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Rodrigues CMC, MacDonald L, Ure R, Smith A, Cameron JC, Maiden MCJ. Exploiting Real-Time Genomic Surveillance Data To Assess 4CMenB Meningococcal Vaccine Performance in Scotland, 2015 to 2022. mBio 2023; 14:e0049923. [PMID: 37036356 PMCID: PMC10127610 DOI: 10.1128/mbio.00499-23] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
The United Kingdom implemented the first national infant immunization schedule for the meningococcal vaccine 4CMenB (Bexsero) in September 2015, targeting serogroup B invasive meningococcal disease (IMD). Bexsero contains four variable subcapsular proteins, and postimplementation IMD surveillance was necessary, as nonhomologous protein variants can evade Bexsero-elicited protection. We investigated postimplementation IMD cases reported in Scotland from 1 September 2015 to 30 June 2022. Patient demographics and vaccination status were combined with genotypic data from the causative meningococci, which were used to assess vaccine coverage with the meningococcal deduced vaccine antigen reactivity (MenDeVAR) index. Eighty-two serogroup B IMD cases occurred in children >5 years of age, 48 (58.5%) of which were in unvaccinated children and 34 (41%) of which were in children who had received ≥1 Bexsero dose. Fifteen of the 34 vaccinated children had received one dose, 17 had received two doses, and two had received three doses. For 39 cases, meningococcal sequence data were available, enabling MenDeVAR index deductions of vaccine-preventable (M-VP) and non-vaccine-preventable (M-NVP) meningococci. Notably, none of the 19 of the children immunized ≥2 times had IMD caused by M-VP meningococci, with 2 cases of NVP meningococci, and no deduction possible for 17. Among the 15 children partially vaccinated according to schedule (1 dose), 7 were infected by M-VP meningococci and 2 with M-NVP meningococci, with 6 for which deductions were not possible. Of the unvaccinated children with IMD, 40/48 were ineligible for vaccination and 20/48 had IMD caused by M-VP meningococci, with deductions not being possible for 14 meningococci. IMPORTANCE This study demonstrates the value of postimplementation genomic surveillance of vaccine-preventable pathogens in providing information on real-world vaccine performance. The data are consistent with 2 and 3 doses of Bexsero, delivered according to schedule, providing good protection against invasive disease caused by meningococci deduced from genomic data to be vaccine preventable. Single doses provide poorer protection to infants. In practical terms, these data can provide public health reassurance when vaccinated individuals develop IMD with non-vaccine-preventable variants. They further indicate that additional testing is needed on variants for which no immunological data exist to improve estimates of protection, although these data suggest that the uncharacterized variants are unlikely to be covered by Bexsero. Finally, the confirmation that incomplete or absent doses in infancy lead to reduced protection supports public health and general practitioners in promoting vaccination according to schedule.
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Affiliation(s)
- C M C Rodrigues
- Department of Biology, University of Oxford, Oxford, United Kingdom
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - L MacDonald
- Public Health Scotland, Glasgow/Edinburgh, United Kingdom
| | - R Ure
- Bacterial Respiratory Infection Service, Scottish Microbiology Reference Laboratory, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - A Smith
- Bacterial Respiratory Infection Service, Scottish Microbiology Reference Laboratory, Glasgow Royal Infirmary, Glasgow, United Kingdom
- College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, Glasgow, United Kingdom
| | - J C Cameron
- Public Health Scotland, Glasgow/Edinburgh, United Kingdom
| | - M C J Maiden
- Department of Biology, University of Oxford, Oxford, United Kingdom
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Dyer TA, Glenny AM, MacDonald L, Marshman Z, Jones K. Effectiveness of strategies to increase participation in school-based epidemiological surveys: a rapid review. Community Dent Health 2023; 40:53-59. [PMID: 36696488 DOI: 10.1922/cdh_00242dyer07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/19/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Rapid review of the literature on strategies to increase participation rates in school-based epidemiological surveys. BASIC RESEARCH DESIGN Rapid review. MEDLINE and Embase databases were searched for articles written in English from 2000 onwards. Synthesised evidence and primary research were included as data sources from peer reviewed journals and reports. INTERVENTIONS Any strategy aiming to increase participation in school-based health surveys. The comparator was usual procedure or an alternative strategy to increase participation. MAIN OUTCOME MEASURES Primary outcomes included participation and consent rates. Secondary outcomes were feasibility, acceptability and adverse effects. RESULTS The search identified 591 unique records, of which 587 were excluded. Four studies were suitable for inclusion, including one systematic review, one randomised controlled trial, one cross-sectional study and one retrospective analysis. Based on very low certainty evidence, recommendations for maximising participation rates in one systematic review of US studies included: promoting the survey to school staff, parents and students; disseminating study information using direct rather than mediated methods; offering incentives to schools, staff and participants; following up non-responders; and employing a research team member to co-ordinate and monitor recruitment. However, UK studies found that different strategies did not increase participation more than that achieved by a standard approach (delivery of covering letter/consent forms via the child with no follow-up of non-responders). CONCLUSION Given the lack of evidence of effectiveness of alternative strategies in the UK, additional measures beyond existing standard approaches for active consent cannot be recommended.
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Affiliation(s)
- T A Dyer
- School of Clinical Dentistry, University of Sheffield, UK
| | - A-M Glenny
- Division of Dentistry, The University of Manchester, UK
| | - L MacDonald
- Cochrane Oral Health, Division of Dentistry, The University of Manchester UK
| | - Z Marshman
- School of Clinical Dentistry, University of Sheffield, UK
| | - K Jones
- Office for Health Improvement and Disparities, London, UK
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Crespo E, Nosalski R, Park I, Goddard M, MacDonald L, McBride MW, Monaco C, Maffia P, Otto T, Guzik T. Single cell atlas of cd45+ cells in angiotensin II-induced hypertension. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Hypertension has been recently identified as an inflammatory disease. Immune cell infiltration is a characteristic feature in the vasculature and the kidneys in experimental hypertension, but the unique nature of such inflammatory infiltrates has not yet been comprehensively characterised.
Accordingly, we aimed to provide in-depth characteristics of immune cells in the vasculature and the kidneys in experimental hypertension.
To achieve this, we used single-cell RNA-sequencing of leukocytes (CD45+ cells were sorted) using the 10x Genomics platform in the aortas and the kidneys of male 12-week-old C57BL/6J mice (n=16–17/group) upon AngII (490 ng/min/kg) or sham buffer 14-day infusion, using osmotic minipumps. Samples were pooled to analyse three independent replicates. Bioinformatics analysis used Seurat/R to identify immune cell subpopulations and characterise differentially expressed genes (DEGs), pathways, and interactions signatures.
Ang II infusion increases the total number of CD45+ leukocytes in the aorta (346.7±89.1 vs. 1210±214.3; p=0,048), while in the kidneys, this was much less pronounced (1.1±0.5 fold vs. sham). Fifteen leukocyte populations/clusters were identified in the aorta and kidney based on their unique markers. In the aorta, shifts in numerous populations were evident, with the most significant differences in tissue-resident macrophages and activated tissue-resident macrophages, monocyte-derived dendritic cells and NK cells (Figure 1). Kidneys did not display such profound changes. The transcriptomic profile analysis showed 767 significant DEGs in the aorta and only 35 in the kidney. CellChat analysis also indicated more robust interactions between the immune cells in the aorta than in kidneys. These included Ifitm1, Apoe, Il1b, and C1q a/b/c, which were shared between aorta and kidney and may play an immunoregulatory role, affecting smooth muscle cell proliferation and arterial vascular remodelling. Top up-regulated leukocyte genes in the aorta included Ccl8, Ccl3, Cxcl2, Lyz2, and Spp1, while in the kidney, Cd74, Cst3, Fos, Fcer1g, Tyrobp, and Ccl4. GO pathway signatures of aortic leukocyte DEGs revealed pathways related to leukocyte migration, cytokine production, T cell activation, and leukocyte activation and adhesion. Cell-specific analysis showed that macrophage subpopulations most strongly increased in Ang II-induced hypertension displayed the most pronounced changes in the transcriptome profiles and cell-cell interactions.
Comprehensive single-cell RNA sequencing identifies tissue-resident macrophages, monocyte-derived dendritic cells, and NK cells as most affected leukocyte subpopulations in hypertensive vasculature. Differentially expressed genes support the role of these cells in vascular remodelling and propagation of inflammation, further supporting the identification of these cells as potential future targets for therapeutic interventions in hypertension.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Research Council
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Affiliation(s)
- E Crespo
- University of Glasgow , Glasgow , United Kingdom
| | - R Nosalski
- University of Glasgow , Glasgow , United Kingdom
| | - I Park
- Kennedy Institute of Rheumatology , Oxford , United Kingdom
| | - M Goddard
- Kennedy Institute of Rheumatology , Oxford , United Kingdom
| | - L MacDonald
- University of Glasgow , Glasgow , United Kingdom
| | - M W McBride
- University of Glasgow , Glasgow , United Kingdom
| | - C Monaco
- Kennedy Institute of Rheumatology , Oxford , United Kingdom
| | - P Maffia
- University of Glasgow , Glasgow , United Kingdom
| | - T Otto
- University of Glasgow , Glasgow , United Kingdom
| | - T Guzik
- University of Glasgow , Glasgow , United Kingdom
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MacDonald S, MacDonald L, Godwin J, Macdonald A, Thornton M. The diagnostic accuracy of the faecal immunohistochemical test in identifying significant bowel disease in a symptomatic population. Colorectal Dis 2022; 24:257-263. [PMID: 34797583 DOI: 10.1111/codi.15994] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/16/2021] [Accepted: 11/13/2021] [Indexed: 12/13/2022]
Abstract
AIM Provisional research on the faecal immunohistochemical test (FIT) for symptomatic colorectal patients has shown a high negative predictive value but has lacked long-term patient follow-up, raising the possibility of missed diagnoses of colorectal cancer (CRC). The aim of this work is to describe the long-term diagnostic accuracy of the FIT for CRC and significant bowel disease (SBD) in a symptomatic population in NHS Lanarkshire. METHOD From October 2016 to February 2019, all primary care referrals of symptomatic colorectal patients in NHS Lanarkshire were asked to provide a FIT. The baseline demographics, investigations and diagnoses for each patient were prospectively completed until February 2021. A FIT result of ≥10 μg haemoglobin (Hb)/g faeces was considered to be positive. RESULTS A total of 5250 patients were identified (median age 62 years; 46% male; median follow-up 31 months) with 65.1% (3418) being FIT negative. The SBD rate was 6.2% and the CRC rate was 2.9% (151). The SBD rate was significantly higher in the FIT-positive group (13.8% vs. 2.2%; p < 0.001) and 32.9% of patients with FIT ≥ 400 μg Hb/g had SBD. The sensitivity of FIT ≥ 10 μg Hb/g for CRC was 87.4% and for SBD it was 76.9%. Specificity was 66.6% and 66.7%, and the negative-predictive value was 99.4% and 97.7%, respectively. Sensitivity for CRC could theoretically be increased to 94.8% if FIT-negative patients were to undergo flexible sigmoidoscopy. CONCLUSION A FIT-only referral pathway for symptomatic colorectal patients will miss over 12% of cancers and over 23% of SBD. Theoretically, combining FIT-negative patients with flexible sigmoidoscopy increases the sensitivity for CRC. The FIT offers a mechanism for prioritizing patient access to investigations, particularly in resource-limited areas; however, further work to identify FIT-negative patients diagnosed with CRC is required.
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Affiliation(s)
- Scott MacDonald
- Department of Surgery, University Hospital Monklands, Airdrie, UK
| | - Linda MacDonald
- Department of Surgery, University Hospital Wishaw, Wishaw, UK
| | - Jon Godwin
- Statistics in Medicine and Society, Glasgow Caledonian University, Glasgow, UK
| | - Angus Macdonald
- Department of Surgery, University Hospital Monklands, Airdrie, UK
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Tsiaousidou A, MacDonald L, Shalli K. Mesh safety in pelvic surgery: Our experience and outcome of biological mesh used in laparoscopic ventral mesh rectopexy. World J Clin Cases 2022; 10:891-898. [PMID: 35127904 PMCID: PMC8790465 DOI: 10.12998/wjcc.v10.i3.891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 11/08/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopic ventral mesh rectopexy (LVMR) continues to be a popular treatment option for rectal prolapse, obstructive defecation/faecal incontinence and rectoceles. In recent years there have been concerns regarding the safety of mesh placements in the pelvis.
AIM To assess the safety of the mesh and the outcome of the procedure.
METHODS Eighty-six patients underwent LVMR with Permacol (Biological) mesh from 2012 to 2018 at University Hospital Wishaw. Forty were treated for obstructive defecation secondary to prolapse, rectocele or internal rectal intussusception, 38 for mixed symptoms obstructive defecation and incontinence, 5 for pain and bleeding secondary to full thickness prolapse and 3 with symptoms of incontinence. Questionnaires for the calculation of Wexner scores for constipation and incontinence were completed by the patients who were followed up in the clinic 12 wk after surgery and again in 6-12 mo. The average review of their notes was 18.3 ± 4.2 mo.
RESULTS The median Wexner scores for constipation pre-operatively and post-operatively were 14.5 [Interquartile range (IQR): 10.5-18.5] and 3 (IQR: 1-6), respectively, while the median Wexner score for faecal incontinence was 11 (IQR: 7-15) and 2 (IQR: 0-5), respectively (P < 0.01). There were 4 (4.6%) recurrences, 2 cases that presented with erosion of a suture through the rectum and one with diskitis. No mesh complications or mortalities were recorded.
CONCLUSION LVMR using a Permacol mesh is a safe and effective procedure for the treatment of obstructive defecation/faecal incontinence, rectal prolapse, rectoceles and internal rectal prolapse/intussusception.
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Affiliation(s)
- Anastasia Tsiaousidou
- Department of Surgery, Wishaw University Hospital, Wishaw ML2 0DP, Lanarkshire, United Kingdom
| | - Linda MacDonald
- Department of Surgery, Wishaw University Hospital, Wishaw ML2 0DP, Lanarkshire, United Kingdom
| | - Kawan Shalli
- Department of Surgery, Wishaw University Hospital, Wishaw ML2 0DP, Lanarkshire, United Kingdom
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Cairns S, Gibbons C, Milne A, King H, Llano M, MacDonald L, Malcolm W, Robertson C, Sneddon J, Weir J, Reilly J. Results from the third Scottish National Prevalence Survey: is a population health approach now needed to prevent healthcare-associated infections? J Hosp Infect 2018; 99:312-317. [PMID: 29621601 DOI: 10.1016/j.jhin.2018.03.038] [Citation(s) in RCA: 5] [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: 01/10/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Healthcare-associated infections (HCAIs) are a major public health concern and a significant cause of morbidity and mortality. A robust and current evidence base that is specific to local, national and Europe-wide settings is necessary to inform the development of strategies to reduce HCAI and contain antimicrobial resistance. AIM To measure the prevalence of HCAI and antimicrobial prescribing and identify key priority areas for interventions to reduce the burden of infection. METHODS A national rolling point-prevalence survey (PPS) in National Health Service (NHS) acute, NHS non-acute, NHS paediatric, and independent hospitals was carried out between September and November 2016 using the European Centre for Disease Prevention and Control protocol designed for the European PPS. FINDINGS The prevalence of HCAI was 4.6%, 2.7%, and 3.2% in acute adults, paediatric and non-acute patient groups, respectively. The most frequent HCAI types reported in adult patients were urinary tract infection and pneumonia. The prevalence of antimicrobial prescribing was 35.7%, 29.3%, and 13.8% in acute adults, paediatric, and non-acute patient groups, respectively. Respiratory, skin and soft tissue, gastrointestinal, and urinary tract infections were the most common infections being treated at the time of survey. CONCLUSION HCAI continues to be a public health concern in Scotland. Urinary tract infection and pneumonia continue to place a significant burden on patients and on healthcare delivery, including those that develop in the community and require hospital admission. A broader population health approach which focuses on reducing the risk of infection upstream would reduce these infections in both community and hospital settings.
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Affiliation(s)
- S Cairns
- National Services Scotland, Health Protection Scotland, Glasgow, UK.
| | - C Gibbons
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - A Milne
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - H King
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - M Llano
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - L MacDonald
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - W Malcolm
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - C Robertson
- National Services Scotland, Health Protection Scotland, Glasgow, UK; University of Strathclyde, Glasgow, UK
| | - J Sneddon
- Healthcare Improvement Scotland, Glasgow, UK
| | - J Weir
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - J Reilly
- National Services Scotland, Health Protection Scotland, Glasgow, UK; Glasgow Caledonian University, Glasgow, UK
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Pierce LA, Pedemonte S, DeWitt D, MacDonald L, Hunter WCJ, Van Leemput K, Miyaoka R. Characterization of highly multiplexed monolithic PET / gamma camera detector modules. Phys Med Biol 2018; 63:075017. [PMID: 29498361 PMCID: PMC5908720 DOI: 10.1088/1361-6560/aab380] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PET detectors use signal multiplexing to reduce the total number of electronics channels needed to cover a given area. Using measured thin-beam calibration data, we tested a principal component based multiplexing scheme for scintillation detectors. The highly-multiplexed detector signal is no longer amenable to standard calibration methodologies. In this study we report results of a prototype multiplexing circuit, and present a new method for calibrating the detector module with multiplexed data. A [Formula: see text] mm3 LYSO scintillation crystal was affixed to a position-sensitive photomultiplier tube with [Formula: see text] position-outputs and one channel that is the sum of the other 64. The 65-channel signal was multiplexed in a resistive circuit, with 65:5 or 65:7 multiplexing. A 0.9 mm beam of 511 keV photons was scanned across the face of the crystal in a 1.52 mm grid pattern in order to characterize the detector response. New methods are developed to reject scattered events and perform depth-estimation to characterize the detector response of the calibration data. Photon interaction position estimation of the testing data was performed using a Gaussian Maximum Likelihood estimator and the resolution and scatter-rejection capabilities of the detector were analyzed. We found that using a 7-channel multiplexing scheme (65:7 compression ratio) with 1.67 mm depth bins had the best performance with a beam-contour of 1.2 mm FWHM (from the 0.9 mm beam) near the center of the crystal and 1.9 mm FWHM near the edge of the crystal. The positioned events followed the expected Beer-Lambert depth distribution. The proposed calibration and positioning method exhibited a scattered photon rejection rate that was a 55% improvement over the summed signal energy-windowing method.
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Affiliation(s)
- L A Pierce
- Imaging Research Laboratory, Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle WA, United States of America
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Cook T, Boniface N, Seller C, Hughes J, Damen C, MacDonald L, Kelly F. Universal videolaryngoscopy: a structured approach to conversion to videolaryngoscopy for all intubations in an anaesthetic and intensive care department. Br J Anaesth 2018; 120:173-180. [DOI: 10.1016/j.bja.2017.11.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 12/20/2022] Open
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Gill N, Sabri S, Arsenault D, Burge F, Clarke B, Fleming M, Grandy M, Harrigan K, MacDonald L, Nichols N. DEVELOPING A CASE DEFINITION FOR CONGESTIVE HEART FAILURE USING PRIMARY CARE EMR DATA. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Petrov ME, Long L, Grandner MA, MacDonald L, Cribbet MR, Robbins R, Cundiff J, Molano JR, Hoffmann N, Howard G, Howard VJ. 0830 SLEEP DURATION BY SOCIODEMOGRAPHIC, SOCIOECONOMIC, AND GEOGRAPHICAL STATUS: THE REGARDS STUDY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Malow BA, Drury BC, MacDonald L, Loring W, Alder M, Matthews M, Wofford D, Lutz J. 0899 INVOLVING COMMUNITY PARTNERS IN PARENT-BASED SLEEP EDUCATION. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
PURPOSE Theories provide a structural knowing about concept relationships, practice intricacies, and intuitions and thus shape the distinct body of the profession. Capturing ways of knowing and being is essential to any professions' practice, education and research. This process defines the phenomenon of the profession - its existence or experience. Theory evaluation is a systematic criterion-based assessment of a specific theory. This study presents a theory analysis of the Dental Hygiene Human Needs Conceptual Model (DH HNCM). METHODS Using the Walker and Avant Theory Analysis, a seven-step process, the DH HNCM, was analysed and evaluated for its meaningfulness and contribution to dental hygiene. The steps include the following: (i) investigate the origins; (ii) examine relationships of the theory's concepts; (iii) assess the logic of the theory's structure; (iv) consider the usefulness to practice; (v) judge the generalizability; (vi) evaluate the parsimony; and (vii) appraise the testability of the theory. FINDINGS Human needs theory in nursing and Maslow's Hierarchy of Need Theory prompted this theory's development. The DH HNCM depicts four concepts based on the paradigm concepts of the profession: client, health/oral health, environment and dental hygiene actions, and includes validated eleven human needs that evolved overtime to eight. It is logical, simplistic, allows scientific predictions and testing, and provides a unique lens for the dental hygiene practitioner. With this model, dental hygienists have entered practice, knowing they enable clients to meet their human needs. CONCLUSION For the DH HNCM, theory analysis affirmed that the model is reasonable and insightful and adds to the dental hygiene professions' epistemology and ontology.
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Affiliation(s)
- L MacDonald
- School of Dental Hygiene, College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - D M Bowen
- Department of Dental Hygiene, Division of Health Sciences, Idaho State University, Pocatello, ID, USA
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Sarson J, MacDonald L. Champions for the cause. Can Nurse 2016; 112:30-32. [PMID: 29461705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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MacDonald L, Thomas C, Syme A. WE-AB-209-06: Dynamic Collimator Trajectory Algorithm for Use in VMAT Treatment Deliveries. Med Phys 2016. [DOI: 10.1118/1.4957775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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MacDonald L, Robar J, Thomas C. PO-0841: Cranial stereotactic trajectory optimization via patient-specific overlap atlas. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32091-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grant R, Bulbeck H, Oliver K, Quinn G, MacDonald L, Day J, Zienius K, Morley R. OP01THE UK TOP 10 CLINICAL RESEARCH PRIORITIES IN NEURO-ONCOLOGY. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov283.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Eadie D, Stead M, MacKintosh AM, MacDonald L, Purves R, Pearce J, Tisch C, van der Sluijis W, Amos A, MacGregor A, Haw S. E-cigarette marketing in UK stores: an observational audit and retailers' views. BMJ Open 2015; 5:e008547. [PMID: 26362665 PMCID: PMC4567676 DOI: 10.1136/bmjopen-2015-008547] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/16/2015] [Accepted: 08/04/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To explore how e-cigarettes are being promoted at point of sale in the UK and how retailers perceive market trends. SETTING Fixed retail outlets subject to a ban on the display of tobacco products. PARTICIPANTS Observational audit of all stores selling tobacco products (n=96) in 4 Scottish communities, conducted over 2 waves 12 months apart (2013-2014), and qualitative interviews with small retailers (n=25) in 4 matched communities. PRIMARY AND SECONDARY OUTCOME MEASURES The audit measured e-cigarette display characteristics, advertising materials and proximity to other products, and differences by area-level disadvantage. Interviews explored retailers' perceptions of e-cigarette market opportunities and risks, and customer responses. RESULTS The number of e-cigarette point-of-sale display units and number of brands displayed increased between waves. E-cigarettes were displayed close to products of interest to children in 36% of stores. Stores in more affluent areas were less likely to have external e-cigarette advertising than those in deprived areas. Although e-cigarettes delivered high profit margins, retailers were confused by the diversity of brands and products, and uncertain of the sector's viability. Some customers were perceived to purchase e-cigarettes as cessation aids, and others, particularly low-income smokers, as a cheaper adjunct to conventional tobacco. CONCLUSIONS E-cigarette point-of-sale displays and number of brands displayed increased over 12 months, a potential cause for concern given their lack of regulation. Further scrutiny is needed of the content and effects of such advertising, and the potentially normalising effects of placing e-cigarettes next to products of interest to children.
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Affiliation(s)
- D Eadie
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - M Stead
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - A M MacKintosh
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - L MacDonald
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - R Purves
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - J Pearce
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - C Tisch
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - W van der Sluijis
- Child and Adolescent Health Research Unit, University of St Andrews, St Andrews, UK
| | - A Amos
- Centre for Population Health Sciences, School of Molecular Genetic and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - S Haw
- School of Health Sciences, University of Stirling, Stirling, UK
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Bradley AJ, MacDonald L, Whiteside S, Johnson RJ, Ramani VAC. Accuracy of preoperative CT T staging of renal cell carcinoma: which features predict advanced stage? Clin Radiol 2015; 70:822-9. [PMID: 25953656 DOI: 10.1016/j.crad.2015.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 03/01/2015] [Accepted: 03/24/2015] [Indexed: 01/13/2023]
Abstract
AIMS To characterise CT findings in renal cell carcinoma (RCC), and establish which features are associated with higher clinical T stage disease, and to evaluate patterns of discrepancy between radiological and pathological staging of RCC. MATERIALS AND METHODS Preoperative CT studies of 92 patients with 94 pathologically proven RCCs were retrospectively reviewed. CT stage was compared with pathological stage using the American Joint Committee on Cancer (AJCC), 7(th) edition (2010). The presence or absence of tumour necrosis, perinephric fat standing, thickening of Gerota's fascia, collateral vessels were noted, and correlated with pT stage. The sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) for predicting pT stage ≥pT3a were derived separately for different predictors using cross-tabulations. RESULTS Twenty-four lesions were pathological stage T1a, 21 were T1b, seven were T2a, 25 were T3a, 11 were T3b, four were T3c, and two were T4. There were no stage T2b. Sixty-three (67%) patients had necrosis, 27 (29%) thickening of Gerota's fascia (1 T1a), 25 had collateral vessels (0 T1a), 28 (30%) had fat stranding of <2 mm, 20 (21%) of 2-5mm and one (1%) of >5 mm. For pT stage ≥pT3a, the presence of perinephric fat stranding had a sensitivity, specificity, PPV and NPV of 74%, 65%, 63%, and 76%, respectively. Presence of tumour necrosis had a sensitivity, specificity, PPV, and NPV of 81%, 44%, 54%, and 72%, respectively. Thickening of Gerota's fascia had a sensitivity, specificity, PPV, and NPV of 52%, 90%, 81% and 70%, respectively; and enlarged collateral vessels had a sensitivity, specificity, PPV, and NPV value of 52%, 94%, 88%, and 71% respectively. CONCLUSION The presence of perinephric stranding and tumour necrosis were not reliable signs for pT stage >T3a. Thickening of Gerota's fascia and the presence of collateral vessels in the peri- or paranephric fat had 90% and 94% specificity, with 82% and 88% PPV, respectively, for the presence of tumour stage for pT stage >T3a. These are considered reliable signs of locally advanced renal cancer.
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Affiliation(s)
- A J Bradley
- Department of Radiology, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK.
| | - L MacDonald
- Department of Radiology, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
| | - S Whiteside
- Department of Medical Statistics, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
| | - R J Johnson
- Department of Radiology, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
| | - V A C Ramani
- Department of Urology, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
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Winters ZE, Emson M, Griffin C, Mills J, Hopwood P, Bidad N, MacDonald L, Turton EPL, Horne R, Bliss JM. Learning from the QUEST multicentre feasibility randomization trials in breast reconstruction after mastectomy. Br J Surg 2015; 102:45-56. [PMID: 25451179 DOI: 10.1002/bjs.9690] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/08/2014] [Accepted: 09/30/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Breast reconstruction aims to improve health-related quality of life after mastectomy. However, evidence guiding patients and surgeons in shared decision-making concerning the optimal type or timing of surgery is lacking. METHODS QUEST comprised two parallel feasibility phase III randomized multicentre trials to assess the impact of the type and timing of latissimus dorsi breast reconstruction on health-related quality of life when postmastectomy radiotherapy is unlikely (QUEST A) or highly probable (QUEST B). The primary endpoint for the feasibility phase was the proportion of women who accepted randomization, and it would be considered feasible if patient acceptability rates exceeded 25 per cent of women approached. A companion QUEST Perspectives Study (QPS) of patients (both accepting and declining trial participation) and healthcare professionals assessed trial acceptability. RESULTS The QUEST trials opened in 15 UK centres. After 18 months of recruitment, 17 patients were randomized to QUEST A and eight to QUEST B, with overall acceptance rates of 19 per cent (17 of 88) and 22 per cent (8 of 36) respectively. The QPS recruited 56 patients and 51 healthcare professionals. Patient preference was the predominant reason for declining trial entry, given by 47 (53 per cent) of the 88 patients approached for QUEST A and 22 (61 per cent) of the 36 approached for QUEST B. Both trials closed to recruitment in December 2012, acknowledging the challenges of achieving satisfactory patient accrual. CONCLUSION Despite extensive efforts to overcome recruitment barriers, it was not feasible to reach timely recruitment targets within a feasibility study. Patient preferences for breast reconstruction types and timings were common, rendering patients unwilling to enter the trial.
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Affiliation(s)
- Z E Winters
- Breast Reconstruction Patient Reported and Clinical Outcomes Research Group, School of Clinical Sciences, University of Bristol and North Bristol Trust, Bristol, UK
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MacDonald L, Thomas C. TH-C-12A-05: Dynamic Couch Motion for Improvement of Radiation Therapy Trajectories in DCA and VMAT. Med Phys 2014. [DOI: 10.1118/1.4889642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
Acute right iliac fossa pain is a common surgical presentation. The presentation is often non-specific and encompasses a wide differential, which creates a diagnostic challenge. Ultrasound is commonly the initial cross-sectional imaging modality and can be used as a tool to triage patients appropriately; assessing for appendicitis and other salient findings, which may indicate an alternative condition. Additionally, the dynamic nature of this imaging modality enables patient interaction. Following a systematic assessment of the abdomen and pelvis, a more focused interrogation of the right iliac fossa is performed. In this pictorial review, we illustrate the sonographic features of appendicitis and other conditions that can mimic appendicitis in its presentation. This highlights that through a systematic approach, it is possible to distinguish between these different pathologies, enabling clinicians to optimally manage the patient.
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Affiliation(s)
- E K White
- University Hospitals of South Manchester, Wythenshawe Hospital, Manchester, UK
| | - L MacDonald
- University Hospitals of South Manchester, Wythenshawe Hospital, Manchester, UK
| | - G Johnson
- University Hospitals of South Manchester, Wythenshawe Hospital, Manchester, UK
| | - V Rudralingham
- University Hospitals of South Manchester, Wythenshawe Hospital, Manchester, UK
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MacDonald L, Yankeelov T, Karellas A, Boone J. WE-A-141-01: Advanced Imaging for Breast Cancer: Screening, Diagnosis, and Assessing Response to Therapy. Med Phys 2013. [DOI: 10.1118/1.4815506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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24
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Bloomfield K, MacDonald L, Finucane G, Snow B, Roxburgh R. Use of antipsychotic medications in patients with Parkinson's disease at Auckland City Hospital. Intern Med J 2013; 42:e151-6. [PMID: 21470354 DOI: 10.1111/j.1445-5994.2011.02499.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The American Academy of Neurology considers clozapine first line treatment for psychosis in Parkinson's disease (PD). In practice, patients are typically treated with quetiapine initially despite only level C evidence for use due to concern about side-effects, and changed to clozapine if they fail this. AIM To review the use of antipsychotics in patients with PD and the demographics of PD patients who develop psychosis. METHODS Patients with PD on antipsychotic medications were identified by the Movement Disorder Nurse Specialist database and by reviewing patients admitted to Auckland City Hospital from January 2006 until March 2008. The demographic data, details of PD and antipsychotic use and comorbidities were recorded. RESULTS Sixty-six patients with PD on antipsychotics were identified. The mean age was 75 years and 48 (73%) were in residential care. Patients admitted on antipsychotics had longer disease duration (P < 0.001) and were more likely to have cognitive impairment (P= 0.02) than those admitted not on antipsychotics. The most common indication for use was hallucinations. Patients on clozapine were younger (P < 0.005) and had less comorbidity (P= 0.04) than those on quetiapine. Fifty per cent (6/12) of patients on clozapine had previously failed quetiapine. CONCLUSION Quetiapine has a good efficacy rate with minimal side-effects. This study lends support to the assumption that quetiapine is a useful medication. However, clozapine also was well tolerated and could be considered for use more frequently than it is.
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Affiliation(s)
- K Bloomfield
- Department of Geriatric Medicine, University of Auckland and Waitemata District Health Board, Shakespeare Road, PO Box 93 503, Takapuna, Northshore 0740, Auckland, New Zealand.
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Wilson C, Sampson D, MacIsaac-Delorey S, MacDonald L. N004 The development and implementation of a Chronic Total Occlusion (CTO) angioplasty program. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Berinstein NL, Morse M, Kaufman H, Nemunaitis JJ, Odunsi K, Chatta GS, Weir G, MacDonald L, Stanford M, Karkada M, Nigam R, Mansour M. A phase I study of the safety and immunogenicity of a therapeutic vaccine, DPX-0907 in patients with advanced-stage ovarian, breast, or prostate cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e13050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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MacDonald L, Fricke M, Wener P, Nelson M, Schönwetter DJ, Anderson JE, The Manitoba Initiative For Interpr. De novo learning in creating a graduate studies course on Interprofessional Education for Collaborative Patient-Centred Practice (IECPCP). J Interprof Care 2009; 23:195-7. [DOI: 10.1080/13561820802293071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Jackson ST, Mullings AM, Booth TF, MacDonald L, Henry SO, Khan CA, McLaughlin PD. Molecular analysis and implications of neurovirulent circulating vaccine-derived poliovirus in Jamaica. A case report and review of literature. W INDIAN MED J 2008; 57:511-514. [PMID: 19565986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
As the goal to eradicate wild polio virus (WPV) is approached, outbreaks associated with vaccine derived polioviruses (VDPV) with neurovirulent properties have emerged. The relevance for the spread of infection by nonparalytic cVDPV cases, with mutations associated with neurovirulence, is discussed with reference to the molecular analysis of a VDPV isolated from a Jamaican child who presented with aseptic meningitis. Potential risks to the Jamaican community resulting from circulation of cVDPV and critical factors defined by the World Health Organization (WHO) in the global eradication of Polio are analyzed in the context of immunization coverage, and the need to stop all Oral Polio Vaccine (OPV) use once wild polioviruses (WPVs) have been eradicated.
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Affiliation(s)
- S T Jackson
- Department of Micobiology, The University of the West Indies, Kingston 7, Jamaica, West Indies.
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MacLeod A, Branch A, Cassidy J, McDonald A, Mohammed N, MacDonald L. A nurse-/pharmacy-led capecitabine clinic for colorectal cancer: Results of a prospective audit and retrospective survey of patient experiences. Eur J Oncol Nurs 2007; 11:247-54. [PMID: 17188937 DOI: 10.1016/j.ejon.2006.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [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: 02/24/2006] [Revised: 09/21/2006] [Accepted: 10/03/2006] [Indexed: 12/27/2022]
Abstract
Oral chemotherapy agents provide patients with choice and home-based therapy but demand greater emphasis on patient support and education to minimise toxicities. To meet this demand, a nurse-/pharmacy-led clinic was established at the Beatson Oncology Centre in 2003 for the provision of oral capecitabine to metastatic colorectal cancer patients to provide a controlled and supportive environment. We conducted a prospective audit of 52 patients attending the clinic from March 2003 to June 2004 and a retrospective survey of patient experiences to assess clinic effectiveness. Of 52 patients, 79% completed at least 3 cycles of treatment (mean 3.5). Capecitabine was well tolerated. The dose was reduced on at least one occasion in 15 (29%) patients and 17 (30%) patients experienced at least one delay. Patient satisfaction, indicated by questionnaire responses (n=27), was high. Most patients (> or =85%) thought that the service provision was useful and well organised. The results indicate that a nurse-/pharmacy-led clinic for the provision of home-based oral capecitabine is safe, effective and acceptable to most patients. The success of this clinic can provide a model for use in other centres and in other types of cancer, such as breast cancer, where oral chemotherapy is a treatment option.
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Affiliation(s)
- A MacLeod
- Beatson Oncology Center, Dumbarton Road, Glasgow, G11 6NT, UK.
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MacDonald L, Cohen A, Baron S, Burchfiel C. Current Practices in the Collection and Use of Occupational Measures in Population-Based Cardiovascular Studies in the United States. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s214-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gallant J, Bonthuis P, Lindsley D, Cabellon J, Gill G, Heaton K, Kelley-Clarke B, MacDonald L, Mercer S, Vu H, Worsley A. On the role of the starved codon and the takeoff site in ribosome bypassing in Escherichia coli. J Mol Biol 2004; 342:713-24. [PMID: 15342232 DOI: 10.1016/j.jmb.2004.07.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2004] [Revised: 07/13/2004] [Accepted: 07/14/2004] [Indexed: 11/25/2022]
Abstract
Translating ribosomes can skip over stretches of messenger RNA and resume protein chain elongation after a "bypassed" region. We have previously shown that limitation for isoleucyl-tRNA can initiate a ribosome bypass when an AUA codon is in the ribosomal A-site. We have now generalized this effect to other "hungry" codons calling for four different limiting aminoacyl-tRNA species, suggesting that a pause at any A-site will have this effect. We have assessed bypassing in a large family of reporters with nearly every different triplet in the "takeoff site", i.e. the P-site on the 5' side of the hungry codon, and an identical "landing site" codon 16 nucleotides downstream. The different takeoff sites vary over a factor of 50 in bypassing proficiency. At least part of this variation appears to reflect stability of the codon Colon, two colons anticodon interaction at the takeoff site, as indicated by the following: (a) the bypassing proficiency of different tRNAs shows a rough correlation with the frequency of A Colon, two colons U as opposed to G Colon, two colons C pairs in the codon Colon, two colons anticodon association; (b) specific tRNAs bypass more frequently from codons ending in U than from their synonym ending in C; (c) an arginine tRNA with Inosine in the wobble position which reads CGU, CGC, and CGA bypasses much more frequently from the last codon than the first two synonyms.
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Affiliation(s)
- J Gallant
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA.
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Hutchinson SJ, Goldberg DJ, King M, Cameron SO, Shaw LE, Brown A, MacKenzie J, Wilson K, MacDonald L. Hepatitis C virus among childbearing women in Scotland: prevalence, deprivation, and diagnosis. Gut 2004; 53:593-8. [PMID: 15016757 PMCID: PMC1774001 DOI: 10.1136/gut.2003.027383] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2003] [Indexed: 12/08/2022]
Abstract
OBJECTIVES (A) To examine the prevalence and demographic characteristics of hepatitis C virus (HCV) infection among childbearing women in Scotland; and (B) to determine the extent of maternal HCV infection diagnosed prior to birth. METHODS (A) Residual dried blood spot samples from routine neonatal screening, collected throughout Scotland during March-October 2000, were unlinked from identifiers and tested anonymously for HCV antibodies; and (B) electronic record linkage of Scotland's databases of births and diagnosed HCV infections was performed. RESULTS (A) Of 30,259 samples, 121 were enzyme linked immunosorbent assay repeat reactive and 88 of these were confirmed as anti-HCV positive in the recombinant immunoblot assay, representing a seroprevalence of 0.29-0.40%. HCV seroprevalence was high among 25-29 year olds (0.4-0.57%), in high deprivation areas (0.92-1.07%), and in Greater Glasgow (0.83-0.96%) and Grampian (0.38-0.62%). Adjusted relative risk for HCV infection was highest among residents in high deprivation areas of Glasgow (7.2 (95% confidence interval 2.0-25.5)). (B) Of 121 HCV infections found among women at delivery, 24% and 46% were estimated to have been diagnosed prior to pregnancy and birth, respectively. CONCLUSIONS HCV prevalence among Scottish childbearing women is consistent with that expected from injecting drug use. Based on reported rates of mother to child transmission, 8-11 paediatric infections are expected per annum. Diagnosis in only 24% of infected women prior to pregnancy indicates the extent to which HCV goes unrecognised in the injecting community. The current HCV screening approach-to test only those with a history of injecting drug use (or other risk factors for infection)-identifies approximately a quarter of previously undetected infections among pregnant women.
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Affiliation(s)
- S J Hutchinson
- Scottish Centre for Infection and Environmental Health, and Public Health and Health Policy Section, University of Glasgow, Glasgow, UK.
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Roy KM, Goldberg DJ, Hutchinson S, Cameron SO, Wilson K, MacDonald L. Hepatitis C virus among self declared non-injecting sexual partners of injecting drug users. J Med Virol 2004; 74:62-6. [PMID: 15258969 DOI: 10.1002/jmv.20146] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
While much is known about hepatitis C virus (HCV) among injecting drug users (IDUs), there is scant information about the risk of HCV infection to non-injecting sexual partners of injecting drug users; it is possible that such individuals may have a greater risk of acquiring HCV than any other group barring injecting drug users. This study examines the prevalence of HCV among a population of non-injecting sexual partners of injecting drug users. Unlinked anonymous testing for anti-HCV of residual sera stored following the named HIV testing of specimens originally from persons who had indicated to their attending clinicians that they were non-injecting sexual partners of injecting drug users. The prevalence of anti-HCV among the sexual partners was 4.1% (25/611) overall, 6.4% (13/202) among heterosexual male and 3.0% (12/397) among the heterosexual female partners. None of the homosexual/bisexual partners were HCV antibody positive (0/12). Although we cannot be sure how non-injecting partners of injecting drug users acquire their HCV infection, having a relationship with someone who injects drugs may place an individual at appreciable risk of being infected; such individuals should consider being tested for HCV.
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Affiliation(s)
- K M Roy
- Blood-borne Virus Section, Scottish Centre for Infection and Environmental Health, Glasgow, United Kingdom.
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Roy KM, Goldberg D, Taylor A, Hutchinson S, MacDonald L, Wilson KS, Cameron SO. A method to detect the incidence of hepatitis C infection among injecting drug users in Glasgow 1993-98. J Infect 2001; 43:200-5. [PMID: 11798260 DOI: 10.1053/jinf.2001.0908] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To determine the incidence of HCV infection in a selected population of Glasgow injectors during the mid-1990s, using a retrospective cohort design. METHODS Unlinked anonymous anti-HCV testing was undertaken on serum residues collected from injecting drug users (IDUs) having two or more voluntary named HIV tests between 1993 and 1998. RESULTS Seventy-seven percent (164/212) of IDUs had detectable HCV antibody in their first specimen collected. Of the 44 IDUs who were initially HCV seronegative and had a subsequent specimen available for testing, 11 (25%) seroconverted, giving an estimated incidence of 28.4 per 100 person-years (95% CI 15.7-51.2); the incidence of infection was greatest amongst older males. CONCLUSION This study provides evidence of continuing transmission of HCV among Glasgow IDUs during an era of interventions to prevent the spread of bloodborne infections in this population and demonstrates the application of the unlinked anonymous testing approach to gauge incidence rather than prevalence of infection.
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Affiliation(s)
- K M Roy
- Scottish Centre for Infection and Environmental Health, Glasgow, UK.
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Abstract
Little is known about the "stigmatizing" effects of Spasmodic Torticollis--a condition that produces physical disfigurement. This is important in understanding the social dimensions of this disorder. This study examined the presence, the dimensions, and the degree of perceived stigma in patients with Spasmodic Torticollis. The study was completed in two stages. In the first stage, ten patients were interviewed to identify the effects of their condition on their social interactions. In the second stage, a self-rating measure of stigma and questions about the impact of the condition on the patients' lives were devised. Perceived stigma was defined as avoidance of others, avoidance by others, self-consciousness, feeling unattractive, feeling apologetic, and feeling different from others. The questionnaires were sent to one hundred patients. The majority of the patients perceived "some" or "severe" stigma. Stigma was found to affect the patients' social, private, and working lives. It is suggested that stigma in Spasmodic Torticollis needs to be considered as a parameter relevant to the clinical management of these patients.
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Affiliation(s)
- I Papathanasiou
- Therapy Services, National Hospital for Neurology and Neurosurgery, United Kingdom.
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MacDonald L. "Minister of the gospel and doctor of medicine": Dr. Robert Grierson physician missionary to Korea, 1898-1913. J Can Church Hist Soc 2001; 43:171-190. [PMID: 18437765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Mai KT, Yazdi HM, MacDonald L. Fine needle aspiration biopsy of primary squamous cell carcinoma of the thyroid gland. Acta Cytol 1999; 43:1194-6. [PMID: 10579006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Abstract
In papillary thyroid carcinoma (PTC) in cytological and surgical specimens, fine chromatin, nuclear grooves and nuclear pseudoinclusions are the hallmarks of diagnosis. We investigated the significance of these nuclear changes in neoplastic non-PTC lesions. Fine needle aspiration biopsies (FNAB) of thyroid lesions were reviewed with histologic correlation. Twenty-five low-grade PTC and 35 neoplastic non-PTC lesions with a fine chromatin pattern in cytology specimens were identified. These lesions were studied along with five multinodular goiters and five follicular adenomas with a coarse chromatin pattern. The neoplastic non-PTC lesions were selected from cases with a histopathologic diagnosis of follicular neoplasm (accompanied by cytopathologic examination) but lacking a coarse chromatin pattern. The nuclear changes were separated into three grades of nuclear atypia with a fine chromatin pattern, depending on the degree of nuclear enlargement and nuclear membrane thickening, or the presence of nuclear grooves or pseudoinclusions. Thyroid lesions with a higher grade of nuclear atypia with a fine chromatin pattern were associated with larger nuclei and more readily visible nucleoli. These lesions correlated histologically with PTC and follicular adenomas with a fine chromatin pattern. The latter could be divided into three grades: grade 1 lesions having a fine chromatin pattern similar to that of nuclei with open chromatin seen in areas of nodular goiter; grade 3 lesions having nuclear features closest to those of PTC; and grade 2 lesions showing intermediate changes. In conclusion, there is a spectrum of nuclear changes in neoplastic non-PTC lesions with a fine chromatin pattern. These lesions are often diagnosed as follicular adenomas in surgical pathology and pose cytopathologic diagnostic problems between nodular goiter, follicular adenoma and PTC. The significance of follicular adenomas with a fine chromatin pattern will be discussed.
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Affiliation(s)
- K T Mai
- Department of Laboratory Medicine and Ottawa Civic Hospital, Ontario, Canada.
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Abstract
OBJECTIVE To determine the accuracy of cytologic interpretation in the diagnosis of Hashimoto's thyroiditis (HT). STUDY DESIGN At Ottawa Hospital from 1987 to 1994, 1,638 fine needle aspiration biopsies (FNABs) from thyroid were performed. HT was suggested in 184 FNAB samples taken from 157 patients. Of the 184 aspirates diagnosed with HT, 39 had corresponding surgical specimens taken from 31 patients. A retrospective review of these FNABs and surgical pathology slides formed the basis of this study. RESULTS In 27 (69%) aspirates, HT was diagnosed on both the FNAB and surgical specimens. In 10 of 27 FNABs an associated lesion was not sampled by FNAB. In four of these 10 aspirates some of the cellular features of HT were misinterpreted, and the possibility of an associated neoplasm could not be ruled out. This resulted in four false positive diagnoses. In 12 (31%) FNABs from nine patients, the cytologic diagnosis of HT was not confirmed histologically. These cases included five Hürthle cell adenomas and one case each of follicular adenoma, nodular goiter, macrofollicular adenoma and malignant lymphoma. This resulted in five false negative diagnoses. CONCLUSION These results support the value of FNAB in the diagnosis of HT. The presence of hyperplastic follicular cells on FNAB samples from HT may mimic a follicular neoplasm and result in a false positive interpretation. Adequate sampling of the thyroid is important, particularly when there is an associated lesion. The diagnosis of lymphocytic thyroiditis should not be made when only a few lymphocytes are present. Finally, pleomorphic Hürthle cells may be present in aspirates from Hürthle cell neoplasms and underdiagnosed as HT, especially when they are associated with a few lymphocytes.
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Affiliation(s)
- L MacDonald
- Department of Laboratory Medicine, Ottawa Hospital, Ontario, Canada
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Abstract
Candida species are increasingly important nosocomial pathogens in critically ill children. A 2.3-fold increase in the rate of nosocomial candidemia at our 200-bed tertiary care children's hospital prompted a study to identify risk factors for this infection. Twenty-six cases were identified between 1992 and 1993, representing 21% of all nosocomial bloodstream infections. Candida albicans was the most frequent isolate (58%), followed by Candida parapsilosis (27%). A case-control study revealed that there was a statistically significant association between the occurrence of candidemia and placement of a central venous catheter in the femoral vein (P = .03), the use of a tunneled central venous catheter (P = .05), and prolonged hyperalimentation (P = .04). Patients with candidemia also were noted to have candiduria more often than controls (P = .003) and were more likely to have had topical antifungal agents prescribed (P = .04). Multivariate analysis showed that hyperalimentation was an independent risk factor for the development of candidemia. We conclude that measures must be taken to reduce these risk factors whenever possible.
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Affiliation(s)
- L MacDonald
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0378, USA
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Hazard RG, Haugh LD, Reid S, McFarlane G, MacDonald L. Early physician notification of patient disability risk and clinical guidelines after low back injury: a randomized, controlled trial. Spine (Phila Pa 1976) 1997; 22:2951-8. [PMID: 9431632 DOI: 10.1097/00007632-199712150-00019] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN Back-injured workers with high disability risk scores on a predictive questionnaire participated in a randomized, controlled trial of physician notification, with outcomes follow-up 3 months after injury. OBJECTIVES To test whether physician intervention improves return to work and self-assessment outcomes for people at relatively high risk for disability. SUMMARY OF BACKGROUND DATA Only a small number of back-injured workers suffer significant disability. Quick identification of these people would facilitate more efficient targeting and trials of interventions. Controlling variations in practice through practice guidelines has been recommended as a promising strategy for improving care and reducing disability. METHODS Workers filing back injury reports responded to a disability prediction questionnaire. Those with high risk scores were randomly assigned to control or intervention groups. Patient-designated physicians in the intervention group received two letters identifying the patient's risk and making recommendations for care, including the Agency for Health Care Policy and Research's algorithms for acute low back pain. Predictive accuracy of the questionnaire and efficacy of physician intervention were evaluated on the basis of work status and self-assessments 3 months after injury. RESULTS Of the 268 workers completing the questionnaire portion of the study, 32 (12%) were out of work because of back pain 3 months after injury. The questionnaire's predictive accuracy included maximum kappa of 0.277 and a receiver operating curve area of 0.78. Fifty-three people completed the physician intervention trial. The intervention had no significant impact on return to work, self-assessed pain, or satisfaction with health care. CONCLUSIONS Stratification of back-injured people according to disability risk can can increase intervention efficiency by identifying those who require treatment and sparing those who do not. The apparent failure of risk notification and practice guidelines to reduce disability in this study may be improved by different application methods in the future.
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Affiliation(s)
- R G Hazard
- Vermont Back Research Center, Burlington, USA
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Moure-Eraso R, Wilcox M, Punnett L, MacDonald L, Levenstein C. Back to the future: sweatshop conditions on the Mexico-U.S. border. II. Occupational health impact of maquiladora industrial activity. Am J Ind Med 1997; 31:587-99. [PMID: 9099362 DOI: 10.1002/(sici)1097-0274(199705)31:5<587::aid-ajim14>3.0.co;2-v] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Present working conditions in one of the most active areas of the maquiladora system along the Mexico-U.S. border are reminiscent of nineteenth-century U.S. sweatshops. The organization of production is Tayloristic and authoritarian, with detailed division of labor, repetitive simple tasks, and piecework wages. Modern participative management styles are not apparent in the maquiladora setting. This study consists of two separate but interrelated surveys conducted in 1992, one of community leaders and this one of workers in maquiladora enterprises in the towns of Matamoros and Reynosa, Mexico. The community survey evaluated the economic and psychosocial impact of the maquiladora enterprise and was conducted simultaneously to the workers' survey and in the same Mexican towns where the workers lived and worked. The community leaders acknowledged the employment opportunities that maquiladora factories had brought to the region but believed them to have high environmental and psychosocial costs. For the occupational component, a community-based survey of 267 maquiladora workers was conducted. participants were chosen with more than a year seniority in the industry and living in the two Mexican cities surveyed. They responded to an extensive questionnaire given by trained canvassers. The workers' survey found evidence that maquiladora workers (81% female) report symptoms from musculoskeletal disorders related to working conditions. Acute health effects compatible with chemical exposures were also identified. Prevalence of symptoms was correlated with increasing duration of exposure to ergonomic risk factors and qualitative chemical exposure indexes. Other chronic disease was not apparent. The survey demonstrated inequalities in salary, working hours, and safety training between the two communities. Matamoros workers are substantially better paid and work fewer hours per week than Reynosa workers. Most hazards reported in the worker's survey have been well studied in the general occupational health literature with respect to adverse health effects. Therefore, it is recommended that hazard surveillance studies would be more useful towards the goal of prevention than further etiologic studies. Specific recommendations on policy and remediation interventions are also made.
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Affiliation(s)
- R Moure-Eraso
- University of Massachusetts Lowell, Work Environment Program 01854, USA
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Shu S, Grant GG, Langevin D, Lombardo DA, MacDonald L. Oviposition and Electroantennogram Responses of Dioryctria abietivorella (Lepidoptera: Pyralidae) Elicited by Monoterpenes and Enantiomers from Eastern White Pine. J Chem Ecol 1997. [DOI: 10.1023/b:joec.0000006344.18966.c6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
OBJECTIVE To evaluate all nondiagnostic fine needle aspiration biopsy (FNAB) specimens from the thyroid gland with subsequent histopathologic diagnoses at Ottawa Civic Hospital. The criterion for specimen adequacy used in our institution was also reexamined to determine if it was too stringent. STUDY DESIGN Review of 114 nondiagnostic FNAB samples from 91 patients with subsequent histopathologic diagnoses formed the basis of this study. Specimen adequacy was determined by the presence of 8-10 fragments of well-preserved follicular cells on at least two smears. RESULTS Review of the 91 surgical specimens found 50 nodular goiters, 23 follicular adenomas, 6 macrofollicular adenomas, 5 cases of thyroiditis, 5 true cysts, 1 papillary carcinoma and 1 minimally invasive follicular carcinoma. Forty-two percent of lesions showed cystic change. In addition, nine cases of papillary microcarcinoma were diagnosed. A considerable difference in the rate (22% vs. 45%) of inadequate thyroid FNAB samples was identified among different groups of physicians at our institution. CONCLUSION Ninety-eight percent of the patients with nondiagnostic FNAB of the thyroid gland had benign lesions. This finding encouraged us to continue using our criteria for adequacy because of the importance of a negative report. The higher rate of nondiagnostic thyroid aspiration in our series may reflect the varied experience of the different aspirators at our institution and/or the cystic nature of many of the lesions.
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Affiliation(s)
- L MacDonald
- Department of Laboratory Medicine, Ottawa Civic Hospital, Ontario, Canada
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Abstract
STUDY DESIGN An inception cohort design was used to study a consecutive sample of back-injured workers. OBJECTIVE To refine and to test the Vermont Disability Prediction Questionnaire's ability to indicate an individual's relative risk for chronic disability after occupational low back injury. SUMMARY OF BACKGROUND DATA Although most back-injured workers return to work quickly, the minority who do not account for the majority of associated costs and health care. Early identification of workers at high risk for disability would facilitate intervention strategies. METHODS During the study recruitment period, people aged 18-60 years reporting occupational low back injury to the Vermont Department of Labor and Industry within 11 days of onset were eligible. A Vermont Disability Prediction Questionnaire was mailed to the 442 subjects who could be contacted and who gave informed consent. One hundred sixty-three of the 166 subjects who completed and returned the questionnaire within 15 days of initial injury were telephoned 3 months later to determine work status. Those who returned the questionnaire were compared with those who would not consent or did not return the questionnaire in time according to age, sex, residence, wages, work hours per week, and length of employment. Employment status (inability to work because of low back pain) was evaluated by telephone interview 3 months after initial injury. RESULTS The follow-up interviewer was blinded to the Vermont Disability Prediction Questionnaire scores. of the 163 subjects, 16 (10%) were not working because of low back pain. Using a simple dichotomous scoring system for 11 questionnaire items, a cut-off score of 0.48 identified 3-month postinjury work status, with 0.94 sensitivity and 0.84 specificity. CONCLUSIONS The Vermont Disability Prediction Questionnaire is a brief, easily administered and scored tool for identifying back-injured workers at relative risk for chronic disability. Such early identification should increase the efficiency of disability prevention strategies by directing them toward people who need them most. The accuracy of the questionnaire needs to be tested in a variety of different clinical and socioeconomic settings.
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Affiliation(s)
- R G Hazard
- Vermont Rehabilitation Research Center, University of Vermont, Burlington 05401, USA
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Abstract
Eighteen psychiatric trainees spent 6 months each as general practice trainees. The educational impact of the experience was assessed by a self-assessment questionnaire, a semi-structured interview and a videotaped interview with a psychiatric patient. Each assessment was conducted at a baseline and after 12 months. A control group of 14 trainees was recruited from the same rotation. On the self-assessment questionnaire, the study registrars rated their abilities to solve general medical problems significantly improved compared to controls. They had also acquired greater understanding of the limitation of their knowledge and their legal responsibilities towards their patients. The semi-structured interview failed to distinguish between the two groups. Videotapes for rating at baseline and follow-up were available for only 17 of the trainees. Assessment of the tapes used the Maguire Scale and the Interview Behaviour Scale. Neither scale demonstrated any intervention effect. The interviews were all characterized by a preponderance of 'closed psychological' and 'checking-out' questions. It appears that psychiatric trainees' interviewing styles had not been influenced by the experience. This study suggests that psychiatric trainees gain greater confidence in their role as a doctor and greater understanding of the scope and nature of general practice by such an attachment. It is unclear whether or not supplementary interviewing skills had been acquired which were not utilized in the taped interview, which conforms very much to traditional psychiatric examination behaviour. Trainees were reassured that they had increased their knowledge without losing any of their specific professional skills.
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Affiliation(s)
- T Burns
- Department of Mental Health Sciences, St George's Hospital Medical School, London, UK
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Pope MH, Phillips RB, Haugh LD, Hsieh CY, MacDonald L, Haldeman S. A prospective randomized three-week trial of spinal manipulation, transcutaneous muscle stimulation, massage and corset in the treatment of subacute low back pain. Spine (Phila Pa 1976) 1994; 19:2571-7. [PMID: 7855683 DOI: 10.1097/00007632-199411001-00013] [Citation(s) in RCA: 110] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A randomized prospective trial of manipulation, massage, corset and transcutaneous muscle stimulation (TMS) was conducted in patients with subacute low back pain. OBJECTIVES The authors determined the relative efficacy of chiropractic treatment to massage, corset, and TMS. SUMMARY OF BACKGROUND DATA Although all of these treatments are used for subacute low back pain treatment, there have been few comparative trials using objective outcome criteria. Patients were enrolled for a period of 3 weeks. They were evaluated once a week by questionnaires, visual analog scale, range of motion, maximum voluntary extension effort, straight leg raising and Biering-Sorensen fatigue test. The dropout rate was highest in the muscle stimulation and corset groups and lowest in the manipulation group. Rates of full compliance did not differ significantly across treatments. A measure of patient confidence was greatest in the manipulation group. RESULTS After 3 weeks, the manipulation group scored the greatest improvements in flexion and pain while the massage group had the best extension effort and fatigue time, and the muscle stimulation group the best extension. CONCLUSION None of the changes in physical outcome measures (range of motion, fatigue, strength or pain) were significantly different between any of the groups.
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Affiliation(s)
- M H Pope
- Iowa Spine Research Center, University of Iowa, Iowa City
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