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Doherty J, McHale H, Killeen SL, Curran S, Bennett M, Sheehy L, Murphy S, Murtagh L, O'Brien E. Women's experiences of Hyperemesis Gravidarum (HG) and of attending a dedicated multi-disciplinary hydration clinic. Women Birth 2023; 36:e661-e668. [PMID: 37438233 DOI: 10.1016/j.wombi.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/14/2023]
Abstract
PROBLEM Hyperemesis Gravidarum (HG) is a severe form of nausea and vomiting in pregnancy that affects 1-3 % of women and has profound nutritional, physical and psychological consequences. Previous research identified that women with HG report inadequate infrastructure for day case management. INTRODUCTION A multi-disciplinary HG day case service (IRIS Hydration Clinic) was launched and provides routine care for women with HG in a dedicated unit. The multi-disciplinary team involves midwives, dietitians, obstetricians and perinatal mental health. AIMS To explore women's experiences of HG and of attending the dedicated clinic. METHODS Ten interviews were conducted with women who attended the clinic. Data were transcribed and analysed using Reflexive Thematic Analysis. FINDINGS The physical and psychological impact of HG was captured. The appreciation for the dedicated clinic was a common theme, regarding having somewhere specific for treatment rather than ad-hoc treatment. 'Relationships' was a significant theme - women described the benefits of continuity of care and the positive impact of peer support. Areas for improvement were explored, such as expansion and extra sensitivity around some women's issues around weight gain/loss. DISCUSSION HG causes significant ill-health and its impact remains undervalued. Women had highly positive experiences of attending the dedicated HG clinic. The impact of continuity and individualized care in a day-case setting improved women's experiences of this condition. CONCLUSION The dedicated HG clinic was highly valued by women experiencing the condition. The IRIS clinic provides much-needed validation for a medical condition with little understanding from the general public or many healthcare professionals.
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Affiliation(s)
- Jean Doherty
- National Maternity Hospital, Holles Street, Dublin 2, Ireland.
| | - Helen McHale
- National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | | | - Sinead Curran
- National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | - Melanie Bennett
- National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | - Lucille Sheehy
- National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | - Suzanne Murphy
- National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | - Lillian Murtagh
- National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | - Eileen O'Brien
- School of Biological and Health Science, Technological University Dublin, Ireland
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Chatham CH, Taylor KI, Charman T, Liogier D'ardhuy X, Eule E, Fedele A, Hardan AY, Loth E, Murtagh L, Del Valle Rubido M, San Jose Caceres A, Sevigny J, Sikich L, Snyder L, Tillmann JE, Ventola PE, Walton-Bowen KL, Wang PP, Willgoss T, Bolognani F. Adaptive behavior in autism: Minimal clinically important differences on the Vineland-II. Autism Res 2018; 11:270-283. [PMID: 28941213 PMCID: PMC5997920 DOI: 10.1002/aur.1874] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [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: 06/13/2017] [Revised: 08/09/2017] [Accepted: 08/16/2017] [Indexed: 12/28/2022]
Abstract
Autism Spectrum Disorder (ASD) is associated with persistent impairments in adaptive abilities across multiple domains. These social, personal, and communicative impairments become increasingly pronounced with development, and are present regardless of IQ. The Vineland Adaptive Behavior Scales, Second Edition (Vineland-II) is the most commonly used instrument for quantifying these impairments, but minimal clinically important differences (MCIDs) on Vineland-II scores have not been rigorously established in ASD. We pooled data from several consortia/registries (EU-AIMS LEAP study, ABIDE-I, ABIDE-II, INFOR, Simons Simplex Collection and Autism Treatment Network [ATN]) and clinical investigations and trials (Stanford, Yale, Roche) resulting in a data set of over 9,000 individuals with ASD. Two approaches were used to estimate MCIDs: distribution-based methods and anchor-based methods. Distribution-based MCID [d-MCID] estimates included the standard error of the measurement, as well as one-fifth and one-half of the covariate-adjusted standard deviation (both cross-sectionally and longitudinally). Anchor-based MCID [a-MCID] estimates include the slope of linear regression of clinician ratings of severity on the Vineland-II score, the slope of linear regression of clinician ratings of longitudinal improvement category on Vineland-II change, the Vineland-II change score maximally differentiating clinical impressions of minimal versus no improvement, and equipercentile equating. Across strata, the Vineland-II Adaptive Behavior Composite standardized score MCID estimates range from 2.01 to 3.2 for distribution-based methods, and from 2.42 to 3.75 for sample-size-weighted anchor-based methods. Lower Vineland-II standardized score MCID estimates were observed for younger and more cognitively impaired populations. These MCID estimates enable users of Vineland-II to assess both the statistical and clinical significance of any observed change. Autism Res 2018, 11: 270-283. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY The Vineland Adaptive Behavior Scales (2nd edition; Vineland-II) is the most widely used scale for assessing day-to-day "adaptive" skills. Yet, it is unknown how much Vineland-II scores must change for those changes to be regarded as clinically significant. We pooled data from over 9,000 individuals with ASD to show that changes of 2-3.75 points on the Vineland-II Composite score represent the "minimal clinically-important difference." These estimates will help evaluate the benefits of potential new treatments for ASD.
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Affiliation(s)
- C H Chatham
- F. Hoffmann La Roche, Innovation Center Basel, Hoffmann La Roche, Basel, 4070, Switzerland
| | - K I Taylor
- F. Hoffmann La Roche, Innovation Center Basel, Hoffmann La Roche, Basel, 4070, Switzerland
| | - T Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Camberwell, London, SE5 8AF, UK
| | - X Liogier D'ardhuy
- F. Hoffmann La Roche, Innovation Center Basel, Hoffmann La Roche, Basel, 4070, Switzerland
| | - E Eule
- F. Hoffmann La Roche, Innovation Center Basel, Hoffmann La Roche, Basel, 4070, Switzerland
| | - A Fedele
- Autism Speaks, New York, New York, 10016
| | - A Y Hardan
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, 94305-5717
| | - E Loth
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Camberwell, London, SE5 8AF, UK
| | - L Murtagh
- F. Hoffmann La Roche, Innovation Center Basel, Hoffmann La Roche, Basel, 4070, Switzerland
| | - M Del Valle Rubido
- F. Hoffmann La Roche, Innovation Center Basel, Hoffmann La Roche, Basel, 4070, Switzerland
| | - A San Jose Caceres
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Camberwell, London, SE5 8AF, UK
| | - J Sevigny
- F. Hoffmann La Roche, Innovation Center Basel, Hoffmann La Roche, Basel, 4070, Switzerland
| | - L Sikich
- Duke Center for Autism and Brain Development, Pavilion East at Lakeview, Durham, North Carolina, 27705
| | - L Snyder
- Simons Foundation, New York, New York, 10010
| | - J E Tillmann
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Camberwell, London, SE5 8AF, UK
| | - P E Ventola
- Yale Child Study Center, New Haven, CT, 06520
| | | | - P P Wang
- Simons Foundation, New York, New York, 10010
| | - T Willgoss
- F. Hoffmann La Roche, Innovation Center Basel, Hoffmann La Roche, Basel, 4070, Switzerland
| | - F Bolognani
- F. Hoffmann La Roche, Innovation Center Basel, Hoffmann La Roche, Basel, 4070, Switzerland
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Reilly C, Senior J, Murtagh L. A comparative study of educational provision for children with neurogenetic syndromes: parent and teacher survey. J Intellect Disabil Res 2015; 59:1094-1107. [PMID: 26780264 DOI: 10.1111/jir.12210] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 06/04/2015] [Accepted: 06/24/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND A number of neurogenetic syndromes have a high association with special educational needs including fragile X syndrome (FXS), Prader-Willi syndrome (PWS), Williams syndrome (WS) and Velo-Cardio-Facial syndrome (VCFS). There is a paucity of research on educational provision for children affected by these syndromes. METHOD Parents (n = 381) and teachers (n = 204) of school-aged children with one of the four syndromes in the UK and Ireland were surveyed in a range of areas concerning the child's educational provision. Areas surveyed included school placement, views on the needs of children with the syndromes, desired changes to current provision and perceived teacher knowledge. RESULTS School placement in mainstream settings decreased with age in all of the syndromes. Males with the syndromes were more likely to be in specialised educational settings with the exception of WS. Teachers reported limited input on initial or subsequent training for all of the syndromes. The majority of teachers did not view the needs of children with syndromes as different from other children with intellectual disability (ID) although there were significant differences between the syndromes. Changes deemed necessary to provision by parents and teachers differed between the syndromes indicating the existence of perceptions of syndrome specific needs. The lowest perceived level of teacher knowledge was in the VCFS group. CONCLUSION The majority of teachers of children with neurogenetic syndromes report limited knowledge of the syndromes, but also a lack of belief that the children's needs are different from the majority of children with ID. Differences between the syndromes in some areas of provision suggest that a child's syndrome does impact on educational provision in some areas.
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Affiliation(s)
- C Reilly
- Research Department, Young Epilepsy, United Kingdom
- University College Dublin, School of Education, Ireland
| | - J Senior
- University College Dublin, School of Education, Ireland
| | - L Murtagh
- University College Dublin, School of Education, Ireland
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Reilly C, Senior J, Murtagh L. ASD, ADHD, mental health conditions and psychopharmacology in neurogenetic syndromes: parent survey. J Intellect Disabil Res 2015; 59:307-318. [PMID: 24965264 DOI: 10.1111/jir.12147] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/04/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND There are a number of neurogenetic syndromes with well described behavioural phenotypes including fragile X syndrome, Prader-Willi syndrome, Williams syndrome and velo-cardio-facial syndrome (VCFS). Autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) and psychiatric conditions are often associated with the syndromes. METHOD Parents (n = 381) of school-aged children with one of the four syndromes in the UK and Ireland were asked whether their child had been professionally diagnosed with ASD, ADHD or a mental health condition. Parents were also asked whether their child had been prescribed medication for behavioural or psychiatric reasons. RESULTS The highest level of reported diagnoses of ASD and ADHD was in fragile X syndrome. In all syndrome groups, lower rates of diagnosis were reported in comparison to previously published research. Prescribing of medication for behavioural/psychiatric reasons was highest in fragile X syndrome although the highest usage of melatonin was in Williams syndrome. CONCLUSION Reasons for a lower recognition of ASD, ADHD and mental health conditions in clinical practice compared with research studies may include 'diagnostic overshadowing' due to presence of intellectual disability and a genetic syndrome. However, there may also be a lack of belief in the utility of such diagnoses in neurogenetic syndromes among relevant professionals and/or lack of access to professionals with sufficient expertise in the recognition of such diagnoses in those with neurogenetic syndromes. The low rates of prescribing of medication for behavioural/psychiatric reasons may reflect the low level of clinical diagnoses or lack of belief in the utility of psychopharmacology in this population.
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Affiliation(s)
- C Reilly
- Young Epilepsy Research Department, Lingfield, UK; School of Education, University College Dublin, Dublin, Ireland
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Guindon Y, Murtagh L, Caron V, Landry SR, Jung G, Bencheqroun M, Faucher AM, Guérin B. Cyclofunctionalization and free-radical-based hydrogen-transfer reactions. An iterative reaction sequence applied to the synthesis of the C(7)-C(16) subunit of zincophorin. J Org Chem 2001; 66:5427-37. [PMID: 11485466 DOI: 10.1021/jo010310f] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The strategy considered herein features an iodocyclofunctionalization/hydrogen-transfer reaction sequence for the elaboration of propionate motifs. Proceeding with excellent yield and diastereoselectivity, the synthetic sequence proposed gives access to the anti-anti dipropionate motif when the reduction step is performed under the control of the exocyclic effect. The tandem sequence is applied successfully to the synthesis of the C(7)-C(16) subunit of zincophorin, and iteration of the process gives the desired anti-anti-anti-anti polypropionate stereopentad. Modifications of the reaction sequence--including phenylselenocyclofunctionalization, carbonate hydrolysis, and chelation-controlled radical reduction reactions--lead to the formation of the anti-syn dipropionate motif with remarkable diastereocontrol.
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Affiliation(s)
- Y Guindon
- Institut de recherches cliniques de Montréal, Bio-organic Chemistry Laboratory, 110 avenue des Pins Ouest, Montréal, Québec, Canada H2W 1R7.
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