1
|
Pourzinal D, Yang J, McMahon KL, Copland DA, Mitchell L, O'Sullivan JD, Byrne GJ, Dissanayaka NN. Hippocampal resting-state connectivity is associated with posterior-cortical cognitive impairment in Parkinson's disease. Brain Behav 2024; 14:e3454. [PMID: 38468574 DOI: 10.1002/brb3.3454] [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] [Received: 09/16/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 03/13/2024] Open
Abstract
AIM Frontal and posterior-cortical cognitive subtypes in Parkinson's disease (PD) present with executive/attention and memory/visuospatial deficits, respectively. As the posterior-cortical subtype is predicted to progress rapidly toward dementia, the present study aimed to explore biological markers of this group using resting-state functional magnetic resonance imaging (rs-fMRI). METHODS K-means cluster analysis delineated subtypes (cognitively intact, frontal, posterior-cortical, and globally impaired) among 85 people with PD. A subset of PD participants (N = 42) and 20 healthy controls (HCs) underwent rs-fMRI. Connectivity of bilateral hippocampi with regions of interest was compared between posterior-cortical, cognitively intact, and HC participants using seed-based analysis, controlling for age. Exploratory correlations were performed between areas of interest from the group analysis and a series of cognitive tests. RESULTS The posterior-cortical subtype (N = 19) showed weaker connectivity between the left hippocampus and right anterior temporal fusiform cortex compared to the cognitively intact (N = 11) group, p-false discovery rate (FDR) = .01, and weaker connectivity between bilateral hippocampi and most fusiform regions compared to HCs (N = 20). No differences were found between HCs and cognitively intact PD. Exploratory analyses revealed strongest associations between connectivity of the right anterior temporal fusiform cortex and left hippocampus with category fluency (p-FDR = .01). CONCLUSION Results suggest that weakened connectivity between the hippocampus and fusiform region is a unique characteristic of posterior-cortical cognitive deficits in PD. Further exploration of hippocampal and fusiform functional integrity as a marker of cognitive decline in PD is warranted.
Collapse
Affiliation(s)
- Dana Pourzinal
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, Australia
| | - Jihyun Yang
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Leander Mitchell
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - John D O'Sullivan
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Gerard J Byrne
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, Australia
- Mental Health Service, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Nadeeka N Dissanayaka
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, Australia
- School of Psychology, The University of Queensland, St Lucia, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Australia
| |
Collapse
|
2
|
Pourzinal D, Yang J, Sivakumaran K, McMahon KL, Mitchell L, O'Sullivan JD, Byrne GJ, Dissanayaka NN. Longitudinal follow up of data-driven cognitive subtypes in Parkinson's disease. Brain Behav 2023; 13:e3218. [PMID: 37574595 PMCID: PMC10570472 DOI: 10.1002/brb3.3218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023] Open
Abstract
AIM The dual syndrome hypothesis proposes that there are two cognitive subtypes in Parkinson's disease (PD): a frontal subtype with executive/attention impairment and gradual cognitive decline, and a posterior-cortical subtype with memory/visuospatial deficits and rapid cognitive decline. We aimed to compare the rate of global cognitive decline between subtypes derived using data-driven methods and explore their longitudinal performance within specific cognitive domains to better understand the prognosis of each subtype. METHOD Frontal, posterior-cortical, globally impaired, and cognitively intact PD subtypes were identified at baseline using k-means clustering (N = 85), and 29 participants (34%) returned for follow-up assessments on average 4.87 years from baseline. Linear mixed effects models compared progression of subtypes on global cognition; psychological symptoms; parkinsonism; and the memory, attention, executive, language, and visuospatial cognitive domains. RESULTS The frontal subtype was lost to attrition. While rate of change in parkinsonism, anxiety, and apathy differed between subtypes, there was no difference in the rate of global cognitive decline. However, the posterior-cortical subtype declined most rapidly in verbal memory, card sorting, trail making, and judgement of line orientation (JLO), while the cognitively intact group declined most rapidly on verbal memory and semantic fluency. The globally impaired subtype declined most rapidly in JLO, although this should be interpreted with caution due to high attrition. CONCLUSION Despite limited sample size, the present study supports the differential progression of the posterior-cortical subtype compared to cognitively intact and globally impaired PD. These results encourage further, large-scale longitudinal investigations of cognitive subtypes in PD.
Collapse
Affiliation(s)
- Dana Pourzinal
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
| | - Jihyun Yang
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
| | - Kumareshan Sivakumaran
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
| | - Katie L. McMahon
- School of Clinical Sciences, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
| | - Leander Mitchell
- School of PsychologyThe University of QueenslandSt. LuciaAustralia
| | - John D. O'Sullivan
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
- Department of NeurologyRoyal Brisbane and Women's HospitalHerstonQLDAustralia
| | - Gerard J. Byrne
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
- Mental Health ServiceRoyal Brisbane and Women's HospitalHerstonQLDAustralia
| | - Nadeeka N. Dissanayaka
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
- School of PsychologyThe University of QueenslandSt. LuciaAustralia
- Department of NeurologyRoyal Brisbane and Women's HospitalHerstonQLDAustralia
| |
Collapse
|
3
|
Shim J, Pavlova AV, Moss RA, MacLean C, Brandie D, Mitchell L, Greig L, Parkinson E, Tzortziou Brown V, Morrissey D, Alexander L, Cooper K, Swinton PA. Patient ratings in exercise therapy for the management of tendinopathy: a systematic review with meta-analysis. Physiotherapy 2023; 120:78-94. [PMID: 37406460 DOI: 10.1016/j.physio.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/26/2023] [Accepted: 05/26/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To synthesise exercise therapy intervention data investigating patient rating outcomes for the management of tendinopathy. DESIGN A systematic review and meta-analysis of randomized controlled trials investigating exercise therapy interventions and reporting patient rating outcomes. SETTING Any setting in any country listed as very high on the human development index. PARTICIPANTS People with a diagnosis of any tendinopathy of any severity or duration. INTERVENTIONS Exercise therapy for the management of tendinopathy comprising five different therapy classes: 1) resistance; 2) plyometric; 3) vibration; 4) flexibility, and 5) movement pattern retraining modalities, were considered for inclusion. MAIN OUTCOME MEASURES Outcomes measuring patient rating of condition, including patient satisfaction and Global Rating of Change (GROC). RESULTS From a total of 124 exercise therapy studies, 34 (Achilles: 41%, rotator cuff: 32%, patellar: 15%, elbow: 9% and gluteal: 3%) provided sufficient information to be meta-analysed. The data were obtained across 48 treatment arms and 1246 participants. The pooled estimate for proportion of satisfaction was 0.63 [95%CrI: 0.53-0.73], and the pooled estimate for percentage of maximum GROC was 53 [95%CrI: 38-69%]. The proportion of patients reporting positive satisfaction and perception of change increased with longer follow-up periods from treatment onset. CONCLUSION Patient satisfaction and GROC appear similar and are ranked moderately high demonstrating that patients generally perceive exercise therapies positively. Further research including greater consistency in measurement tools is required to explore and where possible, identify patient- and exercise-related moderating factors that can be used to improve person-centred care. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO ID=CRD42020168187 CONTRIBUTION OF PAPER.
Collapse
Affiliation(s)
- J Shim
- School of Health Sciences, Robert Gordon University, Aberdeen, UK.
| | - A V Pavlova
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - R A Moss
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - C MacLean
- Library Services, Robert Gordon University, Aberdeen, UK
| | - D Brandie
- Sportscotland Institute of Sport, Stirling, UK
| | | | - L Greig
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - E Parkinson
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - V Tzortziou Brown
- Wolfson Institute of Population Health, Queen Mary University of London, UK
| | - D Morrissey
- William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - L Alexander
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - K Cooper
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - P A Swinton
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| |
Collapse
|
4
|
Dissanayaka N, Brooks D, Worthy P, Mitchell L, Pachana NA, Byrne G, Keramat SA, Comans T, Bennett S, Liddle J, Chatfield MD, Broome A, Oram J, Appadurai K, Beattie E, Au T, King T, Welsh K, Pietsch A. A single-blind, parallel-group randomised trial of a Technology-assisted and remotely delivered Cognitive Behavioural Therapy intervention (Tech-CBT) versus usual care to reduce anxiety in people with mild cognitive impairment and dementia: study protocol for a randomised trial. Trials 2023; 24:420. [PMID: 37340492 DOI: 10.1186/s13063-023-07381-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/16/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Anxiety is commonly experienced by people living with mild cognitive impairment (MCI) and dementia. Whilst there is strong evidence for late-life anxiety treatment using cognitive behavioural therapy (CBT) and delivery via telehealth, there is little evidence for the remote delivery of psychological treatment for anxiety in people living with MCI and dementia. This paper reports the protocol for the Tech-CBT study which aims to investigate the efficacy, cost-effectiveness, usability and acceptability of a technology-assisted and remotely delivered CBT intervention to enhance delivery of anxiety treatment for people living with MCI and dementia of any aetiology. METHODS A hybrid II single-blind, parallel-group randomised trial of a Tech-CBT intervention (n = 35) versus usual care (n = 35), with in-built mixed methods process and economic evaluations to inform future scale-up and implementation into clinical practice. The intervention (i) consists of six weekly sessions delivered by postgraduate psychology trainees via telehealth video-conferencing, (ii) incorporates voice assistant app technology for home-based practice, and (iii) utilises a purpose-built digital platform, My Anxiety Care. The primary outcome is change in anxiety as measured by the Rating Anxiety in Dementia scale. Secondary outcomes include change in quality of life and depression, and outcomes for carers. The process evaluation will be guided by evaluation frameworks. Qualitative interviews will be conducted with a purposive sample of participants (n = 10) and carers (n = 10), to evaluate acceptability and feasibility, as well as factors influencing participation and adherence. Interviews will also be conducted with therapists (n = 18) and wider stakeholders (n = 18), to explore contextual factors and barriers/facilitators to future implementation and scalability. A cost-utility analysis will be undertaken to determine the cost-effectiveness of Tech-CBT compared to usual care. DISCUSSION This is the first trial to evaluate a novel technology-assisted CBT intervention to reduce anxiety in people living with MCI and dementia. Other potential benefits include improved quality of life for people with cognitive impairment and their care partners, improved access to psychological treatment regardless of geographical location, and upskilling of the psychological workforce in anxiety treatment for people living with MCI and dementia. TRIAL REGISTRATION This trial has been prospectively registered with ClinicalTrials.gov: NCT05528302 [September 2, 2022].
Collapse
Affiliation(s)
- Nadeeka Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia.
| | - Deborah Brooks
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Peter Worthy
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Leander Mitchell
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Nancy A Pachana
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Gerard Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Metro North Hospital and Health Services, Brisbane, Australia
| | - Syed Afroz Keramat
- Centre for Health services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Tracy Comans
- Centre for Health services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sally Bennett
- School of Rehabilitation and Behavioural Science, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Jacki Liddle
- School of Rehabilitation and Behavioural Science, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
- Metro South Hospital and Health Services, Brisbane, Australia
| | - Mark D Chatfield
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Annette Broome
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
- Metro South Hospital and Health Services, Brisbane, Australia
| | - Joanne Oram
- Metro South Hospital and Health Services, Brisbane, Australia
| | | | - Elizabeth Beattie
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Tiffany Au
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Teagan King
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Kimberley Welsh
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Ann Pietsch
- Consumer and Community Involvement Group, UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| |
Collapse
|
5
|
Yang J, Pourzinal D, Byrne GJ, McMahon KL, Copland DA, O'Sullivan JD, Mitchell L, Dissanayaka NN. Global assessment, cognitive profile, and characteristics of mild cognitive impairment in Parkinson's disease. Int J Geriatr Psychiatry 2023; 38:e5955. [PMID: 37318156 DOI: 10.1002/gps.5955] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cognitive deficits are evident throughout the course of Parkinson's disease (PD), with 24% of patients experiencing subtle cognitive disturbances at the time of diagnosis, and with up to 80% of patients developing PD dementia (PDD) at advanced stages of the disease PD patients with mild cognitive impairment (MCI), an at-risk phenotype of PDD, present with heterogeneous clinical characteristics that complicate the management of PD. OBJECTIVES This study aims to examine the characteristics of PD-MCI by using the Movement Disorder Society (MDS) diagnostic criteria and evaluate the validity of global cognitive scales in identifying PD-MCI. METHODS Seventy-nine (79) PD patients completed neuropsychological assessments and a comprehensive cognitive battery. PD-MCI was classified according to the level 2 MDS task force criteria. Mini-Mental State Examination (sMMSE), Montreal Cognitive Assessment (MoCA) and Parkinson's Disease Cognitive Rating Scale (PDCRS) were examined against a level 2 dichotomised PD-MCI diagnosis. Characteristics of PD-MCI were evaluated using logistic regression analysis. RESULTS Twenty-seven patients met criteria for PD-MCI (34%). The MoCA and PDCRS demonstrated high validity to screen for PD-MCI. Impairments in multiple cognitive domains were observed in 77.8% of PD-MCI patients. There were significantly more males in the PD-MCI group compared to PD patients without MCI (p < 0.01). CONCLUSIONS PD patients with MCI exhibited impairments in the attention/working memory, executive function and memory domains. Heterogeneous cognitive characteristics in PD warrant further investigation into specific cognitive subtypes to advance understanding and effective evaluation of PD-MCI.
Collapse
Affiliation(s)
- Jihyun Yang
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Dana Pourzinal
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Mental Health Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David A Copland
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - John D O'Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Leander Mitchell
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| |
Collapse
|
6
|
McCall R, Anderton L, Mitchell L. 1287 THE VALUE OF A MULTIDISCIPLINARY TEAM (MDT) IN MANAGING PATIENTS WITH COMPLEX OR UNEXPLAINED SYNCOPE. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.072] [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: 01/18/2023] Open
Abstract
Abstract
Introduction
Syncope is a common clinical problem with a lifetime prevalence of 20%.1 Syncope shares clinical features with other disorders including seizures, metabolic disturbances and sleep disorders.2 The assessment and management of syncope can be challenging. The syncope service at the QEUH is run by geriatricians and cardiologists with an interest in syncope. Although MDTs are recognised key components in contemporary patient care in areas such as heart failure and cancer management, there is no guidance on MDT working in syncope management.3/4 In November 2017, a syncope MDT was introduced at the QEUH involving cardiologists, geriatricians, a neurologist and cardiac physiologists. This in-person MDT occurs monthly with outcomes recorded on electronic medical records in addition to a database. The aim of this review was to understand the potential impact of the MDT on diagnostic yield and time to further investigation or management.
Method
A retrospective case note analysis was performed for patients reviewed at the Syncope MDT between November 2017 and December 2021.
Results
103 patients were discussed with an average age of 64 years. The main reason for referral was cardiology specialist advice (65%), neurology specialist advice (19.4%) and complex case review (13.6%). After MDT discussion, the percentage of patients with unexplained TLoC reduced from 26.2% to 14.6% without requirement for additional investigations. 8.7% of patients were started on anti-epileptic medication prior to outpatient neurology review after a diagnosis of seizure disorder was established and 23.1% of patients were streamlined for pacemaker or ILR insertion.
Conclusion
Introduction of a syncope MDT reduces unexplained syncope rates in complex patients, streamlines investigations, reduces the need for multi-speciality outpatient reviews and allows earlier introduction of anti-epileptic medication for those with a new seizure disorder. These benefits improve the patient experience by reducing time to diagnosis and treatment.
Collapse
Affiliation(s)
- R McCall
- Queen Elizabeth University Hospital
| | | | | |
Collapse
|
7
|
May GP, Bennett LA, Loughrey JP, Littlewood N, Mitchell L. 1288 IMPROVING STAFF AWARENESS OF FRAILTY IN THE EMERGENCY DEPARTMENT: A MULTI-DISCIPLINARY QUALITY IMPROVEMENT PROJECT. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.109] [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: 01/17/2023] Open
Abstract
Abstract
Introduction
Comprehensive Geriatric Assessment (CGA) improves outcomes for frail older adults in acute hospitals. Patients aged 75 and over admitted into the Emergency Department (ED) at the QEUH will automatically generate a “frailty icon” on their electronic record. The number of frail people accessing emergency care is increasing. This Healthcare Improvement Scotland (HIS) frailty tool prompts staff to assess for frailty and refer to the local Frailty Pathway if appropriate. We designed a multidisciplinary quality improvement project (QIP) to increase completion of the frailty icon and the number of referrals to the frailty service from the ED.
Methods
Both medical and nursing staff in the ED were targeted for intervention. Weekly data was collected on the percentage of patients aged 75 and above who were discharged from the ED with a “frailty icon” completed over a 3-month period. Our main intervention was to hold a frailty awareness month. This involved multiple sub-interventions such as; announcements at handovers, e-mails, word-of-mouth, and posters.
Results
The weekly percentage of completed “frailty icons” increased from 28% 2 weeks pre-intervention (n = 283) to 48% in 1 month (n = 258). A peak of 57% (n = 293) completed icons was achieved immediately after our intervention. These increases were then sustained for a further 6 weeks with a weekly average baseline of 45.2% completion (average n = 281). Increased “frailty icon” completion in the ED led to a 100% increase in referrals to the frailty pathway.
Conclusion
Increasing awareness of frailty amongst ED staff results in increased front door assessment for frailty, and subsequent referral to the frailty team. This allows for more patients to receive a CGA. Multidisciplinary QIPs utilise the skills of diverse staff groups to best achieve sustainable change.
Collapse
Affiliation(s)
- G P May
- Queen Elizabeth University Hospital (QEUH) Emergency Department, , Glasgow
| | - L A Bennett
- Queen Elizabeth University Hospital (QEUH) Emergency Department, , Glasgow
| | - J P Loughrey
- Queen Elizabeth University Hospital (QEUH) Emergency Department, , Glasgow
| | - N Littlewood
- Queen Elizabeth University Hospital (QEUH) Emergency Department, , Glasgow
| | - L Mitchell
- QEUH Department of Medicine for the Elderly, , Glasgow
| |
Collapse
|
8
|
Channick R, Chin KM, Kim NH, Ong R, Turricchia S, Mitchell L, McLaughlin VV. Concomitant initiation of combination therapy with macitentan and tadalafil in pulmonary arterial hypertension (PAH) patients with comorbidities: real-world data from OPUS and OrPHeUS. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Guidelines for the management of pulmonary arterial hypertension (PAH) recommend early combination therapy of an endothelial receptor antagonist (ERA) and a phosphodiesterase type-5 inhibitor (PDE5i) [1]. There is, however, limited guidance about the management of PAH patients with comorbidities.
Purpose
To describe the demographics, clinical characteristics, safety, tolerability, and outcomes associated with initiation of the ERA macitentan and the PDE5i tadalafil in patients with comorbidities in the US OPsumit® USers (OPUS) and the OPsumit® Historical USers cohort (OrPHeUS) combined dataset.
Methods
This analysis reports data from the OPUS registry (Apr 2014–Jun 2020) and OrPHeUS medical chart review (Oct 2013–Mar 2017) on PAH patients initiating macitentan and tadalafil (M+T) combination therapy, in any order, as concomitant initiation (≤60 days apart, concomitant initiation group). The index date was defined as the start date of the second therapy (i.e., the start of combination therapy). Patients were further grouped by the number of comorbidities present prior to or at macitentan initiation: systemic hypertension, diabetes, renal insufficiency, BMI ≥30 kg/m2, other signs of right heart failure and atrial fibrillation. Results are presented descriptively alongside results for all PAH patients receiving M+T combination therapy (overall M+T group).
Results
Of the 1336 PAH patients that received M+T combination therapy, 431 (32%) were in the concomitant initiation group. In the concomitant initiation and overall M+T groups, respectively: 72% and 68% had ≥1 comorbidity, and the most common were systemic hypertension (47% and 47%), obesity (32% and 26%) and diabetes (23% and 22%). Patients were more likely to be older, male and have idiopathic/heritable PAH with increasing comorbidity burden (Table 1). Patients in the concomitant initiation group were more likely to be incident (median time from diagnosis: 1–2 months vs 9–24 months in the overall M+T group; Table 1). Most patients had ≥1 adverse event (AE); in both groups, patients with a high comorbidity burden (≥3) were more likely to have had an AE and to have discontinued treatment (Table 2). The incidence rate of first all-cause hospitalisation and mortality by comorbidity was comparable between the concomitant initiation and overall M+T groups.
Conclusions
In the real-world, concomitant initiation of M+T is used in PAH patients with comorbidities, usually shortly after diagnosis. Patient characteristics were similar for the concomitant initiation and overall M+T groups, with the exception of time from diagnosis. At index date, age, gender proportion, and PAH aetiology differed between the comorbidity groups. The safety profile of M+T combination therapy in the concomitant initiation group was consistent with that in the overall M+T group.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson
Collapse
Affiliation(s)
- R Channick
- University of California Los Angeles , Los Angeles , United States of America
| | - K M Chin
- University of Texas Southwestern Medical Center , Dallas , United States of America
| | - N H Kim
- University of California San Diego , San Diego , United States of America
| | - R Ong
- Actelion Pharmaceuticals Ltd , Allschwil , Switzerland
| | - S Turricchia
- Actelion Pharmaceuticals Ltd , Allschwil , Switzerland
| | - L Mitchell
- Actelion Pharmaceuticals Ltd , Allschwil , Switzerland
| | - V V McLaughlin
- University of Michigan , Ann Arbor , United States of America
| |
Collapse
|
9
|
Dewa L, Pappa S, Mitchell L, Hadley M, Cooke J, Aylin P. Reflections, impact and recommendations of a co-produced ecological momentary assessment (EMA) study with young people who have experience of suicidality and psychiatric inpatient care. Eur Psychiatry 2022. [PMCID: PMC9566421 DOI: 10.1192/j.eurpsy.2022.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Patient and public involvement (PPI) in suicide research is ethical, moral and can deliver impact. However, inconsistent reporting of meaningful PPI, and hesitancy in sharing power with people with experience of suicidality (i.e.co-researchers) in research makes it difficult to understand the full potential impact of PPI on the research, researchers and co-researchers. Objectives To describe how our ecological momentary assessment (EMA) study, examining the sleep-suicide relationship in young psychiatric inpatients (aged 18-35) transitioning to the community, has been co-produced, whilst reflecting on impact, challenges, and recommendations. Methods We built on our experience of co-produced mental health research to conduct meaningful PPI in our study. Young adults with experience of psychiatric inpatient care and suicidality were appointed November 2020 to work across all research stages. Reflections on challenges, recommendations and impact have been collected throughout. Results Three young people became co-researchers. Researcher and co-researcher reflections indicated establishing and maintaining safe environments for open discussion, and continued communication (e.g.WhatsApp group) were vital to effectively share power and decision making. Safeguarding and support requirements for both co-researchers (e.g.individualised strategy) and researcher (e.g.clinical supervision) were particularly evident. To date, the co-produced recruitment poster, research documentation, and research article have demonstrated significant impact. Conclusions This is the first EMA study focused on suicide-sleep during transitions to be co-produced with young people with experience of suicidality. Co-producing suicide research is intensive, time-consuming, and challenging but makes a significant impact to the research, researchers, and co-researchers. We expect our learning will directly influence, and help others produce, meaningful co-produced suicide research. Disclosure No significant relationships.
Collapse
|
10
|
Arnott A, Reid G, Godwin J, Anderton L, Mitchell L. 677 UTILITY OF 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING (ABPM) IN PATIENTS WITH ORTHOSTATIC HYPOTENSION (OH) AT SYNCOPE CLINIC. Age Ageing 2022. [DOI: 10.1093/ageing/afac037.677] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
OH is a disabling condition resulting from a sustained reduction in blood pressure (>20 systolic or 10 diastolic) within 3 minutes of standing. It is a common cause of syncope. Patients with concurrent hypertension experiencing syncope present a complex management dilemma where a balance must be established between symptom burden and risk of cardiovascular disease. Current guidance on ABPM use in syncope is limited. European society of cardiology syncope guidelines suggest ABPM in patients with ‘autonomic failure’ to assess nocturnal hypertension or drug-induced hypotension. Could this be improved with further explicit criteria on which patients to assess and how to act on results? The objective of this study is to review the use of 24 hour ABPM in OH within a tertiary referral syncope clinic.
Method
A retrospective analysis was performed electronically for patients with a final diagnosis of OH seen in a syncope clinic between March 2017 and May 2019. Data was collected on comorbidities, medication history, physical mobility, clinic blood pressure, ABPM Results: (if performed) and medication changes. Comparisons were made between patients who had ABPM and those who did not. Statistics were calculated using Fisher’s Exact Test (2 tailed).
Results
119 patients had a final diagnosis of OH in the study period. 45 had ABPM, 74 did not. The ABPM group had a significantly higher proportion of diagnosed hypertension (51.1% vs 23% (p = 0.0025)). A similar proportion of patients in both groups had medication changed however the ABPM group were significantly more likely to have antihypertensive therapy added (19.4% vs 1.8% (p = 0.0053)).
Conclusion
Using 24 hour ABPM in OH patients can aid clinical decision making in the sub-group with hypertension. This can guide the need for alteration/addition of antihypertensive therapy to balance optimum BP control with symptom burden.
Collapse
Affiliation(s)
- A Arnott
- Queen Elizabeth University Hospital; Glasgow Caledonian University
| | - G Reid
- Queen Elizabeth University Hospital; Glasgow Caledonian University
| | - J Godwin
- Queen Elizabeth University Hospital; Glasgow Caledonian University
| | - L Anderton
- Queen Elizabeth University Hospital; Glasgow Caledonian University
| | - L Mitchell
- Queen Elizabeth University Hospital; Glasgow Caledonian University
| |
Collapse
|
11
|
Jenkins E, Dharmaprani D, Schopp M, Xian Quah J, Tiver K, Mitchell L, Nash M, Clayton R, Ganesan A. Evidence for a Novel Self-Inhibitory Effect on Rotor Formation and Destruction Rates With Increased Phase Singularity Population During Human Atrial and Ventricular Fibrillation. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.161] [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]
|
12
|
Jenkins E, Dharmaprani D, Schopp M, Xian Quah J, Tiver K, Mitchell L, Xiong F, Aguilar M, Pope K, Akar F, Roney C, Niederer S, Nattel S, Nash M, Clayton R, Ganesan A. The Inspection Paradox: An Important Consideration in the Evaluation of Rotor Lifetimes in Cardiac Fibrillation. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.199] [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]
|
13
|
Brydon A, Bhar S, Doyle C, Batchelor F, Lovelock H, Almond H, Mitchell L, Nedeljkovic M, Savvas S, Wuthrich V. National Survey on the Impact of COVID-19 on the Mental Health of Australian Residential Aged Care Residents and Staff. Clin Gerontol 2022; 45:58-70. [PMID: 34634217 DOI: 10.1080/07317115.2021.1985671] [Citation(s) in RCA: 11] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study is the first to obtain data on the prevalence of, contributors to, and supports required for, pandemic-related distress within the residential aged care sector in Australia. A nested mixed-methods approach was used to examine aged care leaders' opinions about the impact of COVID-19 on the mental health of aged care residents and staff. METHODS A total of 288 senior staff of Australian residential aged care facilities (care managers, clinical care coordinators, and lifestyle team leaders; mean age = 52.7 years, SD = 10.3) completed an online survey between 10th September and 31st October 2020. RESULTS On average, nearly half of their residents experienced loneliness (41%) and a third experienced anxiety in response to COVID-19 (33%). The most frequently noted contributors to poor mental health among residents were restrictions to recreational outings and watching news coverage relating to COVID-19. Participants emphasized the need for increased access to counseling services and improved mental health training amongst staff. Residential care staff were similarly impacted by the pandemic. More than a third of staff were reported as anxious (36%) and 20% depressed, in response to COVID-19. Staff were worried about introducing COVID-19 into their facility and were impacted by news coverage of COVID-19. Staff would feel supported by financial assistance and by increased staff-resident ratios. CONCLUSIONS Senior staff perceive that the mental health of Australian aged care residents and staff was negatively impacted by the COVID-19 pandemic. The most noted contributors were identified, as was the mental health support for aged care communities. CLINICAL IMPLICATIONS This study provides government and policymakers with clear intervention targets for supporting the sector. Clinicians can support residential aged care communities by providing on-site or telehealth counseling, and upskill and train residential aged care staff on how to respond to the emotional needs of residents in response to COVID-19.
Collapse
Affiliation(s)
- Aida Brydon
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Sunil Bhar
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Colleen Doyle
- National Ageing Research Institute, Melbourne, Australia
| | | | | | - Helen Almond
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Leander Mitchell
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Maja Nedeljkovic
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Steven Savvas
- National Ageing Research Institute, Melbourne, Australia
| | - Viviana Wuthrich
- Department of Psychology, Macquarie University, Sydney, Australia
| |
Collapse
|
14
|
Abbott S, Castiglioni M, Cobley S, Halaki M, Hogan C, Mitchell L, Romann M, Salter J, Yamauchi G. Removing maturational influences from female youth swimming: the application of corrective adjustment procedures. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
15
|
Coghlan GJ, Gaine S, Channick RN, Chin KM, Du Roure C, Gibbs JSR, Hoeper MM, Lang IM, Mathai SC, McLaughlin VV, Mitchell L, Simonneau G, Sitbon O, Tapson V, Galie N. Treatment effect of selexipag on time to disease progression when initiated early in pulmonary arterial hypertension (PAH) patients: GRIPHON and TRITON pooled analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In PAH clinical practice, drugs targeting the prostacyclin pathway, including the oral prostacyclin receptor agonist selexipag, are often initiated years after diagnosis. The GRIPHON (NCT01106014) and TRITON (NCT02558231) randomised controlled trials examined the impact of selexipag on disease progression, primary and secondary endpoints, respectively. In GRIPHON, selexipag significantly reduced the risk of disease progression (composite primary endpoint) in a PAH population (N=1156) with a mean time from diagnosis of 2.4 years, as part of an oral triple, double or monotherapy regimen versus placebo. In TRITON, a potential signal for reduced risk of disease progression was observed with initial triple oral therapy (selexipag, macitentan, tadalafil) versus initial double oral therapy (placebo, macitentan, tadalafil) in a population of 247 newly diagnosed, treatment naïve patients.
Purpose
To investigate the impact of initiating selexipag within 6 months of diagnosis on disease progression in a large PAH population.
Methods
We selected patients from GRIPHON and TRITON diagnosed within 6 months of randomization and compared those on active therapy with selexipag (selexipag group) versus those on control therapy with placebo (control group). Disease progression endpoints were defined as in the GRIPHON and TRITON studies, respectively. Hazard ratios (HR) and 95% CI for time to first disease progression event up to end of double-blind treatment (selexipag/placebo) + 7 days were estimated using a Cox regression model which included treatment as a factor, and baseline prognostic factors and study as covariates.
Results
Overall, 649 patients met the criteria (diagnosis ≤6 months) for these analyses: 329 in the selexipag group (207 from GRIPHON and 122 from TRITON) and 320 in the control group (197 from GRIPHON and 123 from TRITON). Patient characteristics at baseline and treatment regimens were balanced between the treatment groups. With respect to treatment regimen, selexipag/placebo was given as part of triple therapy in 44%, double therapy in 32% and monotherapy in 24% of patients. The median (range) exposure to study treatment was 510 (4–1280) and 409 (3–1318) days in the selexipag and control groups, respectively. There were 67 (20%) and 116 (36%) patients who experienced a disease progression event in the selexipag and control groups, respectively. Selexipag reduced the risk of disease progression (first event) by 52% compared to control (HR 0.48 [95% CI 0.35, 0.66]) (Figure).
Conclusions
This post-hoc pooled analysis of GRIPHON and TRITON patients diagnosed within 6 months suggests that targeting the prostacylin pathway with selexipag within a short time after diagnosis may reduce the risk of disease progression in a broad PAH population.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson
Collapse
Affiliation(s)
| | - S Gaine
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - R N Channick
- University of California Los Angeles, Los Angeles, United States of America
| | - K M Chin
- University of Texas Southwestern Medical Center, Dallas, United States of America
| | - C Du Roure
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - J S R Gibbs
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - M M Hoeper
- Department of Respiratory Medicine, Hannover Medical School and German Center for Lung Research, Hannover, Germany
| | - I M Lang
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - S C Mathai
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - V V McLaughlin
- University of Michigan, Ann Arbor, United States of America
| | - L Mitchell
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - G Simonneau
- Hôpital Bicêtre, Université Paris-Sud, Le Kremlin Bicêtre, France
| | - O Sitbon
- Hôpital Bicêtre, Université Paris-Sud, Le Kremlin Bicêtre, France
| | - V Tapson
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - N Galie
- DIMES, University of Bologna and IRCCS, S.Orsola University Hospital, Bologna, Italy
| |
Collapse
|
16
|
Hall R, Mitchell L, Sachdeva J. Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: retrospective case-note review. BJPsych Open 2021; 7:e184. [PMID: 34593070 PMCID: PMC8503911 DOI: 10.1192/bjo.2021.1022] [Citation(s) in RCA: 10] [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] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND UK adult gender identity clinics (GICs) are implementing a new streamlined service model. However, there is minimal evidence from these services underpinning this. It is also unknown how many service users subsequently 'detransition'. AIMS To describe service users' access to care and patterns of service use, specifically, interventions accessed, reasons for discharge and re-referrals; to identify factors associated with access; and to quantify 'detransitioning'. METHOD A retrospective case-note review was performed as a service evaluation for 175 service users consecutively discharged by a tertiary National Health Service adult GIC between 1 September 2017 and 31 August 2018. Descriptive statistics were used for rates of accessing interventions sought, reasons for discharge, re-referral and frequency of detransitioning. Using multivariate analysis, we sought associations between several variables and 'accessing care' or 'other outcome'. RESULTS The treatment pathway was completed by 56.1%. All interventions initially sought were accessed by 58%; 94% accessed hormones but only 47.7% accessed gender reassignment surgery; 21.7% disengaged; and 19.4% were re-referred. Multivariate analysis identified coexisting neurodevelopmental disorders (odds ratio [OR] = 5.7, 95% CI = 1.7-19), previous adverse childhood experiences (ACEs) per reported ACE (OR = 1.5, 95% CI = 1.1-1.9), substance misuse during treatment (OR = 4.3, 95% CI = 1.1-17.6) and mental health concerns during treatment (OR = 2.2, 95% CI 1.1-4.4) as independently associated with accessing care. Twelve people (6.9%) met our case definition of detransitioning. CONCLUSIONS Service users may have unmet needs. Neurodevelopmental disorders or ACEs suggest complexity requiring consideration during the assessment process. Managing mental ill health and substance misuse during treatment needs optimising. Detransitioning might be more frequent than previously reported.
Collapse
Affiliation(s)
- R Hall
- Devon Partnership Trust, UK
| | | | | |
Collapse
|
17
|
Shih HY, Paterson MBA, Georgiou F, Mitchell L, Pachana NA, Phillips CJC. Two Ends of the Leash: Relations Between Personality of Shelter Volunteers and On-leash Walking Behavior With Shelter Dogs. Front Psychol 2021; 12:619715. [PMID: 33935871 PMCID: PMC8079626 DOI: 10.3389/fpsyg.2021.619715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/19/2021] [Indexed: 01/24/2023] Open
Abstract
Human personality influences the way people interact with dogs. This study investigated the associations between the personality of animal shelter volunteers and behavior during on-leash walks with shelter dogs. Video recording and a canine leash tension meter were used to monitor the on-leash walking. Personality was measured in five dimensions (neurotic, extroverted, open, agreeable and conscientious) with the NEO Five-Factor Inventory (NEO-FFI). Neurotic volunteers pulled the leash harder and tended to interact with dogs using more body language; dogs being walked by neurotic volunteers in turn displayed more lip-licking and body shaking and were more likely to be rated as well-behaved. Extroverted volunteers were associated with stronger maximal leash tension at both the human and dog ends of the leash, and they praised the dog more, often in a high pitched voice. These volunteers eliciting more tail-wagging and body shaking by the dog. Extroverted volunteers were also more tolerant of different dog behaviors. Volunteers with personalities characterized by “openness to experiences” were less likely to verbally attract the attention of dogs, praise dogs and talk to them in a high-pitched voice; however, dogs walked by these volunteers were more likely to pull on the leash, and engaged in more lip-licking but less sniffing. “Agreeable” volunteers liked to verbally attract the attention of the dogs and more commonly initiated hand gestures and physical contact, causing the dogs to pull less frequently; dogs in these dyads displayed more gazing and lip-licking behaviors. Conscientious volunteers were less likely to pull the leash and tended to have more physical contact with the dogs but did not favor verbal communication and did not use a high pitched voice.
Collapse
Affiliation(s)
- Hao-Yu Shih
- School of Veterinary Science, University of Queensland, Gatton, QLD, Australia
| | - Mandy B A Paterson
- School of Veterinary Science, University of Queensland, Gatton, QLD, Australia.,Royal Society for the Prevention of Cruelty to Animals Queensland, Brisbane, QLD, Australia
| | - Fillipe Georgiou
- School of Mathematical and Physical Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Leander Mitchell
- School of Psychology, University of Queensland, St Lucia, QLD, Australia
| | - Nancy A Pachana
- School of Psychology, University of Queensland, St Lucia, QLD, Australia
| | - Clive J C Phillips
- Curtin University Sustainable Policy (CUSP) Institute, Bentley, WA, Australia
| |
Collapse
|
18
|
Dharmaprani D, Jenkins E, Quah J, Lahiri A, Tiver K, Mitchell L, Bradley C, Hayward M, Paterson D, Taggart P, Clayton R, Nash M, Ganesan A. A Governing Equation for Human Ventricular Fibrillation. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
19
|
Stargatt J, Bhar SS, Davison TE, Pachana NA, Mitchell L, Koder D, Hunter C, Doyle C, Wells Y, Helmes E. The Availability of Psychological Services for Aged Care Residents in Australia: A Survey of Facility Staff. Australian Psychologist 2020. [DOI: 10.1111/ap.12244] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jennifer Stargatt
- Faculty of Health, Arts and Design, Swinburne University of Technology,
| | - Sunil S. Bhar
- Faculty of Health, Arts and Design, Swinburne University of Technology,
| | | | - Nancy A. Pachana
- School of Psychology and Counselling, University of Southern Queensland,
| | - Leander Mitchell
- School of Psychology and Counselling, University of Southern Queensland,
| | | | | | - Colleen Doyle
- Faculty of Health Sciences, Australian Catholic University,
| | - Yvonne Wells
- Lincoln Centre for Research on Ageing, La Trobe University,
| | | |
Collapse
|
20
|
Davison TE, Koder D, Helmes E, Doyle C, Bhar S, Mitchell L, Hunter C, Knight B, Pachana N. Brief on the Role of Psychologists in Residential and Home Care Services for Older Adults. Australian Psychologist 2020. [DOI: 10.1111/ap.12209] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Deborah Koder
- Specialist Mental Health Services for Older People, Royal Prince Alfred Hospital,
| | | | - Colleen Doyle
- Australian Catholic University, Villa Maria Catholic Homes,
| | - Sunil Bhar
- Department of Psychological Sciences, Swinburne University of Technology,
| | | | | | - Bob Knight
- School of Psychology and Counselling, University of Southern Queensland,
| | | |
Collapse
|
21
|
Saluja S, Contractor H, Daniells M, Sobolewska J, Khan K, Mitchell L, Saluja S, Jiang X, Anderson S. The utility of coronary artery calcium in non-gated high resolution CT thorax scans in predicting cardiac events as compared to the Framingham risk score: a retrospective study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There is existing evidence to suggest a correlation between coronary artery calcification (CAC) measured using ECG-triggered chest computed tomography and cardiovascular disease. Further evidence has emerged to suggest a correlation between CAC measured using non-gated CT scans and cardiovascular disease. Herein, we sought to ascertain the utility of incidental findings of CAC on non-triggered high resolution CT (HRCT) thorax used for patients undergoing lung cancer screening or follow-up for interstitial lung disease and Framingham risk score (FRS) in predicting cardiovascular events.
Methods
The Computerised Radiology Information Service (CRIS) database was manually searched to determine all HRCT scans performed in a single trust from 05/2015 to 05/2016. The reports issued by Radiologists and images of selected studies were reviewed. For patients with CAC, we calculated the calcium score for patients using the Agatston method. Clinical events were determined from the electronic medical record without knowledge of patients' CAC findings. For these patients, the Framingham Risk Score (FRS) was also calculated. The primary end point of the study was composite of all-cause mortality and cardiac events (non-fatal myocardial infarction, coronary revascularization, new atrial fibrillation or heart failure episode requiring hospitalization).
Results
We selected 300 scans from a total of approximately 2000 scans performed over this time. Data at follow up was available for 100% of the patients, with a median duration of follow up of 1.6 years. Moderate to severe CAC was found in 35% of people. Multivariable analysis showed good concordance between CAC and FRS in predicting composite clinical end point. The Odds Ratio for cardiac events in patients with moderate to severe CAC was 5.3 (p<0.01) and for composite clinical end point was 3.4 (p<0.01). This is similar to the OR predicted by the FRS: 4.8; p<0.01 and 3.1; p<0.01 respectively. Only 6.2% of patients with moderate to severe CAC were currently statin treated.
Conclusion
In this retrospective study of patients with respiratory disease attending for HRCT scanning, co-incidentally detected CAC predicts cardiac events, with good concordance with the FRS. The incidental finding of CAC on non-gated CT scanning should be reported with Agatston score calculation allowing consideration of intervention to mitigate cardiovascular risk and optimize. Further multi-centre prospective studies of this strategy, with a larger patient cohort should be conducted to clarify the utility of CAC as a prediction tool to modify cardiac risk.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- S Saluja
- University of Manchester, 1 Manchester Heart Centre, Central Manchester Foundation Trust, University of Manchester, Manchester, Manchester, United Kingdom
| | - H Contractor
- University of Manchester, 1 Manchester Heart Centre, Central Manchester Foundation Trust, University of Manchester, Manchester, Manchester, United Kingdom
| | - M Daniells
- Royal Oldham Hospital, Cardiology, Oldham, United Kingdom
| | - J Sobolewska
- Royal Oldham Hospital, Cardiology, Oldham, United Kingdom
| | - K Khan
- Royal Oldham Hospital, Cardiology, Oldham, United Kingdom
| | - L Mitchell
- Royal Oldham Hospital, Cardiology, Oldham, United Kingdom
| | - S Saluja
- Royal Oldham Hospital, Cardiology, Oldham, United Kingdom
| | - X Jiang
- University of Manchester, Manchester Heart Centre, Central Manchester Foundation Trust, Manchester, United Kingdom
| | - S.G Anderson
- University of Manchester, Manchester Heart Centre, Central Manchester Foundation Trust, Manchester, United Kingdom
| |
Collapse
|
22
|
Braysher E, Russell B, Collins SM, van Es EM, Shearman R, Molin FD, Read D, Anagnostakis M, Arndt R, Bednár A, Bituh T, Bolivar JP, Cobb J, Dehbi N, Di Pasquale S, Gascó C, Gilligan C, Jovanovič P, Lawton A, Lees AMJ, Lencsés A, Mitchell L, Mitsios I, Petrinec B, Rawcliffe J, Shyti M, Suárez-Navarro JA, Suursoo S, Tóth-Bodrogi E, Vaasma T, Verheyen L, Westmoreland J, de With G. Development of a reference material for analysing naturally occurring radioactive material from the steel industry. Anal Chim Acta 2020; 1141:221-229. [PMID: 33248656 DOI: 10.1016/j.aca.2020.10.053] [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: 05/01/2020] [Revised: 10/15/2020] [Accepted: 10/24/2020] [Indexed: 11/15/2022]
Abstract
Accurate measurement of naturally occurring radionuclides in blast furnace slag, a by-product of the steel industry, is required for compliance with building regulations where it is often used as an ingredient in cement. A matrix reference blast furnace slag material has been developed to support traceability in these measurements. Raw material provided by a commercial producer underwent stability and homogeneity testing, as well as characterisation of matrix constituents, to provide a final candidate reference material. The radionuclide content was then determined during a comparison exercise that included 23 laboratories from 14 countries. Participants determined the activity per unit mass for 226Ra, 232Th and 40K using a range of techniques. The consensus values obtained from the power-moderated mean of the reported participant results were used as indicative activity per unit mass values for the three radionuclides: A0(226Ra) = 106.3 (34) Bq·kg-1, A0(232Th) = 130.0 (48) Bq·kg-1 and A0(40K) = 161 (11) Bq·kg-1 (where the number in parentheses is the numerical value of the combined standard uncertainty referred to the corresponding last digits of the quoted result). This exercise helps to address the current shortage of NORM industry reference materials, putting in place infrastructure for production of further reference materials.
Collapse
Affiliation(s)
- E Braysher
- National Physical Laboratory, Hampton Road, Teddington, Middlesex, TW11 0LW, UK; University of Surrey, Stag Hill, Guildford, Surrey, GU2 7XH, UK.
| | - B Russell
- National Physical Laboratory, Hampton Road, Teddington, Middlesex, TW11 0LW, UK
| | - S M Collins
- National Physical Laboratory, Hampton Road, Teddington, Middlesex, TW11 0LW, UK; University of Surrey, Stag Hill, Guildford, Surrey, GU2 7XH, UK
| | - E M van Es
- National Physical Laboratory, Hampton Road, Teddington, Middlesex, TW11 0LW, UK
| | - R Shearman
- National Physical Laboratory, Hampton Road, Teddington, Middlesex, TW11 0LW, UK
| | - F Dal Molin
- CEFAS, Lowestoft, Pakefield Road, Lowestoft, Suffolk, NR33 0HT, UK
| | - D Read
- National Physical Laboratory, Hampton Road, Teddington, Middlesex, TW11 0LW, UK; University of Surrey, Stag Hill, Guildford, Surrey, GU2 7XH, UK
| | - M Anagnostakis
- Nuclear Engineering Department, National Technical University of Athens, 15780, Athens, Greece
| | - R Arndt
- IAF-Radioökologie GmbH, Wilhelm-Rönsch-Straße 9, 01454, Radeberg, Germany
| | - A Bednár
- RadiÖko Ltd., H-8200, Veszprém, Wartha Vince Str. 1/2, Hungary
| | - T Bituh
- Institute for Medical Research and Occupational Health, Ksaverska Cesta 2, HR-10000, Zagreb, Croatia
| | - J P Bolivar
- University of Huelva, Department of Integrated Sciences, Natural Resources, Health and Environment (RENSMA), Campus El Carmen, 21007, Huelva, Spain
| | - J Cobb
- Jacobs, Renaissance Centre, 601 Faraday Street, Birchwood Park, Warrington, WA3 6GN, UK
| | - N Dehbi
- ASTERALIS (VEOLIA NUCLEAR SOLUTIONS), 556 Chemin de L'Islon, 38670, Chasse sur Rhone, France
| | - S Di Pasquale
- Institute for Radioelements (IRE) - Radioactivity Measurement Laboratory, Avenue de L'Espérance,1, 6220, Fleurus, Belgium
| | - C Gascó
- CIEMAT, Avda de La Complutense 40, Madrid, Spain
| | | | - P Jovanovič
- ZVD D.o.o., Chengdujska Street 25, Ljubljana, Slovenia
| | - A Lawton
- UK National Nuclear Laboratory, NNL Preston, Springfields, Salwick, Lancashire, PR4 0XJ, UK
| | - A M J Lees
- Cavendish Nuclear Ltd, Greeson Court, Westlakes Science & Technology Park, Moor Row, Cumbria, CA24 3HZ, UK
| | - A Lencsés
- Nuclear Power Plant Paks, Environmental Monitoring Laboratory, 7030, Paks, Kurcsatov Str. 1/D, Hungary
| | - L Mitchell
- Public Health England, Centre Chemical Radiation and Environmental Hazards, Didcot, Oxon, OX11 0RQ, UK
| | - I Mitsios
- Nuclear Engineering Department, National Technical University of Athens, 15780, Athens, Greece
| | - B Petrinec
- Institute for Medical Research and Occupational Health, Ksaverska Cesta 2, HR-10000, Zagreb, Croatia
| | - J Rawcliffe
- UK National Nuclear Laboratory, NNL Preston, Springfields, Salwick, Lancashire, PR4 0XJ, UK
| | - M Shyti
- Institute of Applied Nuclear Physics, University of Tirana, Th. Filipeu, Qesarake, Tirana, Albania
| | | | - S Suursoo
- University of Tartu, Institute of Physics, W.Ostwaldi 1, 50411, Tartu, Estonia
| | - E Tóth-Bodrogi
- Department of Radiochemistry and Radioecology, Bio- Environmental- and Chemical-engineering Research and Development Center, Faculty of Engineering, University of Pannonia, H-8200 Veszprém, Egyetem Str. 10., H-8210, Veszprém, POB 1158, Hungary
| | - T Vaasma
- University of Tartu, Institute of Physics, W.Ostwaldi 1, 50411, Tartu, Estonia
| | - L Verheyen
- SCK CEN, Boeretang 200, 2400, Mol, Belgium
| | | | - G de With
- Nuclear Research and Consultancy Group, Utrechtseweg 310 - B50-West, 6812, AR ARNHEM, Netherlands
| |
Collapse
|
23
|
Goldstein A, Mitchell L, Tolson H, Krapf J. 027 Plasma Cell Mucositis of the Vagina and Cervix. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.263] [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]
|
24
|
Pourzinal D, Yang JHJ, Byrne GJ, O'Sullivan JD, Mitchell L, McMahon KL, Copland DA, Dissanayaka NN. Identifying subtypes of mild cognitive impairment in Parkinson's disease using cluster analysis. J Neurol 2020; 267:3213-3222. [PMID: 32535681 DOI: 10.1007/s00415-020-09977-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The concept of Mild Cognitive Impairment (MCI) in Parkinson's disease (PD) has shown the potential for identifying at-risk dementia patients. Identifying subtypes of MCI is likely to assist therapeutic discoveries and better clinical management of patients with PD (PWP). Recent cluster-based approaches have demonstrated dominance in memory and executive impairment in PD. The present study will further explore the role of memory and executive impairment and associated clinical features in non-demented PWP. METHOD A K-means cluster analysis was performed on ten "frontal" and "posterior" cognitive variables derived from a dataset of 85 non-demented PWP. The resulting cluster structure was chosen based on quantitative, qualitative, theoretical, and clinical validity. Cluster profiles were then created through statistical analysis of cognitive and clinical/demographic variables. A descriptive analysis of each cluster's performance on a comprehensive PD-MCI diagnostic battery was also explored. RESULTS The resulting cluster structure revealed four distinct cognitive phenotypes: (1) frontal-dominant impairment; (2) posterior-cortical-dominant impairment; (3) global impairment, and (4) cognitively intact. Demographic profiling revealed significant differences in the age, gender split, global cognitive ability, and motor symptoms between these clusters. However, there were no significant differences between the clusters on measures of depression, apathy, and anxiety. CONCLUSION These results validate the existence of distinct cognitive phenotypes within PD-MCI and encourage future research into their clinical trajectory and neuroimaging correlates.
Collapse
Affiliation(s)
- Dana Pourzinal
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Building 71/918, Herston, Brisbane, QLD, 4029, Australia
- School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4067, Australia
| | - Ji Hyun J Yang
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Building 71/918, Herston, Brisbane, QLD, 4029, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Building 71/918, Herston, Brisbane, QLD, 4029, Australia
- Mental Health Service, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia
| | - John D O'Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Building 71/918, Herston, Brisbane, QLD, 4029, Australia
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia
| | - Leander Mitchell
- School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4067, Australia
| | - Katie L McMahon
- School of Clinical Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - David A Copland
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Building 71/918, Herston, Brisbane, QLD, 4029, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, QLD, 4067, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Building 71/918, Herston, Brisbane, QLD, 4029, Australia.
- School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4067, Australia.
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia.
| |
Collapse
|
25
|
Hight SC, Capar SG, Anderson J, Brzezinski J, Cappon CJ, Carr R, Kim ES, McNerney FG, Mitchell L, Newton J, Panaro K. Electron Capture Gas-Liquid Chromatographic Determination of Methyl Mercury in Fish and Shellfish: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/66.5.1121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
A method for determining methyl mercury in fish and shellfish was collaboratively studied in 8 laboratories. Methyl mercury is isolated from acetonewashed, homogenized tissue by adding hydrochloric acid and extracting into benzene the methyl mercuric chloride that is formed. The benzene extract is concentrated and analyzed for methyl mercuric chloride by electron capture gas-liquid chromatography on 5% DEGS-PS treated with inorganic mercuric chloride solution. The quantitation limit for the method is 0.05 μg Hg/g. Each collaborator determined methyl mercury at 2 levels in blind duplicate samples of swordfish, tuna, oyster, and shrimp tissues. Both fortified and unfortified samples were analyzed. Methyl-bound mercury in the samples ranged from 0.15 to 148 μg Hg/g. The reproducibility coefficients of variation for the 8 samples ranged from 3 to 13%. The accuracy, measured by comparison to reference values, ranged from 99 to 120%. Reference values were determined in the Associate Referee's laboratory by replicate analyses of the fortified and unfortified samples. The method has been adopted official first action.
Collapse
Affiliation(s)
- Susan C Hight
- Food and Drug Administration, Division of Chemical Technology, Washington, DC 20204
| | - Stephen G Capar
- Food and Drug Administration, Division of Chemical Technology, Washington, DC 20204
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Khan S, Wenban C, Mitchell L, Busby-Earle H, Ahmed S. Managing Osteonecrosis of the Jaw Related to Denosumab in Patients with Breast Cancer. Clin Oncol (R Coll Radiol) 2019. [DOI: 10.1016/j.clon.2019.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
27
|
Govind V, Mitchell L, Tolson H, Barela K, Casey J, Goldstein A. 085 Exploring Comorbidity of Anxiety and Depression in Vulvodynia with Associated Overactive Pelvic Floor Muscle Dysfunction. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.526] [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]
|
28
|
Govind V, Mitchell L, Tolson H, Barela K, Casey J, Goldstein A. 089 Exploring Comorbidity of Anxiety and Depression in Lichen Sclerosus. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
29
|
Goldstein A, Mitchell L, Govind V, Heller D. 007 A Randomized Double-Blind Placebo Controlled Trial of Autologous Platelet Rich Plasma Intradermal Injections for the Treatment of Vulvar Lichen Sclerosus. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
30
|
Mitchell L, Govind V, Barela K, Goldstein A. 105 Spironolactone May be a Cause of Hormonally Associated Vestibulodynia and Female Genital Arousal Disorder. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
31
|
O'Connor R, Slater K, Ball L, Jones A, Mitchell L, Rollo ME, Williams LT. The tension between efficiency and effectiveness: a study of dietetic practice in primary care. J Hum Nutr Diet 2019; 32:259-266. [PMID: 30604495 DOI: 10.1111/jhn.12617] [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: 11/29/2022]
Abstract
BACKGROUND Primary healthcare dietitians have a vital role to play in the prevention and management of chronic disease. Working in primary care requires efficient and effective management of practice to ensure client and practitioner needs are met. The present study aimed to explore the way in which primary care dietitians in Australia view the constructs of efficiency and effectiveness within the context of their practice. METHODS The study used an exploratory qualitative design within a pragmatist framework. Individual semi-structured telephone interviews were conducted with Australian primary care dietitians. All interviews were audio-recorded, transcribed verbatim and analysed using an inductive thematic approach. RESULTS Twenty dietitians (17 females) working as private practitioners in primary care from three Australian states participated in the present study. Three themes emerged from the data. The first theme revealed that seeking efficiency and especially effectiveness were important to primary care dietitians and that there was a tension between the two. The second theme identified that efficiency and effectiveness are influenced by personal and structural factors. The final theme explored how dietitians are actively seeking ways to be more efficient and effective, including supportive networks, as well as the utilisation of technology. CONCLUSIONS Achieving a balance between efficiency and effectiveness in primary care dietetics is challenging to practitioners, who may require further training and support to enhance productivity, time management and resource utilisation. Structured issues exist for the workface. Further studies are required to quantify these findings and to explore whether it is possible to optimise efficiency and effectiveness and achieve sustainability of the dietetic workforce in primary care.
Collapse
Affiliation(s)
- R O'Connor
- Nutrition and Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - K Slater
- Nutrition and Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - L Ball
- Nutrition and Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - A Jones
- Nutrition and Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - L Mitchell
- Nutrition and Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - M E Rollo
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, New South Wales, Australia.,Nutrition and Dietetics, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - L T Williams
- Nutrition and Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
32
|
Wenban C, Mitchell L, Khan S, Ahmed S. Managing osteonecrosis of the jaw related to denosumab in patients with lung cancer. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30157-6] [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: 11/27/2022]
|
33
|
Mitchell L, McCarron H, Weinstein A, Gaugler JE. ENGAGING ADULT DAY SERVICE SITES IN THE ADS PLUS PRAGMATIC TRIAL. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2185] [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 Mitchell
- Minneapolis Veterans Administration Medical Center, Minnneapolis, Minnesota, United States
| | - H McCarron
- Families and LTC Projects, University of Minnesota, Minneapolis, MN, USA
| | - A Weinstein
- Families and LTC Projects, University of Minnesota, Minneapolis, MN, USA
| | - J E Gaugler
- Center on Aging, School of Nursing, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
34
|
Winders T, Sofen H, Eftekhari S, Mitchell L, Kaufman L, Dudas D, Paknis B, Kavati A, Delwart V, Goldstein S. PERSPECTIVES ON THE CHRONIC IDIOPATHIC/SPONTANEOUS URTICARIA PATIENT JOURNEY THROUGH ONSET OF SYMPTOMS TO DIAGNOSIS. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
35
|
Marx K, Gaugler JE, Scerpella D, Duffort N, Mitchell L, Gitlin LN. RECRUITMENT AND ENROLLMENT IN A PRAGMATIC TRIAL: ADS PLUS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Marx
- Baltimore, Maryland, United States
| | - J E Gaugler
- Center on Aging, School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - D Scerpella
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - N Duffort
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - L Mitchell
- Minneapolis Veterans Administration Medical Center, Minneapolis, MN, USA
| | - L N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
36
|
Zmora R, Mitchell L, Finlay J, Peterson C, McCarron H, Jutkowitz E, Gaugler J. SIX-MONTH EFFICACY OF REMOTE ACTIVITY MONITORING FOR PERSONS WITH DEMENTIA AND THEIR FAMILY CAREGIVERS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2524] [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 Mitchell
- Minneapolis Veterans Administration Medical Center
| | | | | | | | - E Jutkowitz
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
| | | |
Collapse
|
37
|
Eng L, Bender J, Hueniken K, Kassirian S, Yang D, Mitchell L, Paulo C, Magony A, Smith E, Liang M, Brown M, Xu W, Alibhai S, Liu G, Gupta A. Cancer care-related social media (SM) and internet usage differences between adolescents and young adults (AYA), adults and elderly patients with cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy300.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
38
|
Paulo C, Eng L, Mitchell L, Geist I, Kassirian S, Magony A, Smith E, Brown C, Liang M, Hueniken K, Yang D, Xu W, Liu G, Gupta A, Bender J. What information and features do young and older adults with cancer want in their hospital-based social media cancer resource? Ann Oncol 2018. [DOI: 10.1093/annonc/mdy300.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
39
|
Reid J, Smyth C, McLintock B, Capek E, Anderton L, Mitchell L. 131RISK STRATIFICATION OF SYNCOPE AT THE FRONT DOOR- DOES A PATHWAY LEAD TO CHANGE IN PRACTICE? Age Ageing 2018. [DOI: 10.1093/ageing/afy126.47] [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)
- J Reid
- Department of Medicine for the Elderly, Queen Elizabeth University Hospital Glasgow
| | - C Smyth
- Department of Medicine for the Elderly, Queen Elizabeth University Hospital Glasgow
| | - B McLintock
- Department of Medicine for the Elderly, Queen Elizabeth University Hospital Glasgow
| | - E Capek
- Department of Medicine for the Elderly, Queen Elizabeth University Hospital Glasgow
| | - L Anderton
- Department of Medicine for the Elderly, Queen Elizabeth University Hospital Glasgow
| | - L Mitchell
- Department of Medicine for the Elderly, Queen Elizabeth University Hospital Glasgow
| |
Collapse
|
40
|
Taylor-Rowan M, Quinn T, Smith P, Ellis G, Keir R, McAlpine C, Marsh G, Murtagh J, McElroy M, Mitchell L, Waddell G, Williams A, Duffy L, Oswald S, Myles A, Bann A, Rodger K, Reid J, Kellichan L, Docharty D, Marshall T, McGurn B, Ritchie C, Wells A, Talbot A, McInnes C, Reynish E, Coleman D, Flynn B, Scott A, Coull A, Dingwall L. 53ASSESSING THE PSYCHOMETRIC PROPERTIES OF THE HIS “THINK FRAILTY” TOOL. Age Ageing 2018. [DOI: 10.1093/ageing/afy127.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - T Quinn
- New Lister Building, Glasgow Royal Infirmary
| | - P Smith
- New Lister Building, Glasgow Royal Infirmary
| | - G Ellis
- New Lister Building, Glasgow Royal Infirmary
| | - R Keir
- New Lister Building, Glasgow Royal Infirmary
| | - C McAlpine
- New Lister Building, Glasgow Royal Infirmary
| | - G Marsh
- New Lister Building, Glasgow Royal Infirmary
| | - J Murtagh
- New Lister Building, Glasgow Royal Infirmary
| | - M McElroy
- New Lister Building, Glasgow Royal Infirmary
| | - L Mitchell
- New Lister Building, Glasgow Royal Infirmary
| | - G Waddell
- New Lister Building, Glasgow Royal Infirmary
| | - A Williams
- New Lister Building, Glasgow Royal Infirmary
| | - L Duffy
- New Lister Building, Glasgow Royal Infirmary
| | - S Oswald
- New Lister Building, Glasgow Royal Infirmary
| | - A Myles
- New Lister Building, Glasgow Royal Infirmary
| | - A Bann
- New Lister Building, Glasgow Royal Infirmary
| | - K Rodger
- New Lister Building, Glasgow Royal Infirmary
| | - J Reid
- New Lister Building, Glasgow Royal Infirmary
| | - L Kellichan
- New Lister Building, Glasgow Royal Infirmary
| | - D Docharty
- New Lister Building, Glasgow Royal Infirmary
| | - T Marshall
- New Lister Building, Glasgow Royal Infirmary
| | - B McGurn
- New Lister Building, Glasgow Royal Infirmary
| | - C Ritchie
- New Lister Building, Glasgow Royal Infirmary
| | - A Wells
- New Lister Building, Glasgow Royal Infirmary
| | - A Talbot
- New Lister Building, Glasgow Royal Infirmary
| | - C McInnes
- New Lister Building, Glasgow Royal Infirmary
| | - E Reynish
- New Lister Building, Glasgow Royal Infirmary
| | - D Coleman
- New Lister Building, Glasgow Royal Infirmary
| | - B Flynn
- New Lister Building, Glasgow Royal Infirmary
| | - A Scott
- New Lister Building, Glasgow Royal Infirmary
| | - A Coull
- New Lister Building, Glasgow Royal Infirmary
| | - L Dingwall
- New Lister Building, Glasgow Royal Infirmary
| |
Collapse
|
41
|
Andrew M, Ofosu F, Fernandez F, Jefferies A, Hirsh J, Mitchell L, Buchanan MR. A Low Molecular Weight Heparin Alters the Fetal Coagulation System in the Pregnant Sheep. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661560] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryStandard heparin and a LMWH, CY222 do not cross the placenta nor alter fetal coagulation when injected into the pregnant ewe. We found that another LMWH, Pharmuka-10169 (PK-10169) alters fetal coagulation without crossing the placenta in the pregnant sheep. To characterize this anticoagulant we measured the in vitro and in vivo effects of 125I-PK-10169 in maternal and fetal plasmas following administration of PK-10169 to the mother or fetus. The fetal anticoagulant activity was not neutralizable by protamine sulphate and was attributable to the inhibition of thrombin but not factor Xa. In vitro, the fetal anticoagulant activity had properties similar to dermatan sulphate : both catalyzed the inhibition of thrombin but not factor Xa by sheep plasma; and neither was neutralizable by protamine sulphate. These effects were due to the enhanced neutralization of thrombin by heparin cofactor II. We conclude that PK-10169 does not cross the placenta, but does induce the release of an endogenous dermatan sulphate-like substance which alters fetal coagulation.
Collapse
Affiliation(s)
- M Andrew
- The Departments of Pediatrics and Pathology and Medicine, McMaster University, Hamilton, Ontario, Canada
| | - F Ofosu
- The Departments of Pediatrics and Pathology and Medicine, McMaster University, Hamilton, Ontario, Canada
| | - F Fernandez
- The Departments of Pediatrics and Pathology and Medicine, McMaster University, Hamilton, Ontario, Canada
| | - A Jefferies
- The Departments of Pediatrics and Pathology and Medicine, McMaster University, Hamilton, Ontario, Canada
| | - J Hirsh
- The Departments of Pediatrics and Pathology and Medicine, McMaster University, Hamilton, Ontario, Canada
| | - L Mitchell
- The Departments of Pediatrics and Pathology and Medicine, McMaster University, Hamilton, Ontario, Canada
| | - M R Buchanan
- The Departments of Pediatrics and Pathology and Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
42
|
Cigna S, Mitchell L, Goldstein A. 025 Lysis of Vulvar Adhesions for Lichen Sclerosus: A Series of 5 Patients. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
43
|
Cigna S, Mitchell L, Goldstein A. 079 Vulvar Crohn’s: A Rare Presentation of Crohn’s Disease. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.03.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
44
|
Korpal M, Puyang X, Furman C, Zheng GZ, Banka D, Wu J, Zhang Z, Thomas M, Mackenzie C, Yao H, Rimkunas V, Kumar P, Caleb B, Karr C, Subramanian V, Irwin S, Larsen N, Vaillancourt F, Nguyen TV, Davis A, Chan B, Hao MH, O'Shea M, Prajapati S, Agoulnik S, Kuznetsov G, Kumar N, Yu Y, Lai G, Hart A, Eckley S, Fekkes P, Bowser T, Joshi JJ, Selvaraj A, Wardell S, Norris J, Smith S, Reynolds D, Mitchell L, Wang J, Yu L, Kim A, Rioux N, Sahmoud T, Warmuth M, Smith PG, Zhu P. Abstract P1-10-08: Development of a first-in-class oral selective ERα covalent antagonist (SERCA) for the treatment of ERαWT and ERαMUT breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-10-08] [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
Mutations in estrogen receptor alpha (ERα) are detected in up to 30% of breast cancer patients who have relapsed during endocrine therapy. ERα mutations functionally confer resistance to existing classes of endocrine therapies, likely through gaining constitutive activity. The fact that current ER-directed therapies are only partially effective in the ERα mutant setting, and that a significant proportion of resistant breast cancer metastases continue to remain dependent on ERα signaling for growth/survival, highlights the critical need to develop the next generation of ERα antagonists that can overcome aberrant ERα activity. Using structure-based drug design approaches we have identified a novel class of ERα antagonist referred to as Selective ERα Covalent Antagonist (SERCA) that inactivate both wild-type and mutant ERα by targeting a unique cysteine residue that is not conserved among other steroid hormone receptors. Biophysical, biochemical and cellular analyses confirm the covalent mechanism of action, specific binding to ER and selective inhibition of ERα-dependent transcription of SERCAs. H3B-6545 is a highly selective SERCA that potently antagonizes wild-type and mutant ERα in biochemical and cell based assays demonstrating increased potency over standard of care and other experimental agents. In vivo, H3B-6545 shows superior efficacy to fulvestrant in the MCF-7 xenograft model with once daily oral dosing, achieving maximal antitumor activity at doses >10x below the maximum tolerated dose in mice. In addition, H3B-6545 shows superior antitumor activity to both tamoxifen and fulvestrant in patient derived xenograft models of breast cancer carrying estrogen receptor mutations. In summary, H3B-6545 is a first-in-class, orally available and selective ER covalent antagonist with a compelling pre-clinical profile that is being developed for the treatment of ERα positive breast cancer.
Citation Format: Korpal M, Puyang X, Furman C, Zheng GZ, Banka D, Wu J, Zhang Z, Thomas M, Mackenzie C, Yao H, Rimkunas V, Kumar P, Caleb B, Karr C, Subramanian V, Irwin S, Larsen N, Vaillancourt F, Nguyen T-V, Davis A, Chan B, Hao MH, O'Shea M, Prajapati S, Agoulnik S, Kuznetsov G, Kumar N, Yu Y, Lai G, Hart A, Eckley S, Fekkes P, Bowser T, Joshi JJ, Selvaraj A, Wardell S, Norris J, Smith S, Reynolds D, Mitchell L, Wang J, Yu L, Kim A, Rioux N, Sahmoud T, Warmuth M, Smith PG, Zhu P. Development of a first-in-class oral selective ERα covalent antagonist (SERCA) for the treatment of ERαWT and ERαMUT breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-10-08.
Collapse
Affiliation(s)
- M Korpal
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - X Puyang
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - C Furman
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - GZ Zheng
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - D Banka
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - J Wu
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - Z Zhang
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - M Thomas
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - C Mackenzie
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - H Yao
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - V Rimkunas
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - P Kumar
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - B Caleb
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - C Karr
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - V Subramanian
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - S Irwin
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - N Larsen
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - F Vaillancourt
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - T-V Nguyen
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - A Davis
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - B Chan
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - MH Hao
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - M O'Shea
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - S Prajapati
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - S Agoulnik
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - G Kuznetsov
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - N Kumar
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - Y Yu
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - G Lai
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - A Hart
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - S Eckley
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - P Fekkes
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - T Bowser
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - JJ Joshi
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - A Selvaraj
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - S Wardell
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - J Norris
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - S Smith
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - D Reynolds
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - L Mitchell
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - J Wang
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - L Yu
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - A Kim
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - N Rioux
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - T Sahmoud
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - M Warmuth
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - PG Smith
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - P Zhu
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| |
Collapse
|
45
|
Rubin R, Mitchell L, Winter A, Goldstein A, Goldstein I. 011 Successful Treatment of Interstitial Cystitis/Bladder Pain Syndrome (IC/PBS) in Women with Provoked Vestibulodynia (PVD). J Sex Med 2018. [DOI: 10.1016/j.jsxm.2017.11.030] [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]
|
46
|
Colpitts M, Malinowski M, Phillion R, Coleman R, Mitchell L, Malone A, Eberhart L, Sanders R, Langholz D. Echocardiographic imaging options in ovine research subjects. J Vet Cardiol 2017; 19:502-513. [PMID: 29097107 DOI: 10.1016/j.jvc.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 09/13/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To determine the feasibility of acquiring quality transesophageal (TEE), epicardial (EE), and intracardiac (ICE) echocardiographic images in ovine subjects and to discuss the merits of each technique with a focus on ICE image acquisition. ANIMALS Eleven male castrated Dorset adult sheep. METHODS Transesophageal echocardiography was performed under general anesthesia. Epicardial echocardiography was performed as part of an open chest (thoracotomy or sternotomy) experiment. Subjects were recovered with permanent jugular vein indwelling catheter and ICE from this approach was described. Feasibility of each technique was qualitatively assessed based on subjective image quality from three images for each image plane in each sheep. RESULTS Transesophageal echocardiography was technically challenging and did not provide adequate image quality for consistent interpretation. Epicardial echocardiography and ICE had more favorable results with ICE demonstrating unique benefits for post-operative serial monitoring. CONCLUSIONS Epicardial echocardiography and ICE were effective imaging techniques. Epicardial echocardiography required the least specialized training but was considered to have limited feasibility due to its requirement for an open chest procedure. Even with the necessity for permanent indwelling jugular cannulation, ICE was the least invasive of the three imaging techniques and potentially the most practical approach for chronic studies by minimizing post-operative stress. Transesophageal echocardiography was not a feasible technique in this study.
Collapse
Affiliation(s)
- M Colpitts
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA.
| | - M Malinowski
- Division of Cardiothoracic Surgery, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA; Medical University of Silesia, Department of Cardiac Surgery, Ziolowa 47, 40-635, Katowice, Poland
| | - R Phillion
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - R Coleman
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - L Mitchell
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - A Malone
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - L Eberhart
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - R Sanders
- Michigan State University - College of Veterinary Medicine, Department of Cardiology, 736 Wilson Road, East Lansing, MI 48823, USA
| | - D Langholz
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| |
Collapse
|
47
|
Jamison JM, Fourie E, Siper PM, Trelles MP, George-Jones J, Buxbaum Grice A, Krata J, Holl E, Shaoul J, Hernandez B, Mitchell L, McKay MM, Buxbaum JD, Kolevzon A. Examining the Efficacy of a Family Peer Advocate Model for Black and Hispanic Caregivers of Children with Autism Spectrum Disorder. J Autism Dev Disord 2017; 47:1314-1322. [PMID: 28168677 DOI: 10.1007/s10803-017-3045-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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: 10/20/2022]
Abstract
Autism spectrum disorder (ASD) affects individuals across all racial and ethnic groups, yet rates of diagnosis are disproportionately higher for Black and Hispanic children. Caregivers of children with ASD experience significant stressors, which have been associated with parental strain, inadequate utilization of mental health services and lower quality of life. The family peer advocate (FPA) model has been utilized across service delivery systems to provide family-to-family support, facilitate engagement, and increase access to care. This study used a randomized controlled design to examine the efficacy of FPAs in a racially and ethnically diverse sample. Results demonstrate significantly increased knowledge of ASD and reduced levels of stress for caregivers who received the FPA intervention as compared to treatment as usual.
Collapse
Affiliation(s)
- J M Jamison
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA
| | - E Fourie
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA
| | - P M Siper
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M P Trelles
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julia George-Jones
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA
| | - A Buxbaum Grice
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA
| | - J Krata
- Private Practice, New York, NY, USA
| | - E Holl
- Saint Paul College, 235 Marshall Avenue, St. Paul, MN, 55102, USA
| | - J Shaoul
- NYC Human Resources Administration, 150 Greenwich St., New York, NY, 10007, USA
| | - B Hernandez
- Young Adult Institute (YAI) Autism Center, 460 W. 34th St., New York, NY, 10001, USA
| | - L Mitchell
- Young Adult Institute (YAI) Autism Center, 460 W. 34th St., New York, NY, 10001, USA
| | - M M McKay
- McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, 1 Washington Square North, G03, New York, NY, 10003, USA
| | - J D Buxbaum
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexander Kolevzon
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA. .,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
48
|
Gaugler J, Mitchell L, Peterson C, Rud S, Cowl A, Trost S. “IT’S LIKE A CYBER SECURITY BLANKET”: THE UTILITY OF REMOTE MONITORING IN FAMILY DEMENTIA CARE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J.E. Gaugler
- Center on Aging, School of Nursing, University of Minnesota, Minneapoils, Minnesota
| | - L. Mitchell
- Center on Aging, School of Nursing, University of Minnesota, Minneapoils, Minnesota
| | - C. Peterson
- Center on Aging, School of Nursing, University of Minnesota, Minneapoils, Minnesota
| | - S.R. Rud
- Center on Aging, School of Nursing, University of Minnesota, Minneapoils, Minnesota
| | - A. Cowl
- Center on Aging, School of Nursing, University of Minnesota, Minneapoils, Minnesota
| | - S. Trost
- Center on Aging, School of Nursing, University of Minnesota, Minneapoils, Minnesota
| |
Collapse
|
49
|
King M, Mitchell L, Belkin Z, Goldstein A. 036 Vulvar Vestibulectomy for Neuroproliferative Associated Vestibulodynia: A Retrospective Case-Control Study. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2017.04.040] [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]
|
50
|
Oh C, Hofbauer G, Serra A, Harwood C, Mitchell L, Proby C, Olasz E, Mosel D, Piaserico S, Fortina A, Geusau A, Jahn-Bassler K, Gerritsen M, Seçkin D, Güleç A, Cetkovská P, Ricar J, Imko-Walczuk B, Dębska-Ślizień A, Bouwes Bavinck J. Painful skin lesions and squamous cell carcinoma predict overall mortality risk in organ transplant recipients: a cohort study. Br J Dermatol 2017; 176:1179-1186. [DOI: 10.1111/bjd.15269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 11/29/2022]
Affiliation(s)
- C.C. Oh
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - G.F.L. Hofbauer
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - A.L. Serra
- Epidemiology, Biostatistics and Prevention Institute; University of Zürich; Zürich Switzerland
| | - C.A. Harwood
- Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London U.K
| | - L. Mitchell
- Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London U.K
| | - C.M. Proby
- Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London U.K
- Division of Cancer Research; University of Dundee; Ninewells Hospital and Medical School; Dundee U.K
| | - E.B. Olasz
- Medical College of Wisconsin; Milwaukee WI U.S.A
| | - D.D. Mosel
- Medical College of Wisconsin; Milwaukee WI U.S.A
| | - S. Piaserico
- Department of Medicine; University of Padua; Padua Italy
| | - A.B. Fortina
- Department of Medicine; University of Padua; Padua Italy
| | - A. Geusau
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - K. Jahn-Bassler
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | | | - D. Seçkin
- Başkent University Faculty of Medicine; Ankara Turkey
| | - A.T. Güleç
- Başkent University Faculty of Medicine; Ankara Turkey
| | - P. Cetkovská
- University Hospital Pilsen; Pilsen Czech Republic
| | - J. Ricar
- University Hospital Pilsen; Pilsen Czech Republic
| | | | - A. Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine; Medical University of Gdańsk; Gdańsk Poland
| | | |
Collapse
|