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Sheitman A, Bello I, Montague E, Scodes J, Dambreville R, Wall M, Nossel I, Dixon L. Observed Trajectories of Cannabis Use and Concurrent Longitudinal Outcomes in Youth and Young Adults Receiving Coordinated Specialty Care for Early Psychosis. Schizophr Res 2024; 267:313-321. [PMID: 38608418 DOI: 10.1016/j.schres.2024.04.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/31/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024]
Abstract
Cannabis use is present and persistent in young adults with early psychosis receiving Coordinated Specialty Care (CSC) in the United States. While CSC programs are effective in improving quality of life, helping individuals reach goals, and promoting recovery, cannabis use may limit the extent of these improvements. This study extended upon previous findings to examine trajectories of cannabis use among individuals with early psychosis. The sample consisted of 1325 CSC participants enrolled for more than one year at OnTrackNY and followed up to two years, categorized into three groups: no use, reduced use, and persistent use. Baseline demographic and clinical differences were compared across groups and associations between clinical and psychosocial outcomes at 12 months and 24 months were examined across groups. Of the sample, 40 % remained persistent users over two years while 12.8 % reduced their use. At baseline, persistent users were younger (p = 0.011), more likely to be male (p < 0.001), had lower education levels (p = 0.019), and were more likely to have had past legal issues prior to admission (p < 0.001) than non-users. At 2 years, persistent users had significantly worse symptom scores than non-users (p = 0.0003) and reduced users (p = 0.0004). These findings highlight the presence of persistent cannabis use being common in this population and the need to improve substance use treatment offered to allow more CSC participants to achieve improved outcomes.
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Affiliation(s)
- A Sheitman
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA.
| | - I Bello
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - E Montague
- Zucker Hillside Hospital, Northwell Health, 75-59 263rd St, Queens, NY 11004, USA
| | - J Scodes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA
| | - R Dambreville
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA
| | - M Wall
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - I Nossel
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - L Dixon
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
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Ratneswaren T, Chan N, Aeron-Thomas J, Sait S, Adesalu O, Alhawamdeh M, Benger M, Garnham J, Dixon L, Tona F, McNamara C, Taylor E, Lobotesis K, Lim E, Goldberg O, Asmar N, Evbuomwan O, Banerjee S, Holm-Mercer L, Senor J, Tsitsiou Y, Tantrige P, Taha A, Ballal K, Mattar A, Daadipour A, Elfergani K, Barker R, Chakravartty R, Murchison AG, Kemp BJ, Simister R, Davagnanam I, Wong OY, Werring D, Banaras A, Anjari M, Rodrigues JCL, Thompson CAS, Haines IR, Burnett TA, Zaher REY, Reay VL, Banerjee M, Sew Hee CSL, Oo AP, Lo A, Rogers P, Hughes T, Marin A, Mukherjee S, Jaber H, Sanders E, Owen S, Bhandari M, Sundayi S, Bhagat A, Elsakka M, Hashmi OH, Lymbouris M, Gurung-Koney Y, Arshad M, Hasan I, Singh N, Patel V, Rahiminejad M, Booth TC. COVID-19 Stroke Apical Lung Examination Study 2: a national prospective CTA biomarker study of the lung apices, in patients presenting with suspected acute stroke (COVID SALES 2). Neuroimage Clin 2024; 42:103590. [PMID: 38513535 DOI: 10.1016/j.nicl.2024.103590] [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: 01/26/2024] [Revised: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Apical ground-glass opacification (GGO) identified on CT angiography (CTA) performed for suspected acute stroke was developed in 2020 as a coronavirus-disease-2019 (COVID-19) diagnostic and prognostic biomarker in a retrospective study during the first wave of COVID-19. OBJECTIVE To prospectively validate whether GGO on CTA performed for suspected acute stroke is a reliable COVID-19 diagnostic and prognostic biomarker and whether it is reliable for COVID-19 vaccinated patients. METHODS In this prospective, pragmatic, national, multi-center validation study performed at 13 sites, we captured study data consecutively in patients undergoing CTA for suspected acute stroke from January-March 2021. Demographic and clinical features associated with stroke and COVID-19 were incorporated. The primary outcome was the likelihood of reverse-transcriptase-polymerase-chain-reaction swab-test-confirmed COVID-19 using the GGO biomarker. Secondary outcomes investigated were functional status at discharge and survival analyses at 30 and 90 days. Univariate and multivariable statistical analyses were employed. RESULTS CTAs from 1,111 patients were analyzed, with apical GGO identified in 8.5 % during a period of high COVID-19 prevalence. GGO showed good inter-rater reliability (Fleiss κ = 0.77); and high COVID-19 specificity (93.7 %, 91.8-95.2) and negative predictive value (NPV; 97.8 %, 96.5-98.6). In subgroup analysis of vaccinated patients, GGO remained a good diagnostic biomarker (specificity 93.1 %, 89.8-95.5; NPV 99.7 %, 98.3-100.0). Patients with COVID-19 were more likely to have higher stroke score (NIHSS (mean +/- SD) 6.9 +/- 6.9, COVID-19 negative, 9.7 +/- 9.0, COVID-19 positive; p = 0.01), carotid occlusions (6.2 % negative, 14.9 % positive; p = 0.02), and larger infarcts on presentation CT (ASPECTS 9.4 +/- 1.5, COVID-19 negative, 8.6 +/- 2.4, COVID-19 positive; p = 0.00). After multivariable logistic regression, GGO (odds ratio 15.7, 6.2-40.1), myalgia (8.9, 2.1-38.2) and higher core body temperature (1.9, 1.1-3.2) were independent COVID-19 predictors. GGO was associated with worse functional outcome on discharge and worse survival after univariate analysis. However, after adjustment for factors including stroke severity, GGO was not independently predictive of functional outcome or mortality. CONCLUSION Apical GGO on CTA performed for patients with suspected acute stroke is a reliable diagnostic biomarker for COVID-19, which in combination with clinical features may be useful in COVID-19 triage.
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Affiliation(s)
- T Ratneswaren
- Charing Cross Hospital, London, UK; Addenbrooke's Hospital, Cambridge, UK
| | - N Chan
- Royal London Hospital, London, UK
| | | | - S Sait
- King's College Hospital, London, UK
| | | | | | - M Benger
- King's College Hospital, London, UK
| | | | - L Dixon
- Charing Cross Hospital, London, UK
| | - F Tona
- Charing Cross Hospital, London, UK
| | | | - E Taylor
- Charing Cross Hospital, London, UK
| | | | - E Lim
- Charing Cross Hospital, London, UK
| | | | - N Asmar
- Charing Cross Hospital, London, UK
| | | | | | | | - J Senor
- Charing Cross Hospital, London, UK
| | | | - P Tantrige
- Princess Royal University Hospital, Orpington, UK
| | - A Taha
- Princess Royal University Hospital, Orpington, UK
| | - K Ballal
- Princess Royal University Hospital, Orpington, UK
| | - A Mattar
- Princess Royal University Hospital, Orpington, UK
| | - A Daadipour
- Princess Royal University Hospital, Orpington, UK
| | - K Elfergani
- Princess Royal University Hospital, Orpington, UK
| | - R Barker
- Frimley Park Hospital, Surrey, UK
| | | | | | - B J Kemp
- John Radcliffe Hospital, Oxford, UK
| | | | | | - O Y Wong
- University College Hospital, London, UK
| | - D Werring
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, London, UK; Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - A Banaras
- University College Hospital, London, UK
| | - M Anjari
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, UK
| | | | | | | | | | - R E Y Zaher
- Southampton General Hospital, Southampton, UK
| | - V L Reay
- Southampton General Hospital, Southampton, UK
| | - M Banerjee
- Southampton General Hospital, Southampton, UK
| | | | - A P Oo
- Southampton General Hospital, Southampton, UK
| | - A Lo
- Addenbrooke's Hospital, Cambridge, UK
| | - P Rogers
- Addenbrooke's Hospital, Cambridge, UK
| | - T Hughes
- Cardiff and Vale University Health Board, Cardiff, UK
| | - A Marin
- Cardiff and Vale University Health Board, Cardiff, UK
| | - S Mukherjee
- Cardiff and Vale University Health Board, Cardiff, UK
| | - H Jaber
- Cardiff and Vale University Health Board, Cardiff, UK
| | - E Sanders
- Cardiff and Vale University Health Board, Cardiff, UK
| | - S Owen
- Cardiff and Vale University Health Board, Cardiff, UK
| | | | - S Sundayi
- Watford General Hospital, Watford, UK
| | - A Bhagat
- Watford General Hospital, Watford, UK
| | - M Elsakka
- Watford General Hospital, Watford, UK
| | - O H Hashmi
- Norfolk and Norwich University Hospital, Norwich, UK
| | - M Lymbouris
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | - M Arshad
- Norfolk and Norwich University Hospital, Norwich, UK
| | - I Hasan
- Norfolk and Norwich University Hospital, Norwich, UK
| | - N Singh
- Norfolk and Norwich University Hospital, Norwich, UK
| | - V Patel
- St Thomas' Hospital, London, UK
| | | | - T C Booth
- King's College Hospital, London, UK; School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
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Campbell SA, Bradley HA, Mulder RT, Henderson JMT, Dixon L, Haslett LC, Rucklidge JJ. Effect of antenatal micronutrient or antidepressant exposure on Brazelton neonatal behavioral assessment scale (NBAS) performance within one-month of birth. Early Hum Dev 2024; 190:105948. [PMID: 38367590 DOI: 10.1016/j.earlhumdev.2024.105948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/17/2023] [Accepted: 01/21/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Antenatal depression is a risk factor for poor infant outcomes. Broad-spectrum-micronutrients (vitamins and minerals) have shown efficacy in treating psychiatric symptoms in non-pregnant populations and are associated with reduced incidence of adverse birth outcomes, and improvements in neonatal development. We investigated the effects of treatment of antenatal depression with micronutrients above the Recommended Dietary Allowance on infant development compared to treatment with antidepressant medications and controls. METHOD One-hundred-and-three infants were assessed using the Brazelton Neonatal Behavioral Assessment Scale (NBAS) within 28 days of birth: 37 exposed to micronutrients in-utero (50-182 days exposure), 18 to antidepressants in-utero (exposure for full gestation), and 48 controls whose mothers received neither treatment nor experienced depressive symptoms. RESULTS Controlling for gestational age and parity, there were significant group differences on habituation, orientation, motor, state regulation, autonomic stability and reflexes (p < .05). Micronutrient-exposed performed better than antidepressant-exposed and controls on habituation, motor and autonomic stability (p < .05), effect sizes ranged 1.0-1.7 and 0.5-1.0, respectively. Antidepressant-exposed performed significantly worse on orientation and reflexes compared to micronutrient-exposed and controls. Micronutrient-exposed had significantly better state regulation compared to antidepressant-exposed. There was an association between micronutrient exposure length and better habituation (r = 0.41, p = .028). Micronutrient exposure was generally identified as a stronger predictor of neonatal performance over maternal depression, social adversity, gestational age and infant sex. CONCLUSION In-utero micronutrient exposure appears to mitigate risks of depression on infant outcomes showing positive effects on infant behavior, on par with or better than typical pregnancies and superior to antidepressants. Limitations include differential exposure to micronutrients/antidepressants and lack of group blinding.
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Affiliation(s)
- S A Campbell
- School of Psychology, Speech and Hearing, University of Canterbury, New Zealand
| | - H A Bradley
- School of Psychology, Speech and Hearing, University of Canterbury, New Zealand
| | - R T Mulder
- Department of Psychological Medicine, University of Otago, New Zealand
| | - J M T Henderson
- School of Psychology, Speech and Hearing, University of Canterbury, New Zealand
| | - L Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - L C Haslett
- School of Psychology, Speech and Hearing, University of Canterbury, New Zealand
| | - J J Rucklidge
- School of Psychology, Speech and Hearing, University of Canterbury, New Zealand.
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Caljé E, Oyston C, Wang Z, Bloomfield F, Marriott J, Dixon L, Groom K. The fatigue after infusion or transfusion pilot trial and feasibility study: A three-armed randomized pilot trial of intravenous iron and blood transfusion for the treatment of postpartum anemia. Transfusion 2024; 64:301-314. [PMID: 38149691 DOI: 10.1111/trf.17621] [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] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Evidence for the management of moderate-to-severe postpartum anemia is limited. A randomized trial is needed; recruitment may be challenging. STUDY DESIGN AND METHODS Randomized pilot trial with feasibility surveys. INCLUSION hemoglobin 65-79 g/L, ≤7 days of birth, hemodynamically stable. EXCLUSION ongoing heavy bleeding; already received, or contraindication to intravenous (IV)-iron or red blood cell transfusion (RBC-T). Intervention/control: IV-iron; RBC-T; or IV-iron and RBC-T. PRIMARY OUTCOME number of recruits; proportion of those approached; proportion considered potentially eligible. SECONDARY OUTCOMES fatigue, depression, baby-feeding, and hemoglobin at 1, 6 and 12 weeks; ferritin at 6 and 12 weeks. Surveys explored attitudes to trial participation. RESULTS Over 16 weeks and three sites, 26/34 (76%) women approached consented to trial participation, including eight (31%) Māori women. Of those potentially eligible, 26/167 (15.6%) consented to participate. Key participation enablers were altruism and study relevance. For clinicians and stakeholders the availability of research assistance was the key barrier/enabler. Between-group rates of fatigue and depression were similar. Although underpowered to address secondary outcomes, IV-iron and RBC-T compared with RBC-T were associated with higher hemoglobin concentrations at 6 (mean difference [MD] 11.7 g/L, 95% confidence interval [CI] 2.7-20.7) and 12 (MD 12.8 g/L, 95% CI 1.5-24.2) weeks, and higher ferritin concentrations at 6 weeks (MD 136.8 mcg/L, 95% CI 76.6-196.9). DISCUSSION Willingness to participate supports feasibility for a future trial assessing the effectiveness of IV-iron and RBC-T for postpartum anemia. Dedicated research assistance will be critical to the success of an appropriately powered trial including women-centered outcomes.
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Affiliation(s)
- Esther Caljé
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
- Middlemore Hospital, Auckland, New Zealand
| | - Zeke Wang
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Frank Bloomfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Joy Marriott
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lesley Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - Katie Groom
- Liggins Institute, The University of Auckland, Auckland, New Zealand
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
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Caljé E, Groom KM, Dixon L, Marriott J, Foon R, Oyston C, Bloomfield FH, Jordan V. Intravenous iron versus blood transfusion for postpartum anemia: a systematic review and meta-analysis. Syst Rev 2024; 13:9. [PMID: 38169415 PMCID: PMC10759729 DOI: 10.1186/s13643-023-02400-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Intravenous iron (IV-iron) is used as an alternative to, or alongside, red blood cell transfusion (RBC-T) to treat more severe postpartum anemia (PPA), although optimal treatment options remain unclear. No previous systematic reviews have examined IV-iron and RBC-T, including patient-reported outcomes and hematological responses. METHODS A systematic review and meta-analysis of randomized trials comparing IV-iron and RBC-T with each other, oral iron, no treatment, and placebo for the treatment of PPA. Key inclusion criteria were PPA (hemoglobin < 12 g/dL) and IV-iron or RBC-T as interventions. Key exclusion criteria were antenatal IV-iron or RBC-T. Fatigue was the primary outcome. Secondary outcomes included hemoglobin and ferritin concentrations, and adverse events. From 27th August 2020 to 26th September 2022, databases, registries, and hand searches identified studies. A fixed-effect meta-analysis was undertaken using RevMan (5.4) software. The quality of the studies and the evidence was assessed using the Cochrane Risk of Bias table, and Grading of Recommendations, Assessment, Development, and Evaluation. This review is registered with the Prospective Register of Systematic Reviews (CRD42020201115). RESULTS Twenty studies and 4196 participants were included: 1834 assigned IV-iron, 1771 assigned oral iron, 330 assigned RBC-T, and 261 assigned non-intervention. Six studies reported the primary outcome of fatigue (1251 participants). Only studies of IV-iron vs. oral iron (15 studies) were available for meta-analysis. Of these, three reported on fatigue using different scales; two were available for meta-analysis. There was a significant reduction in fatigue with IV-iron compared to oral iron (standardized mean difference - 0.40, 95% confidence interval (CI) - 0.62, - 0.18, I2 = 0%). The direction of effect also favored IV-iron for hemoglobin (mean difference (MD) 0.54 g/dL, 95% confidence interval (CI) 0.47, 0.61, I2 = 91%), ferritin, (MD 58.07 mcg/L, 95% CI 55.74, 60.41, I2 = 99%), and total adverse events (risk-ratio 0.63, 95% CI 0.52, 0.77, I2 = 84%). The overall quality of the evidence was low-moderate. DISCUSSION For all outcomes, the evidence for RBC-T, compared to IV-iron, non-intervention, or dose effects of RBC-T is very limited. Further research is needed to determine whether RBC-T or IV-iron for the treatment of PPA is superior for fatigue and hematological outcomes.
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Affiliation(s)
- E Caljé
- Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - K M Groom
- Liggins Institute, University of Auckland, Auckland, New Zealand
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - L Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - J Marriott
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - R Foon
- Waikato Hospital, Hamilton, New Zealand
| | - C Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
- Middlemore Hospital, Auckland, New Zealand
| | - F H Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - V Jordan
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
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Dixon L, Daellenbach S, Anderson J, Neely E, Nisa-Waller A, Lockwood S. Building positive respectful midwifery relationships: An analysis of women's experiences of continuity of midwifery care in Aotearoa New Zealand. Women Birth 2023; 36:e669-e675. [PMID: 37422367 DOI: 10.1016/j.wombi.2023.06.008] [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: 01/22/2023] [Revised: 06/01/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
PROBLEM/BACKGROUND Respectful woman-centred care is an expectation of the Midwifery Standards of Practice within Aotearoa New Zealand. With both the national and international expectations identifying human rights as a priority in maternity care. Mistreatment can be experienced by women in all socio-political contexts. Identifying women's experiences of their maternity service is vital when assessing the quality of these services. AIM To explore women's experiences of continuity of midwifery care in Aotearoa NZ, whether they support the expectations within the Standards of Midwifery Practice and identify the characteristics of care that may contribute to positive or negative experiences of care. METHODS A retrospective analysis of women's formal online feedback to their midwife using a mixed method design. Feedback forms received from the 1st January 2019 to the 31st December 2019 were analysed using descriptive statistics with free text thematically analysed. FINDINGS A total of 7749 feedback forms were received demonstrating high levels of satisfaction overall. Three overlapping themes were identified as being central to both positive and negative feedback. Building a positive relationship involved three steps. These were the establishment and maintenance of trust, honouring decisions and empowerment. Overall, the existence of these relationship characteristics contributed to a valued woman-midwife relationship. Women who gave negative feedback identified a lack of trust and a failure to honour decisions which led to women feeling disempowered contributing to a lack of being valued in the relationship. CONCLUSION Continuity of care in Aotearoa NZ supports the development of a respectful partnership through trust, honouring decisions and empowerment.
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Affiliation(s)
- Lesley Dixon
- New Zealand College of Midwives, Christchurch Office, PO Box 21 -106, Christchurch 8140, New Zealand; New Zealand College of Midwives| Te Kāreti o ngā Kaiwhakawhānau ki Aotearoa, New Zealand.
| | - Shanti Daellenbach
- New Zealand College of Midwives| Te Kāreti o ngā Kaiwhakawhānau ki Aotearoa, New Zealand
| | - Jacqui Anderson
- New Zealand College of Midwives| Te Kāreti o ngā Kaiwhakawhānau ki Aotearoa, New Zealand
| | - Eva Neely
- Pūkenga Hāpai Hauora | Health Promotion Victoria University of Wellington\ Te Herenga Waka, New Zealand
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Gaffney J, Rieu R, France AK, Glynn AM, Brown K, Rooney C, Swan A, Kapacee Z, Brennan B, Dyker K, Noble D, Dixon L, Houghton F, Mandeville HC, Brennan SM, Gains J, Lim P, Thomson DD, McPartlin A, Pan S. Evaluation of Radiotherapy Dose and Survival Outcomes for Teenagers, and Young Adults with Nasopharyngeal Carcinoma in UK and Ireland. Int J Radiat Oncol Biol Phys 2023; 117:e582. [PMID: 37785767 DOI: 10.1016/j.ijrobp.2023.06.1924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Nasopharyngeal carcinoma (NPC) follows a bimodal distribution with a smaller incidence peak in teenagers and young adults (TYAs). In TYAs, an over-whelming proportion are associated with Epstein-Barr virus (EBV). We have evaluated the variation in TYA NPC practice patterns across the UK and Ireland, along with survival outcomes. MATERIALS/METHODS We performed a multicenter, observational cohort study, of patients aged 13-25 years, with histologically confirmed NPC, treated between the years 2002-2022. An initial expression of interest was sent to selected centers treating H&N patients in the UK and Ireland. For analysis, patients were assessed based on total prescribed dose, with a cut off for low dose (LD) (≤61.2Gy) versus a high dose (HD)(>61.2Gy). RESULTS Ninety-five patients, from 9 centers, were eligible for inclusion. Patient demographics are shown in table1. At a median follow up of 45 months (IQR 23-111), 3-year overall survival (OS) was 98% (95% CI 93%-100%) with LD versus 91% (95% CI 83%-99%) with HD (Hazard ratio (HR) = 3.0; 95% CI 0.3-27, p = 0.3). 3-year progression free survival (PFS) was 84% (95% CI 71%-97%) with LD versus 83% (95% CI 72%-94%) with HD (HR 1.3; 95% CI 0.4-4.0, p = 0.6), and 5-year PFS was 84% (95% CI 71%-97%) with LD versus 83% (95% CI 72%-94%) with HD (HR 1.3; 95% CI 0.4-4.0, p = 0.6). Incidence of distant metastasis (DM) was 9.9%. 2 patients (6%) with T3-T4 tumors, treated with LD, had locoregional failure (LRF) compared to 1 patient (3%) treated with HD. CONCLUSION We have demonstrated excellent survival outcomes for the UK & Ireland TYA NPC patients. As the majority of cases in this age group have EBV+ NPC, with survival similar between LD and HD protocols, we propose that pediatric protocols, with lower radiotherapy doses should be considered for all TYA NPC, with the aim of reducing late effects. Additional analysis to better understand the impact of heterogeneity between both groups, including choice of protocol, induction and adjuvant treatment will follow this study. Prospective evaluation, as part of an international collaboration, is required to optimize the management strategy for this rare cohort of patients.
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Affiliation(s)
- J Gaffney
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - R Rieu
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - A K France
- The Christie NHS Foundation Trust, Proton Clinical Outcomes Unit, Manchester, United Kingdom
| | - A M Glynn
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - K Brown
- Belfast Health & Social Care Trust, Belfast, Belfast, Ireland
| | - C Rooney
- Belfast Health & Social Care Trust, Belfast, Belfast, Ireland
| | - A Swan
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, United Kingdom
| | - Z Kapacee
- Leeds Teaching Hospital NHS Trust, Leeds, UK, Leeds, United Kingdom
| | - B Brennan
- Royal Manchester Children's Hospital, Manchester, UK, Manchester, United Kingdom
| | - K Dyker
- Leeds Teaching Hospital NHS Trust, Leeds, UK, Leeds, United Kingdom
| | - D Noble
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, United Kingdom
| | - L Dixon
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK, Sheffield, United Kingdom
| | - F Houghton
- Belfast Health & Social Care Trust, Belfast, Belfast, Ireland
| | - H C Mandeville
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - S M Brennan
- St.Luke's Radiation Oncology Network, Dublin, Ireland
| | - J Gains
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - P Lim
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - D D Thomson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - A McPartlin
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - S Pan
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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Rieu R, Prestwich RJ, Paterson C, Vohra S, Swan A, Noble D, Srinivasan D, Dixon L, Chiu K, Scott A, Mendes R, Khan S, Pilar A, Thompson A, Nutting CM, McPartlin A. A Multicenter Study of Clinician and Patient Reported Acute and Late Toxicity after Radical (Chemo)Radiotherapy for Non-Endemic Nasopharyngeal Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e619. [PMID: 37785855 DOI: 10.1016/j.ijrobp.2023.06.2001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Curative (chemo)radiotherapy ((CT)RT) for Nasopharyngeal cancers (NPC) achieves excellent disease control but is associated with significant late toxicities despite modern treatment delivery. Contemporary late toxicity data, including patient reported outcomes (PROs), is limited in the non-endemic population; we present a large contemporary series of toxicity outcomes and late PROs following treatment of non-endemic NPC. MATERIALS/METHODS Adult patients completing radical (CT)RT for primary NPC between February 2016 and 2020 at 7 large UK cancer centers were identified on institutional databases. Patients were excluded if they had prior head and neck cancer or prior therapeutic head and neck surgery (except neck dissection). Patients with an active other cancer were excluded from PRO assessment. Demographic, treatment, acute toxicity and outcome data were collected retrospectively from patient records. Disease-free patients were invited to complete an M.D. Anderson Dysphagia Index (MDADI) and University of Washington (UoW) Quality of Life (QoL) PROs questionnaires. RESULTS A total of 180 eligible patients were identified: 68% male, median age 54 years, 11% ≥70 years. EBV status was positive in 61% (unknown 12%). Patients had stage I (5%), II (22%), III (37%), IV (36%) disease; 95% were performance status ≤1 at baseline. Median follow-up was 31.2 months (range 0-68). A total of 54% received 70Gy in 33-35# and 43% received 65-66 Gy in 30-33#. 66% received induction and 65% received concurrent chemotherapy. 9.5% had residual disease at the first follow-up scan. Subsequent locoregional or distant recurrence occurred in 5% and 12% respectively. At last assessment, 84% patients were alive, 16% had died (of which 70% had active disease). Acute treatment toxicity included: 63% of patients required enteral support (median duration 98 days) with 9% a feeding tube at 1 year post treatment. 18% G3 dermatitis, 53% G3 mucositis. 82% requiring opioids and 40% admitted for symptom management. 90 patients completed the PROs (76% response rate) at a median of 37.8 months post treatment (Table 1). These demonstrate significant QoL detriment: 28% report significant pain, 24% require regular analgesia, and 59% report significant impact on daily activity. This was found to persist at different timepoints (not shown). CONCLUSION Excellent cancer survival outcomes are seen in a non-selected, non-endemic NPC population. However significant acute and late toxicity following radical treatment is identified which can profoundly negatively impact QoL in a relatively young cohort. This highlights the importance of ongoing efforts to reduce toxicity and supports the prospective evaluation of potential toxicity sparing technologies, such as proton beam radiotherapy.
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Affiliation(s)
- R Rieu
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - R J Prestwich
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - C Paterson
- Beatson West of Scotland Cancer Centre, Radiation Oncology Department, Glasgow, United Kingdom
| | - S Vohra
- Beaton West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - A Swan
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, United Kingdom
| | - D Noble
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, United Kingdom
| | - D Srinivasan
- Western General Hospital, Edinburgh, United Kingdom
| | - L Dixon
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK, Sheffield, United Kingdom
| | - K Chiu
- Mount Vernon Cancer Centre, Department of Clinical Oncology, Northwood, United Kingdom
| | - A Scott
- Mount Vernon Hospital, Department of Clinical Oncology, Northwood, United Kingdom
| | - R Mendes
- University College London Hospital, London, United Kingdom
| | - S Khan
- University College London Hospital, London, United Kingdom
| | - A Pilar
- University College London Hospital, London, United Kingdom
| | - A Thompson
- North Middlesex University Hospital, Cambridge CB2 8AP, United Kingdom
| | - C M Nutting
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - A McPartlin
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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9
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Lin L, St Clair S, Gamble GD, Crowther CA, Dixon L, Bloomfield FH, Harding JE. Nitrate contamination in drinking water and adverse reproductive and birth outcomes: a systematic review and meta-analysis. Sci Rep 2023; 13:563. [PMID: 36631499 PMCID: PMC9834225 DOI: 10.1038/s41598-022-27345-x] [Citation(s) in RCA: 6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023] Open
Abstract
Exposure to low levels of nitrate in drinking water may have adverse reproductive effects. We reviewed evidence about the association between nitrate in drinking water and adverse reproductive outcomes published to November 2022. Randomized trials, cohort or case-control studies published in English that reported the relationship between nitrate intake from drinking water and the risk of perinatal outcomes were included. Random-effect models were used to pool data. Three cohort studies showed nitrate in drinking water is associated with an increased risk of preterm birth (odds ratio for 1 mg/L NO3-N increased (OR1) = 1.01, 95% CI 1.00, 1.01, I2 = 23.9%, 5,014,487 participants; comparing the highest versus the lowest nitrate exposure groups pooled OR (ORp) = 1.05, 95% CI 1.01, 1.10, I2 = 0%, 4,152,348 participants). Case-control studies showed nitrate in drinking water may be associated with the increased risk of neural tube defects OR1 = 1.06, 95% CI 1.02, 1.10; 2 studies, 2196 participants; I2 = 0%; and ORp = 1.51, 95% CI 1.12, 2.05; 3 studies, 1501 participants; I2 = 0%). The evidence for an association between nitrate in drinking water and risk of small for gestational age infants, any birth defects, or any congenital heart defects was inconsistent. Increased nitrate in drinking water may be associated with an increased risk of preterm birth and some specific congenital anomalies. These findings warrant regular review as new evidence becomes available.
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Affiliation(s)
- Luling Lin
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Sophie St Clair
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Greg D. Gamble
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Caroline A. Crowther
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Lesley Dixon
- New Zealand College of Midwives, 376 Manchester Street, Richmond, Christchurch, 8014 New Zealand
| | - Frank H. Bloomfield
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane E. Harding
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
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10
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White K, Arey W, Whitfield B, Vizcarra E, Dane'el A, Dixon L, Potter JE, Ogburn T, Beasley A. 002Abortion patients’ priorities and tradeoffs deciding where to obtain out-of-state care following texas 2021 abortion ban. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.007] [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: 11/19/2022]
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11
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Edhem L, Dixon L, Jones J, Bahri S, Maxwell-Armstrong C. O022 Application of customised 3D printed models to aid undergraduate teaching and surgical planning in hepatobiliary surgery. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Introduction
3D-printing in maxillofacial surgery has been used for several years to construct bespoke prostheses prior to surgical procedures. This work aims to assess whether its role can be
expanded into undergraduate teaching and surgical planning in hepatobiliary surgery.
Methods
Four patient CT scans with liver and renal pathology were deemed eligible for printing. A computer aided design was constructed for each scan, segmenting the organ, lesion, and vasculature. One kidney and three liver models were printed. Production time of the models ranged from 31 to 106 hours. One liver model with the associated CT scan was shown to 20 doctors of varying experience. They were asked to complete a survey evaluating its potential in surgery, aiding patient education, and anatomy education. The remaining models were used in an anatomy tutorial for 6 medical students, who were requested to complete a pre-and-post-session survey evaluating the potential for the 3D models in anatomy education.
Results
An average rating from the NHS-staff survey was 6.9 for pre-operative planning, 8.65 for aiding anatomy education, and 9.15 for potential use in patient education. Following the tutorial with the models, 4 of the 6 students felt their overall understanding of liver anatomy improved. In particular, all students expressed increased confidence in hepatic segmentation anatomy.
Conclusion
Our work shows that 3D-printed models can provide benefit in aiding clinical teaching and patient information. Future work will focus on use of the models as an aid to patient education in an outpatient setting.
Take-home message
3D-printed models have a future in aiding anatomy education and hepatobiliary surgical planning. Further research can consolidate their applications.
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12
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Calje E, Marriott J, Oyston C, Dixon L, Bloomfield F, Groom K. Postpartum anaemia in three New Zealand district health board regions: An observational study of incidence and management. Aust N Z J Obstet Gynaecol 2022; 63:178-186. [PMID: 35851951 DOI: 10.1111/ajo.13588] [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: 04/04/2022] [Accepted: 06/27/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The incidence of postpartum anaemia (PPA) in New Zealand, and the extent of intravenous iron (IV-iron) use in its treatment, are unknown. AIMS To report the incidence of PPA in three district health board (DHB) regions and describe current management of moderate to severe PPA, including by ethnicity. MATERIALS AND METHODS Retrospective observational study of PPA (haemoglobin (Hb) <100 g/L) in three DHBs from July-December 2019. Cases with moderate to severe PPA (Hb <90 g/L) were reviewed and management compared to local and national guidance. Logistic regression examined demographic associations of PPA. RESULTS There were 8849 women who gave birth during the study period: 4076 (46%) had postpartum Hb testing and 1544 (38%) had PPA. Of those tested, and after adjusting for deprivation and region, European women had lower adjusted odds ratios compared to Māori for being identified as having PPA (0.46, 95% CI 0.37-0.57, P < 0.01). Of 681 women with Hb <90 g/L, 278 (41%) received IV-iron only, 66 (10%) red blood cell transfusion (RBC-T) only and 155 (23%) both. Of those receiving RBC-T, 40/221 (18%) were actively bleeding. Māori (92/138, 67%) and Pacific (127/188, 68%) women with Hb <90 g/L had the highest incidence of IV-iron use. No guidelines provided recommendations for haemodynamically stable women without active bleeding. CONCLUSION The incidence and management of PPA differs by ethnicity but fewer than half of the women had Hb testing, making precise determination of incidence impossible. The majority of women with Hb <90 g/L received IV-iron, with or without RBC-T.
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Affiliation(s)
- Esther Calje
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Joy Marriott
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
- Middlemore Hospital, Auckland, New Zealand
| | - Lesley Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - Frank Bloomfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Katie Groom
- Liggins Institute, The University of Auckland, Auckland, New Zealand
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
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13
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Fitzsimons D, Carson MA, Reid J, Hill L, Dixon L, Donnelly P, Slater P, Hill A, Piper SE, Mcdonagh TA, Thompson G. The impact and experience of cardiac cachexia in advanced heart failure patients and their caregivers. Eur J Cardiovasc Nurs 2022. [DOI: 10.1093/eurjcn/zvac060.008] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Northern Ireland Chest Heart & Stroke
Background
Cardiac cachexia is a multifactorial wasting syndrome, which is characterised by unintentional weight loss, a reduction in skeletal muscle mass, and reduced quality of life. There is a paucity of qualitative research outlining the impact and experience of cardiac cachexia in advanced heart failure patients and their caregivers. Research in this area may promote a better understanding of the syndrome, enhance current treatment strategies, and highlight priorities for patient care.
Purpose
To qualitatively investigate the impact and experience of cardiac cachexia in advanced heart failure patients and their caregivers.
Methods
Semi-structured interviews were performed with advanced heart failure (NYHA functional class III-IV) patients meeting diagnostic criteria for cardiac cachexia (number (n) = 8) and their caregivers (n = 5). Interview questions followed a "laddered style approach", with a focus on determining the experience of cachexia for patients and carers, and its impact on their daily lives. Interviews were digitally recorded and transcribed verbatim. Average interview duration was 43 (15-64) minutes. Data were thematically analysed, using the 6-step approach of Braun & Clarke. Themes were developed and refined by several members of the research team to ensure rigor.
Results
Four key themes were developed from the data. 1) "Changed relationship with food and eating": patients with cachexia referred to eating as something they now ‘make’ themselves do without enjoyment, often just to placate their caregiver. Caregivers noted this change in habit and were concerned about inadequate nutritional intake due to the patient’s lack of interest in food. 2) "Not me in the mirror": patients struggled with their appearance and had a negative perception of themselves, linked to their weight loss. Caregivers were similarly aware of the physical changes in their loved ones and emotionally impacted. 3) "Lack of understanding regarding cachexia": despite the patient and caregivers’ concerns, they had a perception that healthcare professionals were just ‘fobbing you off’. Even though weight loss was noted and distressing to patients and caregivers, there was little clinical recognition of it, nor any advice or support from the clinical team regarding management. 4) "Uncertainty regarding the future": patients and caregivers recognised cachexia as a bad sign, and many expressed concerns about their future health and prognosis.
Conclusion
These novel qualitative findings highlight the severe impact of cardiac cachexia on the daily lives of patients and caregivers, and demonstrate their limited understanding of the syndrome. To improve care, professionals need to recognise and discuss cachexia with heart failure patients and caregivers, supporting them to cope with prognostic implications and develop more effective management strategies.
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Affiliation(s)
- D Fitzsimons
- Queen's University of Belfast , Belfast , United Kingdom of Great Britain & Northern Ireland
| | - M A Carson
- Queen's University of Belfast , Belfast , United Kingdom of Great Britain & Northern Ireland
| | - J Reid
- Queen's University of Belfast , Belfast , United Kingdom of Great Britain & Northern Ireland
| | - L Hill
- Queen's University of Belfast , Belfast , United Kingdom of Great Britain & Northern Ireland
| | - L Dixon
- Royal Victoria Hospital , Belfast , United Kingdom of Great Britain & Northern Ireland
| | - P Donnelly
- Ulster Hospital , Belfast , United Kingdom of Great Britain & Northern Ireland
| | - P Slater
- University of Ulster , Belfast , United Kingdom of Great Britain & Northern Ireland
| | - A Hill
- University of Ulster , Belfast , United Kingdom of Great Britain & Northern Ireland
| | - S E Piper
- King's College Hospital NHS Foundation Trust , London , United Kingdom of Great Britain & Northern Ireland
| | - T A Mcdonagh
- King's College Hospital NHS Foundation Trust , London , United Kingdom of Great Britain & Northern Ireland
| | - G Thompson
- Queen's University of Belfast , Belfast , United Kingdom of Great Britain & Northern Ireland
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14
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Sinha S, Dimagli A, Dixon L, Gaudino M, Caputo M, Vohra H, Angelini G, Benedetto U. 1657 Systematic Review and Meta-Analysis of Mortality Risk Prediction Models in Adult Cardiac Surgery. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.263] [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: 11/12/2022]
Abstract
Abstract
Background
The most used mortality risk prediction models in cardiac surgery are the European System for Cardiac Operative Risk Evaluation(EuroSCORE)(ES) and Society of Thoracic Surgeons(STS) score. There is no agreement on which score should be considered more accurate nor which score should be utilised in each population sub-group. We sought to provide a thorough quantitative assessment of these 2 models.
Method
We performed a systematic literature review and captured information on discrimination, as quantified by the area under the receiver operator curve(AUC), and calibration, as quantified by the ratio of observed-to-expected mortality(O:E). We performed random effects meta-analysis of the performance of the individual models as well as pairwise comparisons and sub-group analysis by procedure type, time and continent.
Results
The ES2(AUC 0.783[95%CI 0.765-0.800];O:E 1.102[95%CI 0.943-1.289]) and STS(AUC 0.757[95%CI 0.727-0.785];O:E 1.111[95%CI 0.853-1.447]) both showed good overall discrimination and calibration. There was no significant difference in the discrimination of the two models(Difference in AUC -0.016; 95%CI -0.034 to -0.002;p0.09). However, the calibration of ES2 showed significant geographical variations(p < 0.001) and a trend towards miscalibration with time(p0.0057). This was not seen with STS.
Conclusions
ES2 and STS are both reliable predictors of short-term mortality following adult cardiac surgery in the populations from which they were derived. STS may have broader applications when comparing outcomes across continents and time periods as compared to ES2.
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Affiliation(s)
- S Sinha
- Bristol Heart Institute, Bristol, United Kingdom
| | - A Dimagli
- Bristol Heart Institute, Bristol, United Kingdom
| | - L Dixon
- Bristol Heart Institute, Bristol, United Kingdom
| | - M Gaudino
- Weill Cornell Medical College, New York, USA
| | - M Caputo
- Bristol Heart Institute, Bristol, United Kingdom
| | - H Vohra
- Bristol Heart Institute, Bristol, United Kingdom
| | - G Angelini
- Bristol Heart Institute, Bristol, United Kingdom
| | - U Benedetto
- Bristol Heart Institute, Bristol, United Kingdom
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15
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Di Tommaso E, Bruno VD, Annaiah AS, Oo S, Dixon L, Ascione R. 624 Twenty Years' Experience of Coronary Artery Bypass Grafting in Patients with Reduced Left Ventricular Ejection Fraction. Br J Surg 2021. [DOI: 10.1093/bjs/znab258.025] [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: 11/12/2022]
Abstract
Abstract
Aim
Reduced Left Ventricular Ejection Fraction (LVEF) is a risk factor for patients undergoing Coronary Artery Bypass Grafting (CABG). The aim of our study was to compare short term outcomes and long-term (20 years) survival rates of patients with reduced LVEF undergoing CABG.
Method
Between 1996 and 2015, 5016 patients with reduced LVEF underwent CABG: 1024 (20.4%) had poor LVEF (< 30%) and 3992 (79.6%) had moderate LVEF dysfunction (30-49%). After excluding reoperations and combined procedures, the final sample consisted of 3867 patients. Our primary outcomes were early in-hospital mortality and complications and long-term survivals.
Results
In-hospital mortality rate was 4.4%, stroke rate 1.4% and renal failure 2.9%. Survival rates at 1, 5, 10 and 20 years were 91.1%, 76.7%, 55.1% and 22.1% respectively. Additive Euroscore and Logistic Euroscore (AUC 0.78) is less reliable compared to normal LV patients. Complete revascularization was an independent factor affecting long term survival (HR: 0.85). No difference between OPCABG and ONCABG were found.
Conclusions
CABG is still safe and most likely the best treatment option for patients with reduced LVEF. Completeness of revascularization plays an important role in long term outcomes while OPCABG has no significant advantages. Euroscore has a reduced predicting ability in this group of patients.
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Affiliation(s)
- E Di Tommaso
- Bristol Heart Institute, Bristol, United Kingdom
- University of Bristol, Bristol, United Kingdom
| | - V D Bruno
- University of Bristol, Bristol, United Kingdom
| | - A S Annaiah
- Bristol Heart Institute, Bristol, United Kingdom
| | - S Oo
- Bristol Heart Institute, Bristol, United Kingdom
| | - L Dixon
- Bristol Heart Institute, Bristol, United Kingdom
- University of Bristol, Bristol, United Kingdom
| | - R Ascione
- University of Bristol, Bristol, United Kingdom
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16
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Dixon L, Biggs S, Turner B, Embury-Young Y, Wood F, Leandro L, Lok P, Scroggie D. 1113 Surgical Innovators or Spin Doctors: Reporting of Expectations for Robotic Gastrointestinal Surgery. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.808] [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: 11/12/2022]
Abstract
Abstract
Introduction
The use of robotics in gastrointestinal surgery is an increasingly popular area of surgical innovation. Despite uncertainty regarding clinical benefits, gastrointestinal surgery centres continue to introduce robotic services. This may be motivated by perceived benefits, in lieu of substantial empirical benefits. We aimed to summarise the expected advantages and disadvantages of robotic techniques in gastrointestinal surgery, as reported by study authors.
Method
A systematic review was undertaken by the trainee led RoboSurg Collaborative. Searches were conducted on of Embase, Medline, the Cochrane Library and Web of Science. Articles were double screened by abstract, then full text. All primary studies reporting outcomes following robotic cholecystectomy or oesophagectomy were included. Reports of expected benefits and disadvantages or robotic techniques were extracted verbatim, and summarised using descriptive statistics.
Results
We included 192 studies. An expected benefit was reported in 161 (84%). Of those, 127 (79%) expected robotics to have an intra-operative advantage, such as reduced operative time, improved dexterity and improved visualisation. Post-operative benefits, such as reduced recovery time and shorter length of hospital stay, were expected in 72 (45%). Expected disadvantages were reported in 96 (50%) of the included studies. Of those, 74 (77%) expected robotics to have intra-operative disadvantages such as increased operative times and lack of tactile feedback. Increased cost was another commonly expected limitation.
Conclusions
Study authors reported perceived benefits more frequently than disadvantages. Perceived benefits were more commonly advantageous to the surgeon rather than the patient. There were directly conflicting perceptions of how robotic techniques affect operative times.
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Affiliation(s)
- L Dixon
- University of Bristol, Bristol, United Kingdom
- University Hospitals Bristol & Weston, Bristol, United Kingdom
| | - S Biggs
- University Hospitals Bristol & Weston, Bristol, United Kingdom
| | - B Turner
- Gloucestershire Royal Hospital, Gloucester, United Kingdom
| | - Y Embury-Young
- University Hospitals Bristol & Weston, Bristol, United Kingdom
| | - F Wood
- University of Bristol, Bristol, United Kingdom
| | - L Leandro
- University of Bristol, Bristol, United Kingdom
- University Hospitals Bristol & Weston, Bristol, United Kingdom
| | - P Lok
- University of East Anglia, Norwich, United Kingdom
| | - D Scroggie
- University of Bristol, Bristol, United Kingdom
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17
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Biggs S, Dixon L, Brankin-Frisby T, Dewi F, Torkington A, Olivier J, Kirkham E. 1165 Reporting Patient Selection in Robotic Cholecystectomy: Less than IDEAL? A Systematic Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.809] [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: 11/14/2022]
Abstract
Abstract
Introduction
Laparoscopic cholecystectomy is the gold standard definitive treatment option for benign biliary disease. There has been increasing interest in novel robotic surgical techniques; robotic cholecystectomy (RC) represents the most recent innovation in the management of gallstones. The IDEAL Collaboration has provided guidance for the rigorous and comprehensive reporting of surgical innovations, despite this, transparency in patient selection has been limited. We aimed to assess the reporting of patient selection in studies reporting RC.
Method
A collaborative, systematic review was conducted in accordance with the PRISMA guidance to identify all published studies reporting RC. Study specific inclusion and exclusion criteria were detailed in a protocol.
Results
Searches identified 1425 abstracts; 90 papers were included for data extraction. Inclusion criteria were reported in 38 (42%) studies. The most frequently cited were age (20%), aetiology (20%), presence of symptoms (16%) and comorbidities (10%). Forty-nine (54%) studies reported exclusion criteria. Numerous and variably reported exclusion criteria were reported; acute cholecystitis (26%), previous abdominal surgery (25%), comorbidity (17%), pregnancy (13%), common bile duct stones (13%) and pancreatitis (10%) among others. Seven reported no exclusion criteria. Three reported numbers of patients who declined RC.
Conclusions
Patient selection criteria were inconsistently reported and when present lacked standardisation. Concern persists around patients being “cherry picked” for inclusion in studies reporting innovative robotic surgical procedures, making interpretation and applicability of results impossible. Standardised inclusion criteria are needed to enable greater transparency and reproducibility to ensure the safe adoption of new technologies into clinical practice.
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Affiliation(s)
- S Biggs
- University Hospital Bristol, Bristol, United Kingdom
| | - L Dixon
- University Hospital Bristol, Bristol, United Kingdom
| | | | - F Dewi
- University Hospital Bristol, Bristol, United Kingdom
| | | | - J Olivier
- Severn Deanery, Bristol, United Kingdom
| | - E Kirkham
- Gloucestershire Hospitals NHS Trust, Gloucester, United Kingdom
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18
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Sundar S, Biggs S, Abraham M, Cook J, Watts N, Price R, Brack M, Brown N, Dixon L, Crowther O, Trenaman R, Quinn D, Hall W, Younie S. 1232 Trust-Wide Assessment of Delirium in Post-Operative Elective Surgery. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.138] [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: 11/12/2022]
Abstract
Abstract
Aim
Delirium is an acute change in cognition and associated with adverse patient outcomes. The incidence of post-operative delirium after elective non-cardiac surgery is unknown. We aimed to assess the incidence of post-operative delirium in this group and the effect on patient outcomes.
Method
Patients aged 65 and over who underwent elective non-cardiac surgery were identified on post-operative day three. Delirium screening was performed in real time using the validated 4-AT assessment tool. A retrospective review of the patients’ preoperative and perioperative record was conducted to collect demographics and identify risk factors for delirium. Outcome data was collected at 30 days. Patients with a positive delirium score (>4) underwent a more in-depth assessment and managing teams given a delirium management pack.
Results
75 (39 male) consecutive patients were screened over a period of 4 months. Median age 77 years and 18% had frailty assessed as “vulnerable”. The majority of patients (37.3%) underwent thoracic surgery, followed by hepatobiliary (17.3%), gynaecological (17.3%), colorectal (12%), maxillofacial (9.3%) and ENT (4%). 5.3% (4) of patients had a positive 4-AT screen. No patients had a formal delirium screen or diagnosis in the initial 48 hours. The median length of stay for patients with a positive screen was 8.5 days (IQR 7.5-12) compared to 8 days (IQR 5-13) for patients with a negative screen.
Conclusions
Reassuringly, rate of post-operative delirium following elective operations in our Trust are low (5%). Larger numbers of patients are required to assess the impact this has on patient outcomes and identify correlation with risk factors.
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Affiliation(s)
- S Sundar
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - S Biggs
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - M Abraham
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - J Cook
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - N Watts
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - R Price
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - M Brack
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - N Brown
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - L Dixon
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - O Crowther
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - R Trenaman
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - D Quinn
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - W Hall
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - S Younie
- Bristol Royal Infirmary, Bristol, United Kingdom
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Palant A, Zippel-Schultz B, Ski CF, Brandts J, Eurlings C, Furtado Da Luz Brzychcyk E, Hill L, Dixon L, Fitzsimons D, Thompson D, Mueller-Wieland D, Schuett KA, Hoedemakers T, Brunner La-Rocca HP, Helms TM. Understanding needs and expectations of heart failure patients and their caregivers regarding digital health - the PASSION-HF project. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.036] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): INTERREG-NWE
Background/Introduction
Current heart failure (HF) healthcare provision is not sufficient. Due to demographic changes and subsequent increases in comorbidities, along with unequal distribution of medical care in rural areas, alternative approaches need be sought. The use of eHealth applications has potential to enable patients to become more self-sufficient. The "PASSION-HF" project aims to develop an interactive decision-making system – a virtual doctor – that provides solutions based on current guidelines and artificial intelligence. Patient independence is maximized through 24/7 access to personalized HF-management. Furthermore, the application defines decision points, where medical professionals need to be included.
Purpose
To understand needs and expectations of HF patients and their informal caregivers in regard to a virtual doctor.
Methods
We conducted an exploratory mixed-methods study within the Netherlands, UK, Ireland and Germany. Semi-structured qualitative interviews were supplemented by a standardized questionnaire. The interviews focused on i) acceptance and motivation to use a virtual doctor and ii) experience and perception of current health care provision. The interviews were analysed using the content analysis according to Mayring (2010) with the help of "ATLAS.TI" software. Additional information about the role of informal caregivers, technology acceptance and decision-making processes was collected via questionnaires.
Results
A total of 49 patients and 33 informal caregivers were interviewed. Most patients were male (76%), aged between 60 and 69 years (43%). Three key themes were identified in regard to an interactive decision-making system: 1) Reassurance, because patients felt uncertain about their condition and their symptoms, they had a strong desire for an application that could monitor their health 24/7, was able to spot deteriorations, before they occured and gave them instant feedback about their current health status; 2) Personalized advice, e.g. patients wanted the virtual doctor to adapt medication, sport activities and food recommendations to their current health status; and 3) Transparency, e.g. patients wanted to know, where the recommendations are coming from and justifications for management modifications. Interview findings also identified that the HF-nurses play a significant role in the care and management of the condition. Across all countries with HF-nurses, they were the primary point of contact, when patients had any HF related concerns.
Conclusion
The findings provide valuable information for the development and implementation of eHealth solutions. Patients want reassurance, independently of the availability of healthcare services, combined with personalized advice regarding day-to-day management of their HF. For the next step, we are planning a multicentre clinical trial to test the prototype of the application. Here all decisions are examined by a clinical committee and benefits are evaluated.
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Affiliation(s)
- A Palant
- German foundation for the chronically III, Berlin, Germany
| | | | - CF Ski
- University of Suffolk, Integrated Care Academy, Ipswich, United Kingdom of Great Britain & Northern Ireland
| | - J Brandts
- RWTH University Hospital Aachen, Department of Cardiology, Aachen, Germany
| | - C Eurlings
- Laurentius Hospital Roermond, Cardiology Department, Roermond, Netherlands (The)
| | | | - L Hill
- Belfast Health and Social Care Trust, Belfast, United Kingdom of Great Britain & Northern Ireland
| | - L Dixon
- Belfast Health and Social Care Trust, Belfast, United Kingdom of Great Britain & Northern Ireland
| | - D Fitzsimons
- Belfast Health and Social Care Trust, Belfast, United Kingdom of Great Britain & Northern Ireland
| | - D Thompson
- Belfast Health and Social Care Trust, Belfast, United Kingdom of Great Britain & Northern Ireland
| | - D Mueller-Wieland
- RWTH University Hospital Aachen, Department of Cardiology, Aachen, Germany
| | - KA Schuett
- RWTH University Hospital Aachen, Department of Cardiology, Aachen, Germany
| | | | - H-P Brunner La-Rocca
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - TM Helms
- German foundation for the chronically III, Berlin, Germany
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20
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Carson M, Reid J, Hill L, Dixon L, Donnelly P, Slater P, Hill A, Fitzsimons D. Prevalence and effect of cardiac cachexia in advanced heart failure patients living in northern ireland. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.043] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Northern Ireland Chest Heart and Stroke
Background/Introduction: Cardiac cachexia (CC) is a multifactorial wasting syndrome, resulting in significant weight loss and reduction in muscle mass. This is reflected in a detrimental effect on the patients’ physical condition, quality of life and increases the patient’s risk of premature death. Nonetheless, cardiac cachexia remains frequently unrecognised in clinical practice and therefore understudied.
Purpose
To determine the prevalence and effect of cardiac cachexia in 200 patients with advanced heart failure (NYHA class III-IV) living in Northern Ireland.
Methods
A mixed methods cross sectional study of patients recruited from a regional heart failure centre. A total of 200 patients with NYHA class III-IV heart failure were consented, enrolled and detailed data collected from their records. Anthropometric measures were taken (i.e. measures of lean muscle mass and fat tissue) and each individual completed three validated questionnaires - EQ-5D-5L (quality of life), FACIT-Fatigue and FAACT (various wellbeing subscales).
Results
This population was predominately male (65.5%), with an average age of 74.4 years. Of the 200 NYHA class III-IV patients recruited, 30 were identified as cachectic (15%) Physically, cachectic patients were approximately 25 kg lighter than non-cachectic patients (p < 0.01) with an average BMI of 21.8 ± 4.4. The cachectic group showed significant reductions in mid-upper arm circumference (p < 0.01), skinfold thickness (p < 0.01) and upper arm fat area (p < 0.01), in comparison to the non-cachectic group. Measures of muscle mass were reduced, for example upper arm muscle circumference and area (p < 0.01), as well as grip strength (p < 0.01 for both right and left hands). Quality of life results from the EQ-5D-5L [see figure part b)] indicated an overall reduction for the cachectic group (p = 0.047). Of the EQ-5D-5L subscales, mobility and ‘usual activities’ were significantly reduced (p = 0.02 and p < 0.01 respectively), highlighting a significant change in the daily routine and ability of these patients. The FACIT-Fatigue questionnaire showed cachectic patients to be significantly more fatigued (p < 0.01) [see figure part a)], whilst the FAACT demonstrated reduced physical wellbeing (p = 0.02) and greater issues with diet and appetite (p < 0.01).
Conclusions
This is the first prevalence study of cardiac cachexia within Northern Ireland. The 15% prevalence rate shows that the syndrome is relatively common in the advanced heart failure population. Cardiac Cachexia has severe physical consequences, attributed to an individual’s weight loss in both fat and muscle tissue. Such changes may explain the subsequent decrease in mobility and the ability of these patients to conduct their ‘usual activities’. Increased fatigue, reduced physical wellbeing and issues with diet and appetite only intensify these dire physical effects. It is hoped that these results will highlight the impact of this syndrome and promote targeted interventions.
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Affiliation(s)
- M Carson
- Queen"s University of Belfast, Belfast, United Kingdom of Great Britain & Northern Ireland
| | - J Reid
- Queen"s University of Belfast, Belfast, United Kingdom of Great Britain & Northern Ireland
| | - L Hill
- Queen"s University of Belfast, Belfast, United Kingdom of Great Britain & Northern Ireland
| | - L Dixon
- Belfast Health and Social Care Trust, Belfast, United Kingdom of Great Britain & Northern Ireland
| | - P Donnelly
- South Eastern Health and Social Care Trust, Belfast, United Kingdom of Great Britain & Northern Ireland
| | - P Slater
- University of Ulster, Belfast, United Kingdom of Great Britain & Northern Ireland
| | - A Hill
- University of Ulster, Belfast, United Kingdom of Great Britain & Northern Ireland
| | - D Fitzsimons
- Queen"s University of Belfast, Belfast, United Kingdom of Great Britain & Northern Ireland
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21
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Mharapara TL, Staniland N, Stadler M, Clemons JH, Dixon L. Drivers of job satisfaction in midwifery-A work design approach. Women Birth 2021; 35:e348-e355. [PMID: 34312099 DOI: 10.1016/j.wombi.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Identifying common factors that influence job satisfaction for midwives working in diverse work settings is challenging. Applying a work design model developed in organisational behaviour to the midwifery context may help identify key antecedents of midwives job satisfaction. AIM To investigate three job characteristics - decision-making autonomy, empowerment, and professional recognition as antecedents of job satisfaction in New Zealand (NZ) midwives. METHODS Latent multiple regressions were performed on data from Lead Maternity Carer (LMC) midwives n = 327, employed midwives n = 255, and midwives working in 'mixed-roles' n = 123. FINDINGS We found that professional recognition is positively linked to job satisfaction for midwives in all three work settings. At the same time, decision-making autonomy and empowerment were shown to influence job satisfaction for midwives working as LMCs only. DISCUSSION Our main finding suggests that the esteem generated from being acknowledged as an expert and valuable contributor by maternity health colleagues is satisfying across all work contexts. Professional recognition encompasses the social dimension of midwifery work and influences midwives job satisfaction. Decision-making autonomy and empowerment are task and relational job characteristics that may not be similarly experienced by all midwives to noticeably influence job satisfaction. CONCLUSION Given that job satisfaction contributes to recruitment, retention, and sustainability, our findings show that drivers of job satisfaction differ by midwifery work context. We present evidence to support tailored efforts to bolster midwives job satisfaction, especially where resources are limited.
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Affiliation(s)
- Tago L Mharapara
- Auckland University of Technology, AUT Department of Management, Private Bag 92006, Victoria Street West, Auckland 1142, New Zealand.
| | - Nimbus Staniland
- Auckland University of Technology, AUT Department of Management, Private Bag 92006, Victoria Street West, Auckland 1142, New Zealand.
| | - Matthias Stadler
- Ludwig-Maximilians-Universität München, Faculty of Psychology, Raum 3432, Leopoldstr. 13, 80802 München, Germany.
| | - Janine H Clemons
- Auckland University of Technology, AUT Midwifery Department, Private Bag 92006, 640 Great South Road, Manukau, Auckland 2104, New Zealand.
| | - Lesley Dixon
- New Zealand College of Midwives, PO Box 21-106, Edgeware, Christchurch 8143, New Zealand.
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22
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Neely E, Dixon L, Bartle C, Raven B, Aspin C. Providing maternity care for disadvantaged women in Aotearoa New Zealand: The impact on midwives. Women Birth 2021; 35:144-151. [PMID: 33858787 DOI: 10.1016/j.wombi.2021.03.014] [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: 12/08/2020] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Health inequities and socio-economic disadvantage are causes for concern in Aotearoa New Zealand. Becoming pregnant can increase a woman's vulnerability to poverty, with the potential for an increase in multiple stressful life events. Providing midwifery care to women living in socio-economic deprivation has been found to add additional strains for midwives. Exploring the perspectives of the midwives providing care to women living with socio-economic deprivation can illuminate the complexities of maternity care. AIM To explore the impact on midwives when providing care for socio-economically disadvantaged women in Aotearoa New Zealand. METHOD Inductive thematic analysis was used to analyse an open-ended question from a survey that asked midwives to share a story around maternal disadvantage and midwifery care. FINDINGS A total of 214 stories were received from midwives who responded to the survey. Providing care to disadvantaged women had an impact on midwives by incurring increased personal costs (time, financial and emotional), requiring them to navigate threats and uncertainty and to feel the need to remedy structural inequities for women and their wider families. These three themes were moderated by the relationships midwives held with women and affected the way midwives worked across the different maternity settings. CONCLUSION Midwives carry a greater load when providing care to socio-economically deprived women. Enabling midwives to continue to provide the necessary support for women living in socio-economic deprivation is imperative and requires additional resources and funding.
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Affiliation(s)
- Eva Neely
- School of Health, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand; Maternity Equity Action, Hawkes Bay, New Zealand.
| | - Lesley Dixon
- New Zealand College of Midwives, 376 Manchester Street, Richmond, Christchurch 8014, New Zealand.
| | - Carol Bartle
- New Zealand College of Midwives, 376 Manchester Street, Richmond, Christchurch 8014, New Zealand.
| | - Briony Raven
- Maternity Equity Action, Hawkes Bay, New Zealand.
| | - Clive Aspin
- School of Health, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand.
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23
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Robertson H, Huttman M, Dixon L, Macefield R, Hossaini S, Scroggie D. P106 Robotic Roux-en-Y gastric bypass: A systematic review to examine reporting of a surgical innovation. BJS Open 2021. [DOI: 10.1093/bjsopen/zrab032.105] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed bariatric procedures, and robotic methods are increasingly used. Perceived benefits of robotic surgery include improved visualisation and ergonomics, fewer complications, and shorter hospital stay. Rigorous processes that facilitate the safe transition of surgical innovations such as robotic RYGB into clinical practice are currently lacking. This may place patients at risk, and lead to research waste. The IDEAL Collaboration has produced guidance on the reporting of surgical innovations, but it is not known how robotic RYGB has been reported. This project aims to summarise technique description, governance arrangements and outcome reporting in robotic RYGB.
Methods
A systematic review is being conducted, using PRISMA guidance. A search of Embase, Ovid Medline, the Cochrane Library and Web of Science was performed to identify primary studies reporting outcomes of robotic RYGB. Data will be extracted on study characteristics, governance and ethical arrangements, descriptions of technique, and outcomes. The data will be evaluated in relation to IDEAL principles.
Results
The literature search yielded 1012 studies; 754 remained after de-duplication. Following screening by abstract, 229 full texts were screened. 67 studies will undergo extraction of data. A descriptive summary of the data will be presented, with a critique of the findings.
Conclusion
This study will summarise and appraise how robotic RYGB has been reported. This will contribute towards the development of a standardised and methodical process for the introduction of surgical innovation into clinical practice.
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24
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Culleton S, McKenna B, Dixon L, Taranath A, Oztekin O, Prasad C, Siddiqui A, Mankad K. Imaging pitfalls in paediatric posterior fossa neoplastic and non-neoplastic lesions. Clin Radiol 2021; 76:391.e19-391.e31. [PMID: 33648757 DOI: 10.1016/j.crad.2020.12.011] [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] [Received: 10/30/2019] [Accepted: 12/22/2020] [Indexed: 11/27/2022]
Abstract
Paediatric posterior fossa lesions can have much overlap in their clinical and radiological presentation. There are, however, a number of key imaging features that can help the reading radiologist to distinguish tumours from important tumour mimics which are often inflammatory or metabolic entities. This pictorial review provides a number of important cases that proved challenging on imaging and illustrates some common pitfalls when interpreting lesions in the posterior fossa in children. Not everything that is abnormal will be a tumour, but often other causes are overlooked and misinterpreted as tumours, leading to great morbidity for that child. This article highlights some lesions that were mistaken as tumours and will introduce the reader to less commonly seen pathologies which are important to consider on a differential list for this location.
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Affiliation(s)
- S Culleton
- Department of Paediatric Neuroradiology, Great Ormond Street Hospital, London, UK.
| | - B McKenna
- Department of Paediatric Neuroradiology, Great Ormond Street Hospital, London, UK
| | - L Dixon
- Department of Paediatric Neuroradiology, Great Ormond Street Hospital, London, UK
| | - A Taranath
- Department of Paediatric Neuroradiology, Women and Children's Hospital, Adelaide, Australia
| | - O Oztekin
- Department of Paediatric Neuroradiology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - C Prasad
- Department of Paediatric Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - A Siddiqui
- Department of Paediatric Neuroradiology, Evelina London Children's Hospital, London, UK
| | - K Mankad
- Department of Paediatric Neuroradiology, Great Ormond Street Hospital, London, UK
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25
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Gaur P, Dixon L, Jones B, Lyall H, Jan W. COVID-19-Associated Cytotoxic Lesions of the Corpus Callosum. AJNR Am J Neuroradiol 2020; 41:1905-1907. [PMID: 32819904 DOI: 10.3174/ajnr.a6713] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/11/2020] [Indexed: 11/07/2022]
Abstract
There are very limited published data on the neurologic complications associated with coronavirus disease 2019 (COVID-19) in the pediatric population. Here we present the first 2 pediatric cases of presumed COVID-19 related cytotoxic lesions of the corpus callosum. Similar to reports in adults, these cases suggest that the COVID-19 infection in children may rarely mediate a hyperinflammatory response that can cause CNS pathology. As the pandemic continues further, the presentation of cytotoxic lesions of the corpus callosum should prompt radiologists to consider COVID-19, among other known causes.
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Affiliation(s)
- P Gaur
- From the Departments of Imaging (P.G., L.D., B.J., W.J.)
| | - L Dixon
- From the Departments of Imaging (P.G., L.D., B.J., W.J.)
| | - B Jones
- From the Departments of Imaging (P.G., L.D., B.J., W.J.)
| | - H Lyall
- Paediatric Infectious Diseases (H.L.), Imperial Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - W Jan
- From the Departments of Imaging (P.G., L.D., B.J., W.J.)
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26
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Clemons JH, Gilkison A, Mharapara TL, Dixon L, McAra-Couper J. Midwifery Job Autonomy in New Zealand: I do it all the time. Women Birth 2020; 34:30-37. [PMID: 32962945 DOI: 10.1016/j.wombi.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/24/2020] [Accepted: 09/06/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This research aimed to identify what supports and what hinders job autonomy for midwives in New Zealand. METHODS Registered midwives participated in an open-ended, online survey in 2019. Anonymised participants were asked to describe an incident when they felt they were using their professional judgement and/or initiative to make decisions and the resultant actions. The data was analysed thematically. FINDINGS The participants identified that autonomy is embedded within midwifery practice in New Zealand. Self-employed midwives who provide continuity of care as Lead Maternity Carers, identified they practice autonomously 'all the time'. The relationship with women and their family, and informed decision making, motivated the midwife to advocate for the woman - regardless of the midwife's work setting. Midwifery expertise, skills, and knowledge were intrinsic to autonomy. Collegial relationships could support or hinder the midwives' autonomy while a negative hospital work culture could hinder job autonomy. DISCUSSION Midwives identified that autonomous practice is embedded in their day to day work. It strengthens and is strengthened by their relationships with the woman/whanau and when their body of knowledge is acknowledged by their colleagues. Job autonomy was described when midwifery decisions were challenged by health professionals in hospital settings and these challenges could be viewed as obstructing job autonomy. CONCLUSION The high job autonomy that New Zealand midwives enjoy is supported by their expertise, the women and colleagues that understand and respect their scope of practice. When their autonomy is hindered by institutional culture and professional differences provision of woman-centred care can suffer.
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Affiliation(s)
- Janine H Clemons
- Department of Midwifery, Auckland University of Technology, South Campus, Auckland 2104, New Zealand.
| | - Andrea Gilkison
- Department of Midwifery, Auckland University of Technology, South Campus, Auckland 2104, New Zealand
| | - Tago L Mharapara
- Department of Management, Auckland University of Technology, City Campus, Auckland 1142, New Zealand
| | - Lesley Dixon
- New Zealand College of Midwives, Christchurch 8143, New Zealand
| | - Judith McAra-Couper
- Department of Midwifery, Auckland University of Technology, South Campus, Auckland 2104, New Zealand
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27
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Bradley HA, Campbell SA, Mulder RT, Henderson JMT, Dixon L, Boden JM, Rucklidge JJ. Can broad-spectrum multinutrients treat symptoms of antenatal depression and anxiety and improve infant development? Study protocol of a double blind, randomized, controlled trial (the 'NUTRIMUM' trial). BMC Pregnancy Childbirth 2020; 20:488. [PMID: 32842983 PMCID: PMC7448485 DOI: 10.1186/s12884-020-03143-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 07/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Untreated antenatal depression and anxiety can be associated with short and long term health impacts on the pregnant woman, her infant and the rest of the family. Alternative interventions to those currently available are needed. This clinical trial aims to investigate the efficacy and safety of a broad-spectrum multinutrient formula as a treatment for symptoms of depression and anxiety in pregnant women and to determine the impact supplementation has on the general health and development of the infant. METHODS This randomised, controlled trial will be conducted in Canterbury, New Zealand between April 2017 and June 2022. One hundred and twenty women aged over 16 years, between 12 and 24 weeks gestation and who score ≥ 13 on the Edinburgh Postnatal Depression Scale (EPDS) will be randomly assigned to take the intervention (n = 60) or an active control formula containing iodine and riboflavin (n = 60) for 12 weeks. After 12 weeks, participants can enter an open-label phase until the birth of their infant and naturalistically followed for the first 12 months postpartum. Infants will be followed until 12 months of age. Randomisation will be computer-generated, with allocation concealment by opaque sequentially numbered envelopes. Participants and the research team including data analysts will be blinded to group assignment. The EPDS and the Clinical Global Impressions Scale of Improvement (CGI-I) will be the maternal primary outcome measures of this study and will assess the incidence of depression and anxiety and the improvement of symptomatology respectively. Generalized linear mixed effects regression models will analyse statistical differences between the multinutrient and active control group on an intent-to-treat basis. A minimum of a three-point difference in EPDS scores between the groups will identify clinical significance. Pregnancy outcomes, adverse events and side effects will also be monitored and reported. DISCUSSION Should the multinutrient formula be shown to be beneficial for both the mother and the infant, then an alternative treatment option that may also improve the biopsychosocial development of their infants can be provided for pregnant women experiencing symptoms of depression and anxiety. TRIAL REGISTRATION Trial ID: ACTRN12617000354381 ; prospectively registered at Australian New Zealand Clinical Trials Registry on 08/03/2017.
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Affiliation(s)
- Hayley A. Bradley
- School of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8041 New Zealand
| | - Siobhan A. Campbell
- School of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8041 New Zealand
| | - Roger T. Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jaqueline M. T. Henderson
- School of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8041 New Zealand
| | - Lesley Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - Joseph M. Boden
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Julia J. Rucklidge
- School of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8041 New Zealand
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28
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Bao Y, Papp M, Lee R, Dixon L. Financing Early Psychosis Interventions: Provider Organization Perspectives. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Y. Bao
- Weill Cornell Medical College New York NY United States
| | - M. Papp
- Weill Cornell Medical College New York NY United States
| | - R. Lee
- CUNY Hunter College Silberman School of Social Work New York NY United States
| | - L. Dixon
- New York State Psychiatric Institute Columbia University Medical Center New York NY United States
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29
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Slevin F, Pan S, Mistry H, Sen M, Foran B, Slevin N, Dixon L, Thomson D, Prestwich R. A Multicentre UK Study of Outcomes of Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiotherapy ± Chemotherapy. Clin Oncol (R Coll Radiol) 2019; 32:238-249. [PMID: 31813661 DOI: 10.1016/j.clon.2019.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/25/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 12/30/2022]
Abstract
AIMS To report the outcomes of nasopharyngeal carcinoma in adults across three large centres in a non-endemic region in the era of intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS Adult patients with nasopharyngeal carcinoma treated in three large cancer centres with IMRT ± chemotherapy with curative intent between 2009 and 2016 were identified from institutional databases. Radiotherapy was delivered with 70 Gy in 33-35 daily fractions. A univariable analysis was carried out to evaluate the relationship of patient, tumour and treatment factors with progression-free survival (PFS) and overall survival. RESULTS In total, 151 patients were identified with a median follow-up of 5.2 years. The median age was 52 years (range 18-85). Seventy-five per cent were of Caucasian origin; 75% had non-keratinising tumours; Epstein Barr virus status was only available in 23% of patients; 74% of patients had stage III or IV disease; 54% of patients received induction chemotherapy; 86% of patients received concurrent chemotherapy. Five-year overall survival, PFS, local disease-free survival, regional disease-free survival and distant disease-free survival were 70%, 65%, 91%, 94% and 82%, respectively. Keratinising squamous cell carcinoma, older age, worse performance status, smoking and alcohol intake were associated with inferior overall survival and PFS. CONCLUSIONS Local, regional and distant disease control are relatively high following IMRT ± chemotherapy in a non-endemic population. There was considerable heterogeneity in terms of radiotherapy treatment and the use of chemotherapy, encouraging the development of treatment protocols and expert peer review in non-endemic regions.
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Affiliation(s)
- F Slevin
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - S Pan
- The Christie NHS Foundation Trust, Manchester, UK
| | - H Mistry
- University of Manchester, Manchester, UK
| | - M Sen
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - B Foran
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - N Slevin
- The Christie NHS Foundation Trust, Manchester, UK
| | - L Dixon
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - D Thomson
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - R Prestwich
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Ward K, Dixon L, Cloete E, Gentles T, Bloomfield F. Health professionals' views of newborn pulse oximetry screening in a midwifery-led maternity setting. "It's a good thing to do, but fund it!". Midwifery 2019; 81:102593. [PMID: 31812128 DOI: 10.1016/j.midw.2019.102593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/29/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To understand from health professionals who care for newborns their views on the introduction of pulse oximetry screening for the detection of hypoxaemia in a midwifery-led maternity setting. Although oximetry screening for newborns is internationally accepted, national screening is not yet introduced in New Zealand. In this context, we drew on maternity carers' reflections during a feasibility study of oximetry screening to provide perspectives on barriers and enablers to universal screening. METHODS Data were generated from nine focus groups during five months of 2018 in two north island regions of New Zealand. Participants' (n = 45) opinions about the use of oximetry screening in newborns were analysed thematically using an inductive approach. FINDINGS Overall, participants stated pulse oximetry screening was easy to do, non-invasive, and worthwhile. Midwives were reassured by screening that provided evidence of either a healthy baby or a need for urgent review. From participants' reports, we identified three themes: (1) oximetry screening for newborns is reassuring, practical and worthwhile; (2) midwifery services workload expectations and under-resourcing will hinder universal screening, and (3) location of the baby at the time of screening could impede universal access. CONCLUSION AND IMPLICATIONS FOR PRACTICE Midwives viewed implementing a national pulse oximetry screening programme as sensible but problematic unless resourced and funded appropriately. Policymakers should view the concerns of midwives about human and physical resources as significant and account for the need to resource this screening programme appropriately as a priority before implementation.
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Affiliation(s)
- Kim Ward
- The Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - Lesley Dixon
- New Zealand College of Midwives, Christchurch, Auckland, New Zealand
| | - Elza Cloete
- The Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Tom Gentles
- Starship Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Frank Bloomfield
- The Liggins Institute, University of Auckland, Auckland, New Zealand
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Feldsine PT, Lienau AH, Leung SC, Mui LA, Humbert F, Bohnert M, Mooijman K, Schulten S, Veld PI, Rollier P, Leuschner R, Capps K, Agin J, Allaert C, Asmundson R, Asperger H, Bohnert M, Bound A, Dixon L, Donda S, Espersen M, Foster K, Gangar V, Hammack T, Humbert F, Humes L, in’t Veld P, James L, Jost-Keating K, Kalinowski R, Kwan J, Lamb J, Leung S, Lienau A, Littell A, Mooijman K, Mui L, Ott M, Qvist S, Roberts D, Ruby R, Rude R, Santos C, Schulten S, Sellers R, Smith M, Solis D, Stecchini ML, Stegeman H, Steneryd A, Suktankar V, Wiberg C, Young V. Detection of Salmonella in Fresh Cheese, Poultry Products, and Dried Egg Products by the ISO 6579 Salmonella Culture Procedure and the AOAC Official Method: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.2.275] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Three food types were analyzed for the presence of Salmonella by the AOAC culture method and by the International Organization for Standardization (ISO 6579:2002) culture method. Paired test portions of each food type were simultaneously analyzed by both methods. A total of 21 laboratories representing federal government agencies and private industry, in the United States and Europe, participated in this interlaboratory study. Foods were artificially contaminated with Salmonella and competing microflora if naturally contaminated sources were not available. No statistical differences (p < 0.05) were observed between the AOAC and ISO culture methods for fresh cheese and dried egg products. A statistically significant difference was observed for one of the 2 lots of poultry from the first trial. The poultry meat used in this run was radiation sterilized, artificially contaminated with Salmonella and competitive flora, and then lyophilized. A second trial was conducted with 2 separate lots of raw ground chicken that were naturally contaminated. The results from the second trial showed no statistical difference between the 2 culture methods. A third trial involving 4 laboratories was conducted on 2 separate lots of naturally contaminated raw poultry. Again, no statistically significant differences occurred. It is recommended that ISO 6579:2002 culture method for Salmonella be adopted Official First Action for the analysis of fresh cheese, fresh chilled and frozen poultry, and dried egg products.
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Affiliation(s)
| | - Andrew H Lienau
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | | | - Linda A Mui
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | - Florence Humbert
- Agence Française de Sécurité Sanitaire des Aliments, Laboratoire d'Étude et de Recherches Avicoles et Porcines, BP 53, 22440, Ploufragan, France
| | - Marylène Bohnert
- Agence Française de Sécurité Sanitaire des Aliments, Laboratoire d'Étude et de Recherches Avicoles et Porcines, BP 53, 22440, Ploufragan, France
| | - Kirsten Mooijman
- National Institut of Public Health and Environment, Microbiological Laboratory for Health Protection, PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - Saskia Schulten
- National Institut of Public Health and Environment, Microbiological Laboratory for Health Protection, PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - Paul In’t Veld
- Regional Inspectorate South, PO Box 2280, 5202 CG's-Hertogenbosch, Rijzertlaan 19, 's-Hertogenbosch, The Netherlands
| | - Patricia Rollier
- Centre d'Étude et de Controle des Analyses en Industrie Laitière, BP 89, 39801 Poligny, France
| | - Renata Leuschner
- Ministry of Agriculture, Fisheries, and Food, Control Science Laboratory, Sand Hutton, Y041 1LZ York, United Kingdom
| | - Katherine Capps
- Ministry of Agriculture, Fisheries, and Food, Control Science Laboratory, Sand Hutton, Y041 1LZ York, United Kingdom
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Feldsine PT, Mui LA, Forgey RL, Kerr DE, Al-Hasani S, Arling V, Beatty S, Bohannon J, Brannan J, Brown N, Bryant J, Burford M, Chavez C, Chinault K, Cooan N, Copeland F, Dixon L, Fitzgerald S, Franke W, Frissora R, Gailbreath K, Godon S, Good M, Ha T, Hagen H, Hanson S, Johnson K, Koch S, Leung S, Lienau A, Lin J, Lin S, Marolla B, Maycock L, McDonagh S, Miller L, Otten N, Post R, Resutek J, Rice B, Richter D, Ritger C, Schwantes D, Simon J, Smith J, Smith S, Stokes R, Thibideau J, Tuncan E, Uber D, Van Landingham V, Vrana D, West D. Equivalence of Assurance® Gold Enzyme Immunoassay for Visual or Instrumental Detection of Motile and Nonmotile Salmonella in All Foods to AOAC Culture Method: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/83.4.871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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
Six foods representative of a wide variety of processed, dried powder processed, and raw food types were analyzed by the Assurance® Gold Salmonella Enzyme Immunoassay (EIA) and AOAC INTERNATIONAL culture method. Paired samples of each food type were simultaneously analyzed; one sample by the Assurance method and one by the AOAC culture method. The results for Assurance method were read visually and instrumentally with a microplate reader. A total of 24 laboratories representing federal government agencies and private industry, in the United States and Canada, participated in this collaborative study. Food types were inoculated with species of Salmonella with the exception of raw ground chicken, which was naturally contaminated. No statistical differences (p < 0.05) were observed between Assurance Gold Salmonella EIA with either visual or instrumental interpretation and the AOAC culture method for any inoculation level of any food type or naturally contaminated food. The Assurance visual and instrumental options of reading sample reactions produced the same results for 1277 of the 1296 sample and controls analyzed.
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Affiliation(s)
| | - Linda A Mui
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | - Robin L Forgey
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | - David E Kerr
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
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Renfrew MJ, Ateva E, Dennis-Antwi JA, Davis D, Dixon L, Johnson P, Kennedy HP, Knutsson A, Lincetto O, McConville F, McFadden A, Taniguchi H, Ten Hoope Bender P, Zeck W. Midwifery is a vital solution-What is holding back global progress? Birth 2019; 46:396-399. [PMID: 31270851 DOI: 10.1111/birt.12442] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Mary J Renfrew
- Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Elena Ateva
- White Ribbon Alliance, Washington, District of Columbia
| | | | - Deborah Davis
- ACT Government Health Directorate and University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Lesley Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | | | | | | | | | | | - Alison McFadden
- Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Hatsumi Taniguchi
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Praet SFE, Ong JH, Purdam C, Welvaert M, Lovell G, Dixon L, Gaida JE, Anglim J, Manzanero S, Vlahovich N, Hughes D, Waddington G. Microvascular volume in symptomatic Achilles tendons is associated with VISA-A score. J Sci Med Sport 2018; 21:1185-1191. [PMID: 29789266 DOI: 10.1016/j.jsams.2018.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 04/12/2018] [Accepted: 05/09/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The role of neovascularisation in tendinopathy is still poorly understood, potentially due to technical limitations of conventional power Doppler ultrasound. This study aimed to investigate the association between contrast-enhanced ultrasound (CEUS) microvascular volume (MV), Victorian Institute of Sports Assessment-Achilles (VISA-A) scores and intrinsic Achilles tendon tenderness, as well as two different Power Doppler modes. DESIGN Cross-sectional study. METHODS 20 individuals with uni- or bilateral Achilles tendinopathy completed a VISA-A questionnaire, and underwent microvascular volume measurements of the Achilles tendon mid-portion using both conventional, ultrasensitive (SMI™) power Doppler ultrasound and CEUS. Intrinsic tendon tenderness was assessed with sensation detection threshold to extracorporeal shock waves (ESW). Linear Mixed Model analysis was used to determine the association between microvascular volume (MV), VISA-A, and ESW-detection threshold for both symptomatic and asymptomatic Achilles tendons. RESULTS There was a significant association between VISA-A and MV (B=-5.3, 95%CI=[-8.5; -2.0], P=0.0004), and between MV and symptom duration (B=-1.7, 95%CI=[-3.2; -5.0], P=0.023). No significant associations were found between power Doppler ultrasound and CEUS-based MV or between CEUS-based MV and ESW-detection threshold. In comparison with conventional power Doppler ultrasound, SMI™ showed on average similar detection capacity for neovessels in the mid-portion of the Achilles tendon, whilst being superior for detecting neovessels within Kager's fat pad (t=3.46, 95%CI=[0.27; 1.03], P<0.005). CONCLUSIONS Our results indicate that CEUS-based MV of the Achilles tendon is moderately associated with Achilles tendon symptoms. In accordance, CEUS-detected MV could be a novel target for treatment as it seems to be more sensitive than PDU and is correlated with symptoms.
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Affiliation(s)
- S F E Praet
- Department of Sport Medicine, Australian Institute of Sport, Australia; University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia.
| | - J H Ong
- Department of Sport Medicine, Australian Institute of Sport, Australia
| | - C Purdam
- Department of Physiotherapy, Australian Institute of Sport, Australia
| | - M Welvaert
- Department of Sport Medicine, Australian Institute of Sport, Australia; University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia
| | - G Lovell
- Department of Sport Medicine, Australian Institute of Sport, Australia
| | - L Dixon
- Department of Physiotherapy, Australian Institute of Sport, Australia
| | - J E Gaida
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia; Discipline of Physiotherapy, University of Canberra, Australia
| | - J Anglim
- Department of Sport Medicine, Australian Institute of Sport, Australia
| | - S Manzanero
- Department of Sport Medicine, Australian Institute of Sport, Australia; University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia
| | - N Vlahovich
- Department of Sport Medicine, Australian Institute of Sport, Australia
| | - D Hughes
- Department of Sport Medicine, Australian Institute of Sport, Australia
| | - G Waddington
- Department of Sport Medicine, Australian Institute of Sport, Australia; University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia
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Begley C, Guilliland K, Dixon L, Reilly M, Keegan C, McCann C, Smith V. A qualitative exploration of techniques used by expert midwives to preserve the perineum intact. Women Birth 2018; 32:87-97. [PMID: 29730096 DOI: 10.1016/j.wombi.2018.04.015] [Citation(s) in RCA: 7] [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] [Received: 10/04/2017] [Revised: 03/29/2018] [Accepted: 04/18/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The perineum stretches during birth to allow passage of the baby, but 85% of women sustain some degree of perineal trauma during childbirth, which is painful post-partum. Episiotomy rates vary significantly, with some countries having rates of >60%. Recent Irish and New Zealand studies showed lower severe perineal trauma and episiotomy rates than other countries. AIM To explore expert Irish and New Zealand midwives' views of the skills that they employ in preserving the perineum intact during spontaneous vaginal birth. METHODS Following ethical approval a qualitative, descriptive study was undertaken. Semi-structured, recorded, interviews were transcribed and analysed using the constant comparative method. Expert midwives employed in New Zealand and one setting in Ireland, were invited to join the study. "Expert" was defined as achieving, in the preceding 3.5 years, an episiotomy rate for nulliparous women of <11.8%, a 'no suture' rate of 40% or greater, and a severe perineal tear rate of <3.2%. Twenty-one midwives consented to join the study. RESULTS Four core themes emerged: 'Calm, controlled birth', 'Position and techniques in early second stage', 'Hands on or off?' and 'Slow, blow and breathe the baby out.' Using the techniques described enabled these midwives to achieve rates, in nulliparous women, of 3.91% for episiotomy, 59.24% for 'no sutures', and 1.08% for serious lacerations. CONCLUSIONS This study provides further understanding of the techniques used by expert midwives at birth. These findings, combined with existing quantitative research, increases the evidence on how to preserve the perineum intact during spontaneous birth.
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Affiliation(s)
- C Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - K Guilliland
- New Zealand College of Midwives, Christchurch, New Zealand
| | - L Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - M Reilly
- Midwife-Led Unit, Cavan General Hospital, Cavan, Ireland
| | - C Keegan
- Midwife-Led Unit, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - C McCann
- Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - V Smith
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
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Guinat C, Porphyre T, Gogin A, Dixon L, Pfeiffer DU, Gubbins S. Inferring within-herd transmission parameters for African swine fever virus using mortality data from outbreaks in the Russian Federation. Transbound Emerg Dis 2018; 65:e264-e271. [PMID: 29120101 PMCID: PMC5887875 DOI: 10.1111/tbed.12748] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Indexed: 11/28/2022]
Abstract
Mortality data are routinely collected for many livestock and poultry species, and they are often used for epidemiological purposes, including estimating transmission parameters. In this study, we infer transmission rates for African swine fever virus (ASFV), an important transboundary disease of swine, using mortality data collected from nine pig herds in the Russian Federation with confirmed outbreaks of ASFV. Parameters in a stochastic model for the transmission of ASFV within a herd were estimated using approximate Bayesian computation. Estimates for the basic reproduction number varied amongst herds, ranging from 4.4 to 17.3. This was primarily a consequence of differences in transmission rate (range: 0.7-2.2), but also differences in the mean infectious period (range: 4.5-8.3 days). We also found differences amongst herds in the mean latent period (range: 5.8-9.7 days). Furthermore, our results suggest that ASFV could be circulating in a herd for several weeks before a substantial increase in mortality is observed in a herd, limiting the usefulness of mortality data as a means of early detection of an outbreak. However, our results also show that mortality data are a potential source of data from which to infer transmission parameters, at least for diseases which cause high mortality.
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Affiliation(s)
- C Guinat
- Veterinary Epidemiology, Economics and Public Health Group, Royal Veterinary College, Hatfield, Hertfordshire, UK.,The Pirbright Institute, Pirbright, Surrey, UK
| | - T Porphyre
- The Roslin Institute, University of Edinburgh, Roslin, Midlothian, UK
| | - A Gogin
- European Food Safety Authority, Parma, Italy.,Federal Research Center for Virology and Microbiology, Pokrov, Russia
| | - L Dixon
- The Pirbright Institute, Pirbright, Surrey, UK
| | - D U Pfeiffer
- Veterinary Epidemiology, Economics and Public Health Group, Royal Veterinary College, Hatfield, Hertfordshire, UK.,College of Veterinary Medicine & Life Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - S Gubbins
- The Pirbright Institute, Pirbright, Surrey, UK
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Dixon L, Guilliland K, Pallant J, Sidebotham M, Fenwick J, McAra-Couper J, Gilkison A. The emotional wellbeing of New Zealand midwives: Comparing responses for midwives in caseloading and shift work settings. ACTA ACUST UNITED AC 2017. [DOI: 10.12784/nzcomjnl53.2017.1.5-14] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Affiliation(s)
| | - Lesley Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
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Smith V, Guilliland K, Dixon L, Reilly M, Keegan C, McCann C, Begley C. Irish and New Zealand Midwives' expertise at preserving the perineum intact (the MEPPI study): Perspectives on preparations for birth. Midwifery 2017; 55:83-89. [PMID: 28968521 DOI: 10.1016/j.midw.2017.09.011] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 08/26/2017] [Accepted: 09/17/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVES perineal trauma during birth can result in short or long term morbidity for women. Internationally, rates of episiotomy and severe perineal tears vary considerably. In New Zealand, in 2011, and in a trial of midwife-led care in Ireland, episiotomy rates were found to be considerably lower than those in many other countries. A qualitative exploratory study was undertaken to ascertain how midwives achieve these low rates, in these countries and settings. DESIGN AND PARTICIPANTS a qualitative exploratory study was conducted. Midwives expert in preserving the perineum intact (PPI) from two maternity units in the Republic of Ireland and from varied birth settings in New Zealand, were eligible to participate. Twenty-one consenting midwives took part, seven from Ireland and 14 from New Zealand. METHODS university ethical approval was granted. Face-to-face, semi-structured interviews were used to collect the data. Interviews were recorded and transcribed verbatim. The data were analysed using Ethnograph software and were organised into prominent themes. FINDINGS four themes were identified; 'Sources of knowledge for PPI', 'Associated factors', 'Decision-making on episiotomy', and 'Preparations for PPI'. Participants drew heavily on multiple sources of knowledge in building their own expertise for PPI. Physical characteristics of the perineum featured prominently as factors leading to PPI. Episiotomy was, in the main, only performed when there were signs of fetal distress. Antenatal perineal massage was supported. CONCLUSION this study provides valuable insight into the views and skills of midwives, with expertise in PPI at birth, adding to the body of evidence on this topic.
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Affiliation(s)
- Valerie Smith
- School of Nursing and Midwifery, University of Dublin Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | | | - Lesley Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - Mary Reilly
- Midwife Tutor, Midwife-led Unit, Cavan General Hospital, Cavan, Ireland
| | - Caroline Keegan
- School of Nursing, Midwifery and Health Studies, Dundalk Institute of Technology, Co-Louth, Ireland
| | | | - Cecily Begley
- School of Nursing and Midwifery, University of Dublin Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland; Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Dixon L, Garcez K, Lee LW, Sykes A, Slevin N, Thomson D. Ninety Day Mortality After Radical Radiotherapy for Head and Neck Cancer. Clin Oncol (R Coll Radiol) 2017; 29:835-840. [PMID: 28918176 DOI: 10.1016/j.clon.2017.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 11/24/2022]
Abstract
AIMS Treatment for head and neck cancers using definitive radiotherapy, with or without chemotherapy, is associated with significant acute toxicity. Our aim was to assess 90 day mortality after radical radiotherapy. A further aim was to identify patient, tumour or treatment factors associated with early death after treatment and whether these could be used to predict outcomes. MATERIALS AND METHODS In total, 1116 patients with squamous cell pharyngeal and larynx cancer between January 2011 and December 2015 were included. Patients with T1 larynx cancer were excluded. Patients were treated using radical radiotherapy, with or without chemotherapy. Ninety day mortality was calculated using survival of less than 135 days from the planned start date for radical radiotherapy, to include early deaths during and up to 90 days after treatment. RESULTS Overall, 90 day mortality was 4.7%. Among the subgroup of patients treated with concurrent platinum chemotherapy, the 90 day mortality rate was 0.4%. Overall survival at 1, 3 and 5 years was 84%, 62% and 53%, respectively. Factors associated with a higher risk of early death included performance status > 1, haemoglobin <100 g/l, weight < 60 kg, age > 80 years and presence of multiple comorbidities. CONCLUSION We report excellent crude overall survival rates among our radically treated cohort of head and neck cancer patients. Several factors were associated with an increased risk of death within 90 days of completion of radical head and neck radiotherapy. Given the potential severe acute effects and the impact on patient quality of life associated with radical head and neck radiotherapy, this information is helpful to inform treatment-related discussions with patients.
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Affiliation(s)
- L Dixon
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - K Garcez
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - L W Lee
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - A Sykes
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - N Slevin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester, UK
| | - D Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester, UK.
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Linnaus ME, Kosiorek H, Ocal IT, Dixon L, Barrett MT, Gawryletz CD, Anderson KS, McCullough AE, McEachron TA, Pockaj BA. Abstract P1-03-13: Immunohistochemistry cannot be used to detect PD-L1/JAK-2 amplification. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-03-13] [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
Introduction: We have previously identified a 9p24.1 amplicon targeting PD-L1/JAK2 (PDJ) in subset (26.7%) of triple negative breast cancer (TNBC) patients. The PDJ amplicon is common in newly diagnosed and chemotherapy treated TNBCs and is associated with a worse prognosis. Our goal in this study was to determine whether immunohistochemistry (IHC) evaluation could identify those patients who harbor the PDJ amplicon.
Methods: TNBC patients from 1999 to 2015 whose tumors were flow-sorted and evaluated by array-based comparative genomic hybridization (CGH) were identified; paraffin slides were obtained for IHC staining evaluation of JAK-2, phosphorylated STAT3 (pSTAT3), and PD-L1. Pathologic analysis consisted of scoring the stains for intensity (0-3+) and the relative percent of tumor cells with positive staining; positive score was defined as 3+ for any percent staining. Statistical analysis of IHC staining was performed to determine association with the PDJ amplicon defined by focal 9p24.1 copy number gain with CGH log2ratios of >1.0 for each sorted TNBC sample.
Results: Eleven of 43 TNBC patients evaluable by IHC had the PDJ amplicon. There was no association between PDJ amplification and IHC staining for JAK-2, pSTAT3, or PD-L1 regardless of staining intensity or percentage tumor cells positive. Table 1 describes PDJ amplicon status and positivity for JAK2, pSTAT3 and PD-L1. Of PDJ-positive samples, 64%, stained positive for JAK2, 27% positive for pSTAT3, but 0% for PD-L1 in tumor cells. However, in the PDJ-negative group, 69% still stained positive for JAK2, 19% positive for pSTAT3, and 9% for PD-L1.
Table 1: PDJ amplicon status and IHC staining JAK2 (3+) (n;%)pSTAT3 (3+) (n;%)PD-L1 (3+) (n;%)PDJ - (n=32)22;69%6;19%3;9%PDJ + (n=11)7;64%3;27%0;0%
JAK2: Most PDJ-positive samples (10/11, 91%) showed some JAK-2 staining. Although one had only 1+ staining at 5% of the cells, the majority (7/11, 64%) had staining of 3+ and >10% of the cells with 2 patients demonstrating 3+ staining of 75% and 90% of the cells. However, those patients without the PDJ amplicon also exhibited JAK2 staining, with 66% (n= 22) of PDJ-negative cases staining strongly for JAK-2 (3+) and > 10% of cells.
pSTAT3: All but one PDJ-positive case demonstrated some staining (1+ or greater) for pSTAT3; the staining intensity and percent positivity were much less than the JAK-2 staining with only 2 cases (18%) having 3+ staining of > 10%. Similar staining was seen in the PDJ-negative cohort; 75% of PDJ-negative patients had some pSTAT3 staining (1+ or greater) and 1 patient (5%) exhibited 3+ staining > 10%.
PD-L1: Finally, the PD-L1 staining was low overall with only 18% of PDJ-positive cases demonstrating some staining for PD-L1. Notably, only one case stained 3+ with 20% positivity while the majority of the samples had a 2+ intensity encompassing 5-50% of the cells.
Conclusions: IHC staining for JAK2, pSTAT3, or PD-L1 was not associated with the presence of the PDJ amplicon. Notably positive IHC staining for JAK2 was observed for both PDJ-positive and PDJ-negative tumor cells, thereby nullifying its application as a screening tool for PDJ amplification. Alternative methods, such as fluorescence in situ hybridization, are needed to identify PDJ-positive patients for further study.
Citation Format: Linnaus ME, Kosiorek H, Ocal IT, Dixon L, Barrett MT, Gawryletz CD, Anderson KS, McCullough AE, McEachron TA, Pockaj BA. Immunohistochemistry cannot be used to detect PD-L1/JAK-2 amplification [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-03-13.
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Affiliation(s)
- ME Linnaus
- Mayo Clinic Arizona, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ; Translational Genomics Research Institute (TGen), Phoenix, AZ
| | - H Kosiorek
- Mayo Clinic Arizona, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ; Translational Genomics Research Institute (TGen), Phoenix, AZ
| | - IT Ocal
- Mayo Clinic Arizona, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ; Translational Genomics Research Institute (TGen), Phoenix, AZ
| | - L Dixon
- Mayo Clinic Arizona, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ; Translational Genomics Research Institute (TGen), Phoenix, AZ
| | - MT Barrett
- Mayo Clinic Arizona, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ; Translational Genomics Research Institute (TGen), Phoenix, AZ
| | - CD Gawryletz
- Mayo Clinic Arizona, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ; Translational Genomics Research Institute (TGen), Phoenix, AZ
| | - KS Anderson
- Mayo Clinic Arizona, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ; Translational Genomics Research Institute (TGen), Phoenix, AZ
| | - AE McCullough
- Mayo Clinic Arizona, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ; Translational Genomics Research Institute (TGen), Phoenix, AZ
| | - TA McEachron
- Mayo Clinic Arizona, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ; Translational Genomics Research Institute (TGen), Phoenix, AZ
| | - BA Pockaj
- Mayo Clinic Arizona, Phoenix, AZ; Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ; Translational Genomics Research Institute (TGen), Phoenix, AZ
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Guinat C, Vergne T, Jurado-Diaz C, Sánchez-Vizcaíno JM, Dixon L, Pfeiffer DU. Effectiveness and practicality of control strategies for African swine fever: what do we really know? Vet Rec 2017; 180:97. [PMID: 27852963 PMCID: PMC5293861 DOI: 10.1136/vr.103992] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2016] [Indexed: 12/05/2022]
Abstract
African swine fever (ASF) is a major pig health problem, and the causative virus is moving closer to Western European regions where pig density is high. Stopping or slowing down the spread of ASF requires mitigation strategies that are both effective and practical. Based on the elicitation of ASF expert opinion, this study identified surveillance and intervention strategies for ASF that are perceived as the most effective by providing the best combination between effectiveness and practicality. Among the 20 surveillance strategies that were identified, passive surveillance of wild boar and syndromic surveillance of pig mortality were considered to be the most effective surveillance strategies for controlling ASF virus spread. Among the 22 intervention strategies that were identified, culling of all infected herds and movement bans for neighbouring herds were regarded as the most effective intervention strategies. Active surveillance and carcase removal in wild boar populations were rated as the most effective surveillance and intervention strategies, but were also considered to be the least practical, suggesting that more research is needed to develop more effective methods for controlling ASF in wild boar populations.
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Affiliation(s)
- C Guinat
- Veterinary Epidemiology, Economics and Public Health Group, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK
| | - T Vergne
- Veterinary Epidemiology, Economics and Public Health Group, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK
| | - C Jurado-Diaz
- VISAVET Center and Animal Health Department, Veterinary School, Complutense University of Madrid, Madrid, Spain
| | - J M Sánchez-Vizcaíno
- VISAVET Center and Animal Health Department, Veterinary School, Complutense University of Madrid, Madrid, Spain
| | - L Dixon
- The Pirbright Institute, Ash Road, Pirbright, Surrey, GU24 0NF, UK
| | - D U Pfeiffer
- Veterinary Epidemiology, Economics and Public Health Group, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK
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Kensington M, Campbell N, Gray E, Dixon L, Tumilty E, Pairman S, Calvert S, Lennox S. New Zealand's midwifery profession: Embracing graduate midwives' transition to practice. ACTA ACUST UNITED AC 2016. [DOI: 10.12784/nzcomjnl52.2016.3.20-25] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pairman S, Dixon L, Tumilty E, Gray E, Campbell N, Calvert S, Lennox S, Kensington M. The Midwifery First Year of Practice programme: Supporting New Zealand midwifery graduates in their transition to practice. ACTA ACUST UNITED AC 2016. [DOI: 10.12784/nzcomjnl52.2016.2.12-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Alamri Y, Buchwald P, Dixon L, Dobbs B, Eglinton T, McCormick J, Wakeman C, Frizelle F. Salvage surgery in patients with recurrent or residual squamous cell carcinoma of the anus. Eur J Surg Oncol 2016; 42:1687-1692. [DOI: 10.1016/j.ejso.2016.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/11/2016] [Accepted: 05/12/2016] [Indexed: 11/16/2022] Open
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Parker J, Summerfeldt L, Crane G, McIntyre R, Dixon L. Stability of trait EI during the transition to adulthood: Results of a 15-year follow-up study. Personality and Individual Differences 2016. [DOI: 10.1016/j.paid.2016.05.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
A U.K. population of young offenders show the typical deficits in Verbal IQ reported in conduct disordered populations. Performance IQs are generally lower than those of previous studies from the 1970s, raising a question about decline in intellectual ability.
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Affiliation(s)
- J P Kennedy
- Department of Clinical Psychology, Northern Forensic Mental Health Service for Young People, St Nicholas Hospital, Newcastle upon Tyne, England
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Buchwald P, Diesing L, Dixon L, Wakeman C, Eglinton T, Dobbs B, Frizelle F. Cohort study of mesenteric panniculitis and its relationship to malignancy. Br J Surg 2016; 103:1727-1730. [DOI: 10.1002/bjs.10229] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 04/13/2016] [Accepted: 05/13/2016] [Indexed: 01/10/2023]
Abstract
Abstract
Background
Mesenteric panniculitis (MP) is a rare condition that historically has been associated with the presence of malignancy. Paraneoplastic phenomena in general regress with cure and in most cases with treatment of the cancer. This study was undertaken to determine whether MP regressed with cancer treatment and cure.
Methods
This was a retrospective review of a database of all patients with MP confirmed on CT between 2003 and August 2015 at Christchurch Hospital. Patients were categorized as having malignant or non-malignant disease, and follow-up scans were assessed for remission of MP. Patients with malignancy were further categorized as having malignancy cured or not cured.
Results
A total of 308 patients were identified with possible MP; 135 were excluded as radiological appearances were not typical of MP (43 patients) or there was no follow-up CT (92). Of 173 patients (131 men) included, 75 (43·4 per cent) were diagnosed with malignancy. Follow-up imaging showed that 33 patients (19·1 per cent) had remission of MP, whereas 140 (80·9 per cent) had no remission. There was no difference in the rates of MP remission in the malignancy versus no malignancy groups (P = 1·000), or between groups in which malignancy was cured or not cured (P = 0·572). Nor was there any difference in the rates of MP remission in malignancy cured versus no malignancy groups (P = 0·524).
Conclusion
MP does not behave like a paraneoplastic phenomenon. The association with malignancy is most likely an epiphenomenon of the many CT images acquired for staging of cancer.
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Affiliation(s)
- P Buchwald
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
| | - L Diesing
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
| | - L Dixon
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
| | - C Wakeman
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
| | - T Eglinton
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
| | - B Dobbs
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
| | - F Frizelle
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch 8011, New Zealand
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Guinat C, Relun A, Wall B, Morris A, Dixon L, Pfeiffer DU. Exploring pig trade patterns to inform the design of risk-based disease surveillance and control strategies. Sci Rep 2016; 6:28429. [PMID: 27357836 PMCID: PMC4928095 DOI: 10.1038/srep28429] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/22/2016] [Indexed: 11/09/2022] Open
Abstract
An understanding of the patterns of animal contact networks provides essential information for the design of risk-based animal disease surveillance and control strategies. This study characterises pig movements throughout England and Wales between 2009 and 2013 with a view to characterising spatial and temporal patterns, network topology and trade communities. Data were extracted from the Animal and Plant Health Agency (APHA)'s RADAR (Rapid Analysis and Detection of Animal-related Risks) database, and analysed using descriptive and network approaches. A total of 61,937,855 pigs were moved through 872,493 movements of batches in England and Wales during the 5-year study period. Results show that the network exhibited scale-free and small-world topologies, indicating the potential for diseases to quickly spread within the pig industry. The findings also provide suggestions for how risk-based surveillance strategies could be optimised in the country by taking account of highly connected holdings, geographical regions and time periods with the greatest number of movements and pigs moved, as these are likely to be at higher risk for disease introduction. This study is also the first attempt to identify trade communities in the country, information which could be used to facilitate the pig trade and maintain disease-free status across the country in the event of an outbreak.
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Affiliation(s)
- C. Guinat
- Department of Production and Population Health, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, United Kingdom
- The Pirbright Institute, Ash Road, Pirbright, Surrey, GU24 0NF, United Kingdom
| | - A. Relun
- Centre de coopération international en recherche agronomique pour le développement (CIRAD), UPR AGIRs, Campus international de Baillarguet, F-34398 Montpellier, France
| | - B. Wall
- Department of Production and Population Health, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, United Kingdom
| | - A. Morris
- Department of Production and Population Health, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, United Kingdom
- Department of Epidemiological Sciences, Animal and Plant Health Agency (APHA) Weybridge, Woodham Lane, Addlestone, Surrey, KT15 3NB, United Kingdom
| | - L. Dixon
- The Pirbright Institute, Ash Road, Pirbright, Surrey, GU24 0NF, United Kingdom
| | - D. U. Pfeiffer
- Department of Production and Population Health, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, United Kingdom
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Hildingsson I, Gamble J, Sidebotham M, Creedy DK, Guilliland K, Dixon L, Pallant J, Fenwick J. Midwifery empowerment: National surveys of midwives from Australia, New Zealand and Sweden. Midwifery 2016; 40:62-9. [PMID: 27428100 DOI: 10.1016/j.midw.2016.06.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 03/15/2016] [Revised: 05/17/2016] [Accepted: 06/06/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND the predicted midwifery workforce shortages in several countries have serious implications for the care of women during pregnancy, birth and post partum. There are a number of factors known to contribute to midwifery shortages and work attrition. However, midwives assessment of their own professional identity and role (sense of empowerment) are perhaps among the most important. There are few international workforce comparisons. AIM to compare midwives' sense of empowerment across Australia, New Zealand and Sweden using the Perceptions of Empowerment in Midwifery Scale-R (PEMS-Revised). METHOD a self-administered survey package was distributed to midwives through professional colleges and networks in each country. The surveys asked about personal, professional and employment details and included the Perceptions of Empowerment in Midwifery Scale-R (PEMS-Revised). Descriptive statistics for the sample and PEMS were generated separately for the three countries. A series of analysis of variance with posthoc tests (Tukey's HSD) were conducted to compare scale scores across countries. Effect size statistics (partial eta squared) were also calculated. RESULTS completed surveys were received from 2585 midwives (Australia 1037; New Zealand 1073 and Sweden 475). Respondents were predominantly female (98%), aged 50-59 years and had significant work experience as a midwife (+20 years). Statistically significant differences were recorded comparing scores on all four PEMS subscales across countries. Moderate effects were found on Professional Recognition, Skills and Resources and Autonomy/Empowerment comparisons. All pairwise comparisons between countries reached statistical significance (p<.001) except between Australia and New Zealand on the Manager Support subscale. Sweden recorded the highest score on three subscales except Skills and Resources which was the lowest score of the three countries. New Zealand midwives scored significantly better than both their Swedish and Australian counterparts in terms of these essential criteria. DISCUSSION/CONCLUSIONS midwives in New Zealand and Sweden had a strong professional identity or sense of empowerment compared to their Australian counterparts. This is likely the result of working in more autonomous ways within a health system that is primary health care focused and a culture that constructs childbirth as a normal but significant life event. If midwifery is to reach its full potential globally then developing midwives sense of autonomy and subsequently their empowerment must be seen as a critical element to recruitment and retention that requires attention and strengthening.
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Affiliation(s)
- Ingegerd Hildingsson
- Mid Sweden University, Department of Nursing, Sundsvall, Sweden; Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden.
| | - Jenny Gamble
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia.
| | - Mary Sidebotham
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia.
| | - Debra K Creedy
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia.
| | | | - Lesley Dixon
- Research Development, New Zealand College of Midwives, New Zealand.
| | - Julie Pallant
- Menzies Health Institute Queensland, Griffith University, Australia.
| | - Jennifer Fenwick
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia; Gold Coast University Hospital, Australia.
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