of Neonatology, Brooke Army Medical Center, San Antonio, TX, USA
| | - A Ganster
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - J Arnold
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - A Urban
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Johnston
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - C Bruno
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - M M Gray
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children's Hospital. Seattle, WA, USA
| | - T Sawyer
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children's Hospital. Seattle, WA, USA
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Werner-Seidler A, Huckvale K, Larsen ME, Calear AL, Maston K, Johnston L, Torok M, O’Dea B, Batterham PJ, Schweizer S, Skinner SR, Steinbeck K, Ratcliffe J, Oei JL, Patton G, Wong I, Beames J, Wong QJJ, Lingam R, Boydell K, Salmon AM, Cockayne N, Mackinnon A, Christensen H. A trial protocol for the effectiveness of digital interventions for preventing depression in adolescents: The Future Proofing Study. Trials 2020; 21:2. [PMID: 31898512 PMCID: PMC6941300 DOI: 10.1186/s13063-019-3901-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 11/11/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Depression frequently first emerges during adolescence, and one in five young people will experience an episode of depression by the age of 18 years. Despite advances in treatment, there has been limited progress in addressing the burden at a population level. Accordingly, there has been growing interest in prevention approaches as an additional pathway to address depression. Depression can be prevented using evidence-based psychological programmes. However, barriers to implementing and accessing these programmes remain, typically reflecting a requirement for delivery by clinical experts and high associated delivery costs. Digital technologies, specifically smartphones, are now considered a key strategy to overcome the barriers inhibiting access to mental health programmes. The Future Proofing Study is a large-scale school-based trial investigating whether cognitive behaviour therapies (CBT) delivered by smartphone application can prevent depression. METHODS A randomised controlled trial targeting up to 10,000 Year 8 Australian secondary school students will be conducted. In Stage I, schools will be randomised at the cluster level either to receive the CBT intervention app (SPARX) or to a non-active control group comparator. The primary outcome will be symptoms of depression, and secondary outcomes include psychological distress, anxiety and insomnia. At the 12-month follow-up, participants in the intervention arm with elevated depressive symptoms will participate in an individual-level randomised controlled trial (Stage II) and be randomised to receive a second CBT app which targets sleep difficulties (Sleep Ninja) or a control condition. Assessments will occur post intervention (both trial stages) and at 6, 12, 24, 36, 48 and 60 months post baseline. Primary analyses will use an intention-to-treat approach and compare changes in symptoms from baseline to follow-up relative to the control group using mixed-effect models. DISCUSSION This is the first trial testing the effectiveness of smartphone apps delivered to school students to prevent depression at scale. Results from this trial will provide much-needed insight into the feasibility of this approach. They stand to inform policy and commission decisions concerning if and how such programmes should be deployed in school-based settings in Australia and beyond. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry, ACTRN12619000855123. Registered on 31 May 2019. Clinical Trial Notification Scheme (CTN), CT-2019-CTN-02110-1-v1. Registered on 30 June 2019.
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Affiliation(s)
| | - Kit Huckvale
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Mark E. Larsen
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Alison L. Calear
- Centre for Mental Health Research, The Australian National University, Canberra, ACT Australia
| | - Kate Maston
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Lara Johnston
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Bridianne O’Dea
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Philip J. Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, ACT Australia
| | - Susanne Schweizer
- School of Psychology, University of New South Wales, Sydney, NSW Australia
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - S. Rachel Skinner
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Katharine Steinbeck
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA Australia
| | - Ju-Lee Oei
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW Australia
| | - George Patton
- Murdoch Children’s Research Institute and University of Melbourne, Melbourne, VIC Australia
| | - Iana Wong
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Joanne Beames
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Quincy J. J. Wong
- School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW Australia
| | - Raghu Lingam
- Population Child Health Clinical Research Group, School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW Australia
| | - Katherine Boydell
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Allison M. Salmon
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Nicole Cockayne
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Andrew Mackinnon
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, NSW Australia
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Luvai A, Johnston L, Curtis A, Potter A, Musson S, Pattman S, Kamarrudin S, Weaver J, Arutchevelam V, Anderson M, Burns M, Hopper N, McAnulty C, Sutton R, Neely R, Carey P. High Polygenic Snp Scores Do Not Exclude Monogenic Familial Hypercholesterolaemia. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Agarwal A, Miller S, Hadden W, Johnston L, Wang W, Arnold G, Abboud RJ. Comparison of gait kinematics in total and unicondylar knee replacement surgery. Ann R Coll Surg Engl 2019; 101:391-398. [PMID: 31155888 DOI: 10.1308/rcsann.2019.0016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study is aimed to compare kinematic gait data of patients who have undergone total and unicondylar knee replacement. MATERIALS AND METHODS This single-surgeon retrospective cohort study evaluated 13 patients with unilateral total knee arthroplasty (TKA) and 14 unicondylar knee arthroplasty (UKA). Gait analysis was carried out using a Vicon motion analysis system. The limits of knee flexion during stance phase, at heel strike and at loading response were measured. RESULTS The total range of motion of the UKA knees was significantly greater than the TKA knees. UKA knees exhibited significantly greater knee extension during the stance phase than the TKA knees. Unlike TKA, UKA knees demonstrated improved knee flexion during the gait cycle when compared to the contralateral non-operated knee. The hips also demonstrated near normal hip flexion in UKA patients. Predictably, UKA knees had significantly greater varus compared with TKA in the coronal plane. Spatiotemporal variables demonstrated similar walking speed and step length to aid a fair comparison between knee replacement groups. CONCLUSIONS The UKA knees moved more physiologically in the sagittal plane with a greater range of motion during gait. Despite having a stiff gait pattern, the patients undergoing TKA demonstrated a more neutral alignment in the coronal plane. Neither type of knee arthroplasty restored knee kinematics to those of the non-operated side.
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Affiliation(s)
- A Agarwal
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - S Miller
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - W Hadden
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - L Johnston
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - W Wang
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - G Arnold
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - R J Abboud
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
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Abstract
OBJECTIVES The aim of this study was to test the feasibility, acceptability and preliminary effects of a recently developed smartphone application, Sleep Ninja, for adolescent sleep difficulties. SETTING The study was conducted online with Australian individuals recruited through the community. PARTICIPANTS Participants were 50 young people aged 12-16 years with sleep difficulties. DESIGN A single-arm pre-post design was used to evaluate feasibility, acceptability and sleep and mental health variables at baseline and postintervention. INTERVENTION Cognitive-behavioural therapy for insomnia informed the development of the Sleep Ninja. The core strategies covered by the app are psychoeducation, stimulus control, sleep hygiene and sleep-related cognitive therapy. It includes six training sessions (lessons), a sleep tracking function, recommended bedtimes based on sleep guidelines, reminders to start a wind-down routine each night, a series of sleep tips and general information about sleep. Users progress through each training session and conclude the 6-week programme with a black belt in sleep. OUTCOME MEASURES Feasibility was evaluated based on consent rates, adherence and attrition, acceptability was assessed using questionnaires and a poststudy interview, and sleep, depression and anxiety variables were assessed at baseline and postintervention. RESULTS Data indicated that the Sleep Ninja is a feasible intervention and is acceptable to young people. Findings showed that there were significant improvements on sleep variables including insomnia (within-group effect size d=-0.90), sleep quality (d=-0.46), depression (d=-0.36) and anxiety (d=-0.41). CONCLUSIONS The Sleep Ninja is a promising intervention that could assist adolescents who experience sleep difficulties. A follow-up randomised controlled trial is now warranted. TRIAL REGISTRATION NUMBER ACTRN12617000141347.
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Affiliation(s)
| | - Quincy Wong
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
- School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW, Australia
| | - Lara Johnston
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Bridianne O’Dea
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
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Colditz IG, Paull DR, Lloyd JB, Johnston L, Small AH. Efficacy of meloxicam in a pain model in sheep. Aust Vet J 2019; 97:23-32. [DOI: 10.1111/avj.12779] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 11/28/2022]
Affiliation(s)
- IG Colditz
- CSIRO FD McMaster Laboratory; Locked Bag 1, Delivery Centre, Armidale New South Wales 2350 Australia
| | - DR Paull
- CSIRO FD McMaster Laboratory; Locked Bag 1, Delivery Centre, Armidale New South Wales 2350 Australia
| | - JB Lloyd
- Joan Lloyd Consulting Pty Ltd; West Ryde, NSW Australia
| | - L Johnston
- Boehringer Ingelheim Animal Health Pty Ltd; Sydney NSW Australia
| | - AH Small
- CSIRO FD McMaster Laboratory; Locked Bag 1, Delivery Centre, Armidale New South Wales 2350 Australia
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Affiliation(s)
- L. Rose
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada and Intensive Care Unit, St Vincent's Hospital, Department of Medicine, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia and School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
- Lawrence S. Bloomberg Limited Term Professor in Critical Care, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto
| | - J. J. Presneill
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada and Intensive Care Unit, St Vincent's Hospital, Department of Medicine, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia and School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
- Intensive Care Unit, St Vincent's Hospital and Associate Professor, Department of Medicine, University of Melbourne
| | - L. Johnston
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada and Intensive Care Unit, St Vincent's Hospital, Department of Medicine, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia and School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
- School of Nursing and Midwifery, Queen's University Belfast
| | - S. Nelson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada and Intensive Care Unit, St Vincent's Hospital, Department of Medicine, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia and School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto
| | - J. F. Cade
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada and Intensive Care Unit, St Vincent's Hospital, Department of Medicine, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia and School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
- Intensive Care Unit, Royal Melbourne Hospital
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Li Y, Cui S, Baidoo S, Johnston L. PSX-39 Effect of body condition measured using a sow caliper on performance of group-housed gestating sows. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.1070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Y Li
- West Central Research and Outreach Center, University of Minnesota,Morris, MN, United States
| | - S Cui
- West Central Research and Outreach Center, University of Minnesota,Morris, MN, United States
| | - S Baidoo
- Southern Research and Outreach Center, University of Minnesota,Waseca, MN, United States
| | - L Johnston
- West Central Research and Outreach Center, University of Minnesota,Morris, MN, United States
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Abstract
This paper describes the work of the National Advisory Committee on Infection Prevention and Control (NAC-IPC), previously Infection Prevention and Control Expert Working Group, a longstanding external advisory body that provides subject matter expertise and advice to the Public Health Agency of Canada (PHAC) on the prevention and control of infectious diseases in Canadian health care settings. Originally established by Health Canada as the Infection Control Guidelines Steering Committee in 1992, this advisory board has been providing expert advice on infection prevention and control (IPC) guideline development for over 25 years. The NAC-IPC provides advice to inform the development of comprehensive or concise guidelines, quick reference guides and interim guidelines (usually for emerging pathogens), working closely with PHAC's national Healthcare-Associated Infections (HAIs) surveillance programs for Canadian health care facilities. PHAC's HAI-IPC professionals conduct the necessary literature research, data extraction, evidence synthesis, evidence grading (where applicable) and scientific writing for the guidelines. Due to the paucity of clinical trials and high quality observational studies to inform recommendations for emerging pathogens, expert opinion is critical for interpreting available evidence. .
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Affiliation(s)
- T Ogunremi
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - K Dunn
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | | | - J Embree
- University of Manitoba, Winnipeg, MB
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21
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Johnston L, Potter A, Carey P, Luvai A, McKenna P, Weaver J, Pattman S, Kamaruddin S, Arutchevelam V, Anderson M, Burns M, Hopper N, Sutton R, McAnulty C, Curtis A, Neely R. Mutations in LDLR, APOB, PCSK9 and APOE genes contribute to the genetic spectrum of familial hypercholesterolaemia in the north of England. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sawyer T, Foglia E, Hatch LD, Moussa A, Ades A, Johnston L, Nishisaki A. Improving neonatal intubation safety: A journey of a thousand miles. J Neonatal Perinatal Med 2018; 10:125-131. [PMID: 28409758 DOI: 10.3233/npm-171686] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neonatal intubation is one of the most common procedures performed by neonatologists, however, the procedure is difficult and high risk. Neonates who endure the procedure often experience adverse events, including bradycardia and severe oxygen desaturations. Because of low first attempt success rates, neonates are often subjected to multiple intubation attempts before the endotracheal tube is successfully placed. These factors conspire to make intubation one of the most dangerous procedures in neonatal medicine. In this commentary we review key elements in the journey to improve neonatal intubation safety. We begin with a review of intubation success rates and complications. Then, we discuss the importance of intubation training. Next, we examine quality improvement efforts and patient safety research to improve neonatal intubation safety. Finally, we evaluate new tools which may improve success rates, and decrease complications during neonatal intubation.
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Affiliation(s)
- T Sawyer
- Seattle Children's Hospital and University of Washington School of Medicine, Department of Pediatric, Division of Neonatology, Seattle, WA, USA
| | - E Foglia
- The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Department of Pediatric, Division of Neonatology, Philadelphia, PA, USA
| | - L Dupree Hatch
- Vanderbilt University Medical Center and Vanderbilt University School of Medicine, Department of Pediatric, Division of Neonatology, Nashville, TN, USA
| | - A Moussa
- Université de Montréal, Department of Pediatric, Division of Neonatology, Montréal, QC, Canada
| | - A Ades
- The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Department of Pediatric, Division of Neonatology, Philadelphia, PA, USA
| | - L Johnston
- Yale-New Haven Hospital and Yale School of Medicine, Department of Pediatric, Division of Neonatology, New Haven, CT, USA
| | - A Nishisaki
- The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Department of Pediatric, Division of Neonatology, Philadelphia, PA, USA
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23
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Bruno CJ, Johnston L, Lee C, Bernstein PS, Goffman D. Opinions regarding neonatal resuscitation training for the obstetric physician: a survey of neonatal and obstetric training program directors. J Matern Fetal Neonatal Med 2018; 31:1035-1039. [DOI: 10.1080/14767058.2017.1306052] [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: 10/20/2022]
Affiliation(s)
- C. J. Bruno
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - L. Johnston
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - C. Lee
- Department of Obstetrics & Gynecology and Women’s Health, Columbia Presbyterian Medical Center, New York, NY, USA
| | - P. S. Bernstein
- Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - D. Goffman
- Department of Obstetrics & Gynecology and Women’s Health, Columbia Presbyterian Medical Center, New York, NY, USA
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24
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Miller S, Agarwal A, Haddon WB, Johnston L, Arnold G, Wang W, Abboud RJ. Comparison of gait kinetics in total and unicondylar knee replacement surgery. Ann R Coll Surg Engl 2018; 100:267-274. [PMID: 29484928 PMCID: PMC5958845 DOI: 10.1308/rcsann.2017.0226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to compare kinetical data from gait analysis of patients who have undergone total and uni-condylar knee replacement. Materials and methods Thirteen patients with unilateral total knee arthroplasty (TKA) and 13 unicondylar knee arthroplasty (UKA), were included, all performed by the same surgeon more than one year prior. The Vicon gait analysis system was used. Statistical power was calculated using SPSS. Results No significant difference was found in the spatiotemporal parameters of gait and survival years of the knee prosthesis between the two groups. The UKA group was found to have significantly larger moments than the TKA group in knee adduction on the operated side and knee flexion moment on the unoperated side during the loading phase. The maximum and minimum sagittal plane moments of the operated sides in the TKA group were significantly lower than the unoperated side. The difference was most significant at pre-swing. The maximum and minimum moments on the operated sides in the UKA group were significantly lower for the knee flexion and adduction moments when compared with the unoperated side and were most prevalent during the loading phase. Conclusions These results are relevant in terms of prosthesis wear. The TKA knees had smaller magnitude moments than the UKA knees in the sagittal and coronal planes. This could explain the higher revision rates for UKA. In both groups, the non-operated knees had significantly larger moments than the operated knees, which implies that after unilateral knee replacement of either type, the non-operated knee is being put under greater stress.
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Affiliation(s)
- S Miller
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - A Agarwal
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - WB Haddon
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - L Johnston
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - G Arnold
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - W Wang
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - RJ Abboud
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
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Werner-Seidler A, Johnston L, Christensen H. Digitally-delivered cognitive-behavioural therapy for youth insomnia: A systematic review. Internet Interv 2018; 11:71-78. [PMID: 30135762 PMCID: PMC6084877 DOI: 10.1016/j.invent.2018.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/28/2018] [Accepted: 01/30/2018] [Indexed: 11/26/2022] Open
Abstract
Sleep disturbance is common among young people, with consequences for academic, emotional and behavioural development. Cognitive-behavioural therapy for insomnia (CBT-I) is efficacious, yet it is costly and not available to many who need it. Digitally-delivered CBT-I (eCBT-I) has the potential to overcome these barriers. The purpose of this systematic review was to identify studies which report on the efficacy or effectiveness of eCBT-I for young people with sleep disturbance. Electronic databases were systematically searched and three studies met inclusion criteria. Two studies used the same online intervention for adolescents with insomnia symptoms, while the other was conducted in a college sample of individuals who opted into a stress-management study. Results showed that eCBT-I improved sleep efficiency, sleep quality, sleep-onset latency and total sleep time with effect sizes ranging from 0.17-1.30 (Cohen's d). This suggests that eCBT-I is a promising intervention for young people, but more studies are needed to verify the conditions under which it is most effective.
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Key Words
- Adolescence
- BDI-II, Beck Depression Inventory-II
- CBT-I, Cognitive-behavioural therapy for insomnia
- Cognitive-behavioural therapy
- Insomnia
- PSQI, Pittsburgh Sleep Quality Index
- SE, sleep efficiency
- SOL, sleep onset latency
- SQ, sleep quality
- STAI-S, State-Trait Anxiety Inventory State Version
- Sleep disturbance
- TIB, time in bed
- TST, total sleep time
- WASO, wake after sleep onset
- eCBT-I, digitally-delivered CBT-I
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Werner-Seidler A, O'Dea B, Shand F, Johnston L, Frayne A, Fogarty AS, Christensen H. A Smartphone App for Adolescents With Sleep Disturbance: Development of the Sleep Ninja. JMIR Ment Health 2017; 4:e28. [PMID: 28754651 PMCID: PMC5554352 DOI: 10.2196/mental.7614] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/09/2017] [Accepted: 06/22/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Sleep disturbances are common in young people and have consequences for academic, social, emotional, and behavioral development. The most effective treatment is cognitive behavioral therapy for insomnia (CBT-I), with evidence suggesting that it is efficacious even when delivered digitally. OBJECTIVE There are no commercially available digitally delivered CBT-I programs for use by young people. The aim of this project was to develop a smartphone app that delivers CBT-I to young people to improve sleep. METHODS To inform the development of the app, young people (N=21) aged between 12 and 16 years attended one of the 3 focus groups (each with 4-10 participants). These focus groups were conducted at different stages of the development process such that the process could be iterative. Participants were asked the reasons why they might use an app to help them sleep, the kinds of features or functions that they would like to see in such an app, and any concerns they may have in using the app. Data were analyzed using a thematic analysis approach. Of the issues discussed by the participants, the researchers selected themes associated with content, functionality, and accessibility and user experience to examine, as these were most informative for the app design process. RESULTS In terms of content, young people were interested in receiving information about recommended sleep guidelines and personalized information for their age group. They reported that keeping a sleep diary was acceptable, but they should be able to complete it flexibly, in their own time. They reported mixed views about the use of the phone's accelerometer. Young people felt that the functionality of the app should include elements of game playing if they were to remain engaged with the app. Flexibility of use and personalized features were also desirable, and there were mixed views about the schedule of notifications and reminders. Participants reported that for the app to be accessible and usable, it should be from a trusted developer, have engaging aesthetics, have a layout that is easy to navigate, not rely on Internet coverage, and preferably be free. Participants felt that being able to conceal the purpose of the app from peers was an advantage and were willing to provide personal information to use the app if the purpose and use of that information was made clear. Overall, participants endorsed the use of the app for sleep problems among their age group and reported motivation to use it. CONCLUSIONS The Sleep Ninja is a fully-automated app that delivers CBT-I to young people, incorporating the features and information that young people reported they would expect from this app. A pilot study testing the feasibility, acceptability, and efficacy of the Sleep Ninja is now underway.
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Affiliation(s)
| | - Bridianne O'Dea
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Lara Johnston
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Anna Frayne
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Andrea S Fogarty
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, Australia
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Johnston L, Terp D. SUPPORT IS COMPLICATED: HOW INCREASED SUPPORT AFTER CRITICAL ILLNESS CAN CREATE INCREASED ANXIETY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L. Johnston
- Social Sciences, Cal Poly University, San Luis Obispo, California,
| | - D. Terp
- Curry Senior Center, San Francisco, California
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Cheng L, Tahim A, Ali S, Blanchard J, Johnston L, Leung H, Jones A, Grant C. The use of TissuePatch™, a self-adhesive sealant film to prevent postoperative vascular leakage after thyroid surgery. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.1153] [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: 11/25/2022]
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Cheng L, Tahim A, Ali S, Blanchard J, Johnston L, Leung H, Jones A, Grant C. The use of TissuePatch™, a self-adhesive sealant film to prevent postoperative vascular leakage after head and neck surgery. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Diffin J, Spence K, Naranian T, Badawi N, Johnston L. Stress and distress in parents of neonates admitted to the neonatal intensive care unit for cardiac surgery. Early Hum Dev 2016; 103:101-107. [PMID: 27565126 DOI: 10.1016/j.earlhumdev.2016.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 08/08/2016] [Accepted: 08/08/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Parents of infants admitted to the Neonatal Intensive Care Unit (NICU) are at risk of psychological distress and NICU-related stress. However, parents of infants admitted to NICU for cardiac surgery are an under-researched population. AIMS Identify levels of NICU-related stress, and levels of psychological distress, reported by parents of infants admitted to the NICU for cardiac surgery. STUDY DESIGN Observational study. SUBJECTS 69 parents of infants admitted to the NICU for cardiac surgery (cardiac group) and 142 parents of healthy infants (control group). OUTCOME MEASURES Questionnaire packs provided to parents prior to discharge (time-point 1), and at six and 12months corrected age included: Hospital Anxiety and Depression Scale, Coping Inventory for Stressful Situations, and Family Support Scale. The Parental Stressor Scale:NICU was administered to the cardiac group at time-point 1. RESULTS The cardiac group reported (i) that parental role alteration was the most stressful aspect of the NICU and (ii) higher scores for anxiety and depression than the control group at all three time-points, with the highest levels reported during the NICU stay. Correlation analyses indicated (i) stress associated with the sights and sounds of the NICU, and the appearance and behaviour of the infant in the NICU, had a significant positive association with anxiety and depression, and (ii) a significant negative relationship between anxiety and task-focused coping. CONCLUSIONS An individualised parent-targeted intervention aimed at reducing stress associated with the NICU and enhancing task-focused coping style may help to reduce levels of anxiety and depression within this group of parents.
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Affiliation(s)
- J Diffin
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
| | - K Spence
- Grace Centre for Newborn Care, Children's Hospital Westmead, Sydney, Australia; School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK
| | - T Naranian
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK
| | - N Badawi
- Grace Centre for Newborn Care, Children's Hospital Westmead, Sydney, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - L Johnston
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Dear BF, Staples LG, Terides MD, Fogliati VJ, Sheehan J, Johnston L, Kayrouz R, Dear R, McEvoy PM, Titov N. Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for Social Anxiety Disorder and comorbid disorders: A randomized controlled trial. J Anxiety Disord 2016; 42:30-44. [PMID: 27261562 DOI: 10.1016/j.janxdis.2016.05.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/22/2016] [Accepted: 05/07/2016] [Indexed: 12/14/2022]
Abstract
Disorder-specific (DS-CBT) and transdiagnostic (TD-CBT) cognitive behaviour therapy have both been used to treat social anxiety disorder (SAD). This study compared internet-delivered DS-CBT and TD-CBT for SAD across clinician-guided (CG-CBT) and self-guided (SG-CBT) formats. Participants with SAD (n=233) were randomly allocated to receive internet-delivered TD-CBT or DS-CBT and CG-CBT or SG-CBT. Large reductions in symptoms of SAD (Cohen's d≥1.01; avg. reduction≥30%) and moderate-to-large reductions in symptoms of comorbid depression (Cohen's d≥1.25; avg. reduction≥39%), generalised anxiety disorder (Cohen's d≥0.86; avg. reduction≥36%) and panic disorder (Cohen's d≥0.53; avg. reduction≥25%) were found immediately post-treatment and were maintained or further improved to 24-month follow-up. No marked differences were observed between TD-CBT and DS-CBT or CG-CBT and SG-CBT highlighting the potential of each for the treatment of SAD and comorbid disorders.
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Affiliation(s)
- B F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - L G Staples
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - M D Terides
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - V J Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - J Sheehan
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - L Johnston
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - R Kayrouz
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - R Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - P M McEvoy
- School of Psychology and Speech Pathology, Curtin University, Australia
| | - N Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia.
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Sawyer T, French H, Ades A, Johnston L. Neonatal-perinatal medicine fellow procedural experience and competency determination: results of a national survey. J Perinatol 2016; 36:570-4. [PMID: 26938919 DOI: 10.1038/jp.2016.19] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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] [Received: 08/27/2015] [Revised: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Ensuring that neonatal-perinatal medicine (NPM) fellows attain competency in performing neonatal procedures is a requirement of training-competent neonatologists. STUDY DESIGN A survey of NPM fellows was performed to determine the procedural experience of current fellows, investigate techniques used to track procedural experience and examine the methods programs use to verify procedural competency. RESULTS One hundred and sixty-three fellows in 57 accredited training programs responded to the survey. Reported number of procedures provide contemporary normative data on procedural experience during training. The majority of fellows reported using an online reporting system to track experience. The most common technique to verify procedural competency was supervised practice until an arbitrary number of procedures had been performed. CONCLUSIONS NPM fellow procedural experience increases significantly for most, but not all, procedures duration training. We speculate that supplemental simulation training for rare neonatal procedures would help ensure the competency of graduating NPM fellows. Experience alone is insufficient to verify competency. Further work on the accurate tracking of experience and verification of procedural competency is needed.
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Affiliation(s)
- T Sawyer
- University of Washington School of Medicine, Division of Neonatology, Seattle, WA, USA
| | - H French
- Children's Hospital of Philadelphia, Division of Neonatology, Philadelphia, PA, USA
| | - A Ades
- Children's Hospital of Philadelphia, Division of Neonatology, Philadelphia, PA, USA
| | - L Johnston
- Yale School of Medicine, Division of Neonatology, New Haven, CT, USA
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Gandy M, Fogliati V, Terides M, Johnston L, Nicholson Perry K, Newall C, Titov N, Dear B. Short message service prompts for skills practice in Internet-delivered cognitive behaviour therapy for chronic pain - are they feasible and effective? Eur J Pain 2016; 20:1288-98. [DOI: 10.1002/ejp.853] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2016] [Indexed: 01/24/2023]
Affiliation(s)
- M. Gandy
- eCentreClinic; Department of Psychology; Macquarie University; Sydney NSW Australia
| | - V.J. Fogliati
- eCentreClinic; Department of Psychology; Macquarie University; Sydney NSW Australia
| | - M.D. Terides
- eCentreClinic; Department of Psychology; Macquarie University; Sydney NSW Australia
| | - L. Johnston
- eCentreClinic; Department of Psychology; Macquarie University; Sydney NSW Australia
| | | | - C. Newall
- Institute of Early Childhood; Macquarie University; Sydney NSW Australia
| | - N. Titov
- eCentreClinic; Department of Psychology; Macquarie University; Sydney NSW Australia
| | - B.F. Dear
- eCentreClinic; Department of Psychology; Macquarie University; Sydney NSW Australia
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Alway Y, Gould KR, Johnston L, McKenzie D, Ponsford J. A prospective examination of Axis I psychiatric disorders in the first 5 years following moderate to severe traumatic brain injury. Psychol Med 2016; 46:1331-1341. [PMID: 26867715 DOI: 10.1017/s0033291715002986] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychiatric disorders commonly emerge during the first year following traumatic brain injury (TBI). However, it is not clear whether these disorders soon remit or persist for long periods post-injury. This study aimed to examine, prospectively: (1) the frequency, (2) patterns of co-morbidity, (3) trajectory, and (4) risk factors for psychiatric disorders during the first 5 years following TBI. METHOD Participants were 161 individuals (78.3% male) with moderate (31.2%) or severe (68.8%) TBI. Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV, administered soon after injury and 3, 6 and 12 months, and 2, 3, 4 and 5 years post-injury. Disorder frequencies and generalized estimating equations were used to identify temporal relationships and risk factors. RESULTS In the first 5 years post-injury, 75.2% received a psychiatric diagnosis, commonly emerging within the first year (77.7%). Anxiety, mood and substance-use disorders were the most common diagnostic classes, often presenting co-morbidly. Many (56.5%) experienced a novel diagnostic class not present prior to injury. Disorder frequency ranged between 61.8 and 35.6% over time, decreasing by 27% [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.65-0.83] with each year post-injury. Anxiety disorders declined significantly over time (OR 0.73, 95% CI 0.63-0.84), whilst mood and substance-use disorder rates remained stable. The strongest predictors of post-injury disorder were pre-injury disorder (OR 2.44, 95% CI 1.41-4.25) and accident-related limb injury (OR 1.78, 95% CI 1.03-3.07). CONCLUSIONS Findings suggest the first year post-injury is a critical period for the emergence of psychiatric disorders. Disorder frequency declines thereafter, with anxiety disorders showing greater resolution than mood and substance-use disorders.
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Affiliation(s)
- Y Alway
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences,Monash University,Melbourne,Australia
| | - K R Gould
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences,Monash University,Melbourne,Australia
| | - L Johnston
- Monash-Epworth Rehabilitation Research Centre,Epworth Hospital,Melbourne,Australia
| | - D McKenzie
- Research Development and Governance,Epworth Healthcare,Melbourne,Australia
| | - J Ponsford
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences,Monash University,Melbourne,Australia
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Fogliati VJ, Dear BF, Staples LG, Terides MD, Sheehan J, Johnston L, Kayrouz R, Dear R, McEvoy PM, Titov N. Disorder-specific versus transdiagnostic and clinician-guided versus self-guided internet-delivered treatment for panic disorder and comorbid disorders: A randomized controlled trial. J Anxiety Disord 2016; 39:88-102. [PMID: 27003376 DOI: 10.1016/j.janxdis.2016.03.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [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: 12/08/2015] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 11/19/2022]
Abstract
Transdiagnostic cognitive behaviour therapy (TD-CBT) aims to target the symptoms of multiple disorders whereas disorder-specific CBT (DS-CBT) targets the symptoms of principal disorders. This study compared the relative benefits of internet-delivered TD-CBT and DS-CBT when provided in clinician-guided (CG-CBT) and self-guided (SG-CBT) formats for people with a principal diagnosis of Panic Disorder (PD). Participants (n=145) were randomly allocated to receive TD-CBT or DS-CBT and CG-CBT or SG-CBT. Large reductions in symptoms of PD (Cohen's d ≥ 0.71; avg. reduction ≥ 36%) and moderate-to-large reductions in symptoms of comorbid depression (Cohen's d ≥ 0.71; avg. reduction ≥ 33%), generalised anxiety disorder (Cohen's d ≥ 0.91; avg. reduction ≥ 34%) and social anxiety disorder (Cohen's d ≥ 0.50; avg. reduction ≥ 15%) were found over the 24-month follow-up period. Highlighting their efficacy and acceptability, no marked and consistent differences were observed between TD-CBT and DS-CBT or CG-CBT and DS-CBT.
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Affiliation(s)
- V J Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - B F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia.
| | - L G Staples
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - M D Terides
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - J Sheehan
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - L Johnston
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - R Kayrouz
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - R Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - P M McEvoy
- School of Psychology and Speech Pathology, Curtin University, Australia
| | - N Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
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Johnston L, Chan A, Arieno A, Morgan R, Highnam R, Destounis S. Abstract P6-10-12: Volumetric breast density better predicts tumour characteristics associated with poor prognosis compared to visual BI-RADS. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-10-12] [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: 11/16/2022]
Abstract
Abstract
Purpose:
Early detection of breast cancer through mammography screening reduces breast cancer mortality. To improve outcomes from screening, more than half of invasive cancers and a third of high grade cancers should be small at detection (<15mm), and more than 70% of all cancers should be node negative at diagnosis. Although breast density is associated with reduced mammographic sensitivity, it is unclear whether certain tumor characteristics associated with poorer prognosis are more prevalent in women with denser breasts. The study investigated associations between visually- or volumetrically-assessed breast density and tumor characteristics related to poor prognosis.
Methods:
Our IRB-approved study included 755 DCIS, invasive ductal or invasive lobular breast cancers diagnosed in women (aged over 40) between January 2009 and December 2012. Information on the patients' tumor characteristics including stage, size, receptor, grade and lymph node status was collected retrospectively. Women were excluded if they had a previous history of breast cancer or breast surgery, or if they were missing tumour size data or raw digital mammograms taken within 24 months of the cancer diagnosis. For women with multiple cancers, only the first diagnosed cancer was included. Breast density was assessed using visual BI-RADS density categories and Volpara Density Grades (VDG; an automated equivalent to 4th Edition BI-RADS, assigned using preset cut-offs of volumetric breast density: 4.5, 7.5, 15.5 and >15.5%). VDG was calculated from both breasts if the prior negative mammogram was available, and the contralateral breast for positive mammograms.
Results:
Overall, 55% of invasive tumors and 33% of grade 3 tumors were smaller than 15 mm and 83% were node negative. Mean tumor size increased significantly with increasing VDG (VDG 1 = 12.8, 2 = 14.7, 3 = 16.1, 4 = 20.4 mm, p<0.001) and increasing BI-RADS (1 = 12.2, 2 = 13.9, 3 = 16.8, 4 = 18.2 mm, p=0.01). The proportion of node positive tumors also increased significantly with increasing VDG (5.1%, 12.8%, 19.3%, 26.1%, p<0.001) and BI-RADS (0%, 10.6%, 19.5%, 26%, p=0.01). There was a significant increase in grade 3 tumors (11%, 16.1%, 21.7%, 21.7%, p =0.02) and HER-2 positive tumors (5.6%, 10.5%, 13.3%, 14.3%, p=0.02) with increasing VDG that was not seen with visual BI-RADS assessment (p=0.4). Increasing VDG was also significantly associated with increased proportions of larger (i.e. >15mm) node positive cancers (1.7%, 6.3%, 10.5%, 16%, p=0.004) that were not seen with BI-RADS (p=0.2).
Conclusion:
We found that tumour size and node status differed significantly with breast density as measured by VDG and visual BI-RADS. However, grade 3, HER-2 positive and large/node-positive cancers were all significantly associated with increasing VDG, but not BI-RADS density grade. Further research is needed to investigate whether automated volumetric breast density can be used to predict which women are more likely to be diagnosed with tumours that have poorer prognostic features.
Citation Format: Johnston L, Chan A, Arieno A, Morgan R, Highnam R, Destounis S. Volumetric breast density better predicts tumour characteristics associated with poor prognosis compared to visual BI-RADS. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-10-12.
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Affiliation(s)
- L Johnston
- Volpara Solutions, Wellington, New Zealand; Elizabeth Wende Breast Care, Rochester, NY
| | - A Chan
- Volpara Solutions, Wellington, New Zealand; Elizabeth Wende Breast Care, Rochester, NY
| | - A Arieno
- Volpara Solutions, Wellington, New Zealand; Elizabeth Wende Breast Care, Rochester, NY
| | - R Morgan
- Volpara Solutions, Wellington, New Zealand; Elizabeth Wende Breast Care, Rochester, NY
| | - R Highnam
- Volpara Solutions, Wellington, New Zealand; Elizabeth Wende Breast Care, Rochester, NY
| | - S Destounis
- Volpara Solutions, Wellington, New Zealand; Elizabeth Wende Breast Care, Rochester, NY
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Dear BF, Staples LG, Terides MD, Karin E, Zou J, Johnston L, Gandy M, Fogliati VJ, Wootton BM, McEvoy PM, Titov N. Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for generalized anxiety disorder and comorbid disorders: A randomized controlled trial. J Anxiety Disord 2015; 36:63-77. [PMID: 26460536 DOI: 10.1016/j.janxdis.2015.09.003] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/25/2015] [Accepted: 09/07/2015] [Indexed: 11/29/2022]
Abstract
Generalized anxiety disorder (GAD) can be treated effectively with either disorder-specific cognitive behavior therapy (DS-CBT) or transdiagnostic CBT (TD-CBT). The relative benefits of DS-CBT and TD-CBT for GAD and the relative benefits of delivering treatment in clinician guided (CG-CBT) and self-guided (SG-CBT) formats have not been examined. Participants with GAD (n=338) were randomly allocated to receive an internet-delivered TD-CBT or DS-CBT intervention delivered in either CG-CBT or SG-CBT formats. Large reductions in symptoms of GAD (Cohen's d ≥ 1.48; avg. reduction ≥ 50%) and comorbid major depressive disorder (Cohen's d ≥ 1.64; avg. reduction ≥ 45%), social anxiety disorder (Cohen's d ≥ 0.80; avg. reduction ≥ 29%) and panic disorder (Cohen's d ≥ 0.55; avg. reduction ≥ 33%) were found across the conditions. No substantive differences were observed between DS-CBT and TD-CBT or CG-CBT and SG-CBT, highlighting the public health potential of carefully developed TD-CBT and SG-CBT.
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Affiliation(s)
- B F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia.
| | - L G Staples
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - M D Terides
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - E Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - J Zou
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - L Johnston
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - M Gandy
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - V J Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - B M Wootton
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia; School of Medicine (Psychology), University of Tasmania, Tasmania, Australia
| | - P M McEvoy
- School of Psychology and Speech Pathology, Curtin University, Western Australia, Australia
| | - N Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
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Turner C, Bushby K, Johnston L, Lochmüller H, Riess O, Wirth B, Straub V, Thompson R, van Ommen G. Collaboration in NeurOmics: Enabling effective data-sharing and maximising impact in neuromuscular disease. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.400] [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: 10/23/2022]
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Titov N, Dear BF, Staples LG, Terides MD, Karin E, Sheehan J, Johnston L, Gandy M, Fogliati VJ, Wootton BM, McEvoy PM. Disorder-specific versus transdiagnostic and clinician-guided versus self-guided treatment for major depressive disorder and comorbid anxiety disorders: A randomized controlled trial. J Anxiety Disord 2015; 35:88-102. [PMID: 26422822 DOI: 10.1016/j.janxdis.2015.08.002] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [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: 05/27/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 01/29/2023]
Abstract
Disorder-specific cognitive behavior therapy (DS-CBT) is effective at treating major depressive disorder (MDD) while transdiagnostic CBT (TD-CBT) addresses both principal and comorbid disorders by targeting underlying and common symptoms. The relative benefits of these two models of therapy have not been determined. Participants with MDD (n=290) were randomly allocated to receive an internet delivered TD-CBT or DS-CBT intervention delivered in either clinician-guided (CG-CBT) or self-guided (SG-CBT) formats. Large reductions in symptoms of MDD (Cohen's d≥1.44; avg. reduction≥45%) and moderate-to-large reductions in symptoms of comorbid generalised anxiety disorder (Cohen's d≥1.08; avg. reduction≥43%), social anxiety disorder (Cohen's d≥0.65; avg. reduction≥29%) and panic disorder (Cohen's d≥0.45; avg. reduction≥31%) were found. No marked or consistent differences were observed across the four conditions, highlighting the efficacy of different forms of CBT at treating MDD and comorbid disorders.
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Affiliation(s)
- N Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - B F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia.
| | - L G Staples
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - M D Terides
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - E Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - J Sheehan
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - L Johnston
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - M Gandy
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - V J Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - B M Wootton
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia; School of Medicine (Psychology), University of Tasmania, Tasmania, Australia
| | - P M McEvoy
- School of Psychology and Speech Pathology, Curtin University, Australia
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Anderson UA, Carson C, Johnston L, Joshi S, Gurney AM, McCloskey KD. Functional expression of KCNQ (Kv7) channels in guinea pig bladder smooth muscle and their contribution to spontaneous activity. Br J Pharmacol 2014; 169:1290-304. [PMID: 23586426 PMCID: PMC3746117 DOI: 10.1111/bph.12210] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 03/15/2013] [Accepted: 03/26/2013] [Indexed: 12/30/2022] Open
Abstract
Background and Purpose The aim of the study was to determine whether KCNQ channels are functionally expressed in bladder smooth muscle cells (SMC) and to investigate their physiological significance in bladder contractility. Experimental Approach KCNQ channels were examined at the genetic, protein, cellular and tissue level in guinea pig bladder smooth muscle using RT-PCR, immunofluorescence, patch-clamp electrophysiology, calcium imaging, detrusor strip myography, and a panel of KCNQ activators and inhibitors. Key Results KCNQ subtypes 1–5 are expressed in bladder detrusor smooth muscle. Detrusor strips typically displayed TTX-insensitive myogenic spontaneous contractions that were increased in amplitude by the KCNQ channel inhibitors XE991, linopirdine or chromanol 293B. Contractility was inhibited by the KCNQ channel activators flupirtine or meclofenamic acid (MFA). The frequency of Ca2+-oscillations in SMC contained within bladder tissue sheets was increased by XE991. Outward currents in dispersed bladder SMC, recorded under conditions where BK and KATP currents were minimal, were significantly reduced by XE991, linopirdine, or chromanol, and enhanced by flupirtine or MFA. XE991 depolarized the cell membrane and could evoke transient depolarizations in quiescent cells. Flupirtine (20 μM) hyperpolarized the cell membrane with a simultaneous cessation of any spontaneous electrical activity. Conclusions and Implications These novel findings reveal the role of KCNQ currents in the regulation of the resting membrane potential of detrusor SMC and their important physiological function in the control of spontaneous contractility in the guinea pig bladder.
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Affiliation(s)
- U A Anderson
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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Abstract
Matching the number of surgeons to the demands for orthopedic services has been notoriously difficult. Not only does one need to evaluate current trends in the supply and provision of services but anticipate the impact of future reforms on these variables. The British Orthopaedic Association has aspired to provide consultant to population ratio of 1:15,000 by 2020. Currently, the orthopedic community is tasked with providing care for an aging population with soaring levels of obesity; with both of these factors set to grow and also with an overall decline in productivity. Orthopedic surgeons must brace themselves for an explosion in demand. At the same time, a paradigm shift has occurred in the delivery of services with the creation of specialist centers. We are amidst a generational shift in the demographics and psychology of the orthopedic workforce. The orthopedic community must be aware of the effects of these far-reaching changes when tailoring the supply of surgeons for the future needs.
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Affiliation(s)
- S Khan
- Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
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Legge C, Al-Sinan A, Holley A, Johnston L, Larsen P, Harding S. Does timing of platelet function testing (PFT) contribute to variability in residual on-treatment platelet reactivity in patients with acute coronary syndrome (ACS)? Heart Lung Circ 2014. [DOI: 10.1016/j.hlc.2014.04.205] [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: 10/25/2022]
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Hally K, Johnston L, Holley A, Larsen P, Harding S. Platelet count and platelet function testing in acute coronary syndromes. Heart Lung Circ 2014. [DOI: 10.1016/j.hlc.2014.04.192] [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: 10/25/2022]
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Middleditch D, Scott B, Simmonds M, Aitken A, Johnston L, Larsen P, Harding S. Temporary and permanent discontinuation of clopidogrel following acute coronary syndromes. Heart Lung Circ 2014. [DOI: 10.1016/j.hlc.2014.04.166] [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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Mataseje LF, Boyd DA, Lefebvre B, Bryce E, Embree J, Gravel D, Katz K, Kibsey P, Kuhn M, Langley J, Mitchell R, Roscoe D, Simor A, Taylor G, Thomas E, Turgeon N, Mulvey MR, Boyd D, Bryce E, Conly J, Deheer J, Embil J, Embree J, Evans G, Forgie S, Frenette C, Lemieux C, Golding G, Gravel D, Henderson E, Hutchinson J, John M, Johnston L, Katz K, Kibsey P, Kuhn M, Langley J, Lesaux N, Loeb M, Matlow A, McGeer A, Miller M, Mitchell R, Moore D, Mounchili A, Mulvey M, Pelude L, Roth V, Simor A, Suh K, Taylor G, Thomas E, Turgeon N, Vearncombe M, Vayalumkal J, Weiss K, Wong A. Complete sequences of a novel blaNDM-1-harbouring plasmid from Providencia rettgeri and an FII-type plasmid from Klebsiella pneumoniae identified in Canada. J Antimicrob Chemother 2013; 69:637-42. [DOI: 10.1093/jac/dkt445] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [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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Adamson C, Johnston L, Mareels I, Toga A, Huang X, Egan G. 3D model-based approach to identification of laminar structures of the cerebral cortex: Application to Brodmann areas 17 and 18. Biomed Signal Process Control 2013. [DOI: 10.1016/j.bspc.2013.08.005] [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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Liu A, Meyer E, Johnston L, Brown J, Gerson LB. Prevalence of graft versus host disease and cytomegalovirus infection in patients post-haematopoietic cell transplantation presenting with gastrointestinal symptoms. Aliment Pharmacol Ther 2013; 38:955-66. [PMID: 24003975 DOI: 10.1111/apt.12468] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 07/18/2013] [Accepted: 08/09/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is lack of consensus regarding whether both upper and lower endoscopic examinations are required for diagnosis of gastrointestinal acute graft versus host disease (GI-AGVHD). AIM To evaluate the impact of endoscopic procedures on the diagnosis of GI-AGVHD. METHODS We performed a retrospective case-control study of recipients of allogeneic haematopoetic cell transplant (HCT) from 2000 to 2011, who presented with GI symptoms between 20 and 125 days post-HCT. GI-AGVHD status was based on the National Institutes of Health (NIH) clinical grading system. RESULTS One hundred and twenty-nine clinical GI-AGVHD cases and 184 controls underwent endoscopic examinations. Diarrhoea was present in 73% of cases and 38% of controls (P < 0.0001); 99% of patients with nausea ± vomiting and diarrhoea underwent bidirectional endoscopy. Histology had a sensitivity of 92% and specificity of 91% compared to the clinical criteria. The sensitivity for GI-AGVHD was 80% or greater when upper endoscopy (EGD) was performed with either sigmoidoscopy or colonoscopy, or if lower endoscopic examinations were performed alone. The sensitivity of EGD alone was only 48% (P = 0.003). Sensitivity was highest with biopsy of the terminal ileum (79%), followed by the ascending (74%), transverse/descending (73%) and sigmoid colons (69%). Diagnostic yield for cytomegalovirus (CMV) infection was equivalent for biopsies from both upper and lower GI tracts. Patients found to have concurrent GI-AGVHD and CMV infection (N = 18) had a poorer overall prognosis. CONCLUSION In patients post-HCT with GI symptoms, sigmoidoscopy alone had equivalent diagnostic yield for GI-AGVHD and CMV infection, compared with the addition of EGD or performance of full colonoscopy.
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Affiliation(s)
- A Liu
- Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
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Johnston L, Bennani A, Latifi A, Oumzil H, Omari BE, Rhoufrani FE, Ouarsas L, Alami K, rhilani HE. P3.105 Using Respondent-Driven Sampling to Estimate HIV and Syphilis Prevalence Among Female Sex Workers in Agadir, Fes, Rabat and Tangier, Morocco. Sex Transm Infect 2013. [DOI: 10.1136/sextrans-2013-051184.0564] [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] Open
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Plunkett S, Johnston L, Holley A, Matsis P, Larsen P, Harding S. Variation in Platelet Reactivity due to Severity of Diabetes in Patients with Acute Coronary Syndrome (ACS). Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.04.059] [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: 11/24/2022]
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