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Kearney A, Butlin L, Coffey T, Conway T, Cotterill S, Evans A, Fox J, Hunter A, Inglis S, Murphy L, Noor NM, Walker-Smith T, Gamble C. The overlap between randomised evaluations of recruitment and retention interventions: An updated review of recruitment (Online Resource for Recruitment in Clinical triAls) and retention (Online Resource for Retention in Clinical triAls) literature. Clin Trials 2024:17407745241238444. [PMID: 38576071 DOI: 10.1177/17407745241238444] [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] [Indexed: 04/06/2024]
Abstract
BACKGROUND The Online Resource for Recruitment in Clinical triAls (ORRCA) and the Online Resource for Retention in Clinical triAls (ORRCA2) were established to organise and map the literature addressing participant recruitment and retention within clinical research. The two databases are updated on an ongoing basis using separate but parallel systematic reviews. However, recruitment and retention of research participants is widely acknowledged to be interconnected. While interventions aimed at addressing recruitment challenges can impact retention and vice versa, it is not clear how well they are simultaneously considered within methodological research. This study aims to report the recent update of ORRCA and ORRCA2 with a special emphasis on assessing crossover of the databases and how frequently randomised studies of methodological interventions measure the impact on both recruitment and retention outcomes. METHODS Two parallel systematic reviews were conducted in line with previously reported methods updating ORRCA (recruitment) and ORRCA2 (retention) with publications from 2018 and 2019. Articles were categorised according to their evidence type (randomised evaluation, non-randomised evaluation, application and observation) and against the recruitment and retention domain frameworks. Articles categorised as randomised evaluations were compared to identify studies appearing in both databases. For randomised studies that were only in one database, domain categories were used to assess whether the methodological intervention was likely to impact on the alternate construct. For example, whether a recruitment intervention might also impact retention. RESULTS In total, 806 of 17,767 articles screened for the recruitment database and 175 of 18,656 articles screened for the retention database were added as result of the update. Of these, 89 articles were classified as 'randomised evaluation', of which 6 were systematic reviews and 83 were randomised evaluations of methodological interventions. Ten of the randomised studies assessed recruitment and retention and were included in both databases. Of the randomised studies only in the recruitment database, 48/55 (87%) assessed the content or format of participant information which could have an impact on retention. Of the randomised studies only in the retention database, 6/18 (33%) assessed monetary incentives, 4/18 (22%) assessed data collection location and methods and 3/18 (17%) assessed non-monetary incentives, all of which could have an impact on recruitment. CONCLUSION Only a small proportion of randomised studies of methodological interventions assessed the impact on both recruitment and retention despite having a potential impact on both outcomes. Where possible, an integrated approach analysing both constructs should be the new standard for these types of evaluations to ensure that improvements to recruitment are not at the expense of retention and vice versa.
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Affiliation(s)
- Anna Kearney
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Laura Butlin
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Taylor Coffey
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Thomas Conway
- HRB-TMRN, Trial Methodology and Evidence Synthesis, University of Galway, Galway, Ireland
| | - Sarah Cotterill
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | | | - Jackie Fox
- MRC Clinical Trials Unit, University College London, London, UK
| | - Andrew Hunter
- School of Nursing & Midwifery, University of Galway, Galway, Ireland
| | - Sarah Inglis
- Tayside Clinical Trials Unit (TCTU), University of Dundee, Dundee, UK
| | - Louise Murphy
- Health Research Institute, Department of Nursing Studies & Midwifery, University of Limerick, Limerick, Ireland
| | | | | | - Carrol Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
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O'Brien A, Murphy L, Hunt A, Dwyer D, Hunter A. A co-created multimethod evaluation of recovery education in Ireland. Health Expect 2024; 27:e13937. [PMID: 38549203 PMCID: PMC10978797 DOI: 10.1111/hex.13937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND This paper aims to explore the impact of recovery education on recovery knowledge, attitudes and the quality of life of students undertaking recovery education, contributing to the evidence base in relation to the impact of recovery education. It also explores the experiences of all stakeholders involved in the co-facilitation, delivery and participation in recovery education. SETTING AND PARTICIPANTS This study evaluates the experiences of stakeholders involved in the co-facilitation, delivery and participation in recovery education across four recovery colleges in Ireland. Participants included students undertaking recovery education, peer educators, education facilitators, recovery college coordinators and practitioner/service providers. DISCUSSION Findings from the quantitative survey when compared with extant literature suggest that students had a good understanding of recovery education. The social aspect of empowerment for growth and wellbeing was identified through themes relating to co-production and facilitating student learning. Support for equitable access to recovery education, including co-production for both the public and staff, was identified as a challenge for the future. CONCLUSION The findings from both the qualitative and quantitative components of the study show the positive impact of recovery education on stakeholders while acknowledging the need for ongoing support for people working in recovery education and the development of services. In particular, there was a high level of recovery knowledge found in students undertaking recovery education. PATIENT OR PUBLIC CONTRIBUTION This study utilised a co-created study design. From inception a steering group comprising stakeholders (peer educators, recovery education facilitators including past recovery college students and nonpeer staff involved in the co-production of recovery education) directed the conduct of the evaluation. This steering group participated in an iterative process of information sharing, suggestions for evaluation process and language.
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Affiliation(s)
- Ann O'Brien
- Business Information Systems, J. E. Cairnes School of Business & EconomicsUniversity of GalwayGalwayIreland
| | - Louise Murphy
- Department of Nursing and Midwifery, Health Research InstituteUniversity of LimerickLimerickIreland
| | - Amanda Hunt
- East Galway Recovery College (REGARI)RoscommonIreland
| | | | - Andrew Hunter
- School of Nursing and MidwiferyUniversity of GalwayGalwayIreland
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Xie W, Ravi P, Buyse M, Halabi S, Kantoff P, Sartor O, Soule H, Clarke N, Dignam J, James N, Fizazi K, Gillessen S, Mottet N, Murphy L, Parulekar W, Sandler H, Tombal B, Williams S, Sweeney CJ. Validation of metastasis-free survival as a surrogate endpoint for overall survival in localized prostate cancer in the era of docetaxel for castration-resistant prostate cancer. Ann Oncol 2024; 35:285-292. [PMID: 38061427 PMCID: PMC10922430 DOI: 10.1016/j.annonc.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Prior work from the Intermediate Clinical Endpoints in Cancer of the Prostate (ICECaP) consortium (ICECaP-1) demonstrated that metastasis-free survival (MFS) is a valid surrogate for overall survival (OS) in localized prostate cancer (PCa). This was based on data from patients treated predominantly before 2004, prior to docetaxel being available for the treatment of metastatic castrate-resistant prostate cancer (mCRPC). We sought to validate surrogacy in a more contemporary era (ICECaP-2) with greater availability of docetaxel and other systemic therapies for mCRPC. PATIENTS AND METHODS Eligible trials for ICECaP-2 were those providing individual patient data (IPD) after publication of ICECaP-1 and evaluating adjuvant/salvage therapy for localized PCa, and which collected MFS and OS data. MFS was defined as distant metastases or death from any cause, and OS was defined as death from any cause. Surrogacy was evaluated using a meta-analytic two-stage validation model, with an R2 ≥ 0.7 defined a priori as clinically relevant. RESULTS A total of 15 164 IPD from 14 trials were included in ICECaP-2, with 70% of patients treated after 2004. The median follow-up was 8.3 years and the median postmetastasis survival was 3.1 years in ICECaP-2, compared with 1.9 years in ICECaP-1. For surrogacy condition 1, Kendall's tau was 0.92 for MFS with OS at the patient level, and R2 from weighted linear regression (WLR) of 8-year OS on 5-year MFS was 0.73 (95% confidence interval 0.53-0.82) at the trial level. For condition 2, R2 was 0.83 (95% confidence interval 0.64-0.89) from WLR of log[hazard ratio (HR)]-OS on log(HR)-MFS. The surrogate threshold effect on OS was an HR(MFS) of 0.81. CONCLUSIONS MFS remained a valid surrogate for OS in a more contemporary era, where patients had greater access to docetaxel and other systemic therapies for mCRPC. This supports the use of MFS as the primary outcome measure for ongoing adjuvant trials in localized PCa.
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Affiliation(s)
- W Xie
- Dana-Farber Cancer Institute, Boston, USA
| | - P Ravi
- Dana-Farber Cancer Institute, Boston, USA
| | - M Buyse
- International Drug Development Institute, Louvain-la-Neuve; I-BioStat, Hasselt University, Hasselt, Belgium
| | | | | | | | - H Soule
- Prostate Cancer Foundation, Santa Monica, USA
| | - N Clarke
- The Christie NHS Foundation Trust, Manchester, UK
| | - J Dignam
- University of Chicago, Chicago, USA
| | - N James
- The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, London, UK
| | - K Fizazi
- Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | - S Gillessen
- Oncology Institute of Southern Switzerland, EOC, Bellinzona; Università della Svizzera Italiana, Lugano, Switzerland
| | - N Mottet
- Mutualite Francoise Loire, St Etienne, France
| | - L Murphy
- Medical Research Council at UCL, London, UK
| | - W Parulekar
- Queens University, Kingston, Ontario, Canada
| | - H Sandler
- Cedars-Sinai Medical Center, Los Angeles, USA
| | - B Tombal
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - S Williams
- Peter MacCallum Cancer Centre, Melbourne
| | - C J Sweeney
- South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, Australia.
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McFeely O, Walsh PM, Desmond R, Enright H, Costa Blasco M, Wolinska A, Murphy L, Andrawis M, Beatty P, Doyle C, Tobin AM, O'Gorman S, Molloy K. Incidence of cutaneous T-cell lymphoma in the Republic of Ireland between 1994 and 2019. J Eur Acad Dermatol Venereol 2024; 38:e145-e147. [PMID: 37705380 DOI: 10.1111/jdv.19497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Affiliation(s)
- O McFeely
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - P M Walsh
- National Cancer Registry of Ireland, Cork, Ireland
| | - R Desmond
- Department of Haematology, Tallaght University Hospital, Dublin, Ireland
| | - H Enright
- Department of Haematology, Tallaght University Hospital, Dublin, Ireland
| | - M Costa Blasco
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - A Wolinska
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - L Murphy
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - M Andrawis
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - P Beatty
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - C Doyle
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - A M Tobin
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - S O'Gorman
- Department of Dermatology, St. James's Hospital, Dublin, Ireland
| | - K Molloy
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
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Russell-Smith A, Murphy L, Nguyen A, Blauer-Peterson C, Terpenning M, Cao F, Li S, Bancroft T, Webb N, Dorman S, Shah R. Real-world use of inotuzumab ozogamicin is associated with lower health care costs than blinatumomab in patients with acute lymphoblastic leukemia in the first relapsed/refractory setting. J Comp Eff Res 2024; 13:e230142. [PMID: 38099517 PMCID: PMC10842295 DOI: 10.57264/cer-2023-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
Aim: To compare all-cause and acute lymphoblastic leukemia (ALL)-related healthcare resource utilization (HCRU) and costs among patients receiving inotuzumab ozogamicin (InO) and blinatumomab (Blina) for ALL in the first relapsed/refractory (R/R) setting. Patients & methods: We studied retrospective claims for adult commercial and Medicare Advantage enrollees with ALL receiving InO (n = 29) or Blina (n = 23) from 1 January 2015 to 16 February 2021. Mean per-patient-per-month (PPPM) HCRU and total costs were described and multivariable-adjusted PPPM total all-cause and ALL-related predicted costs were calculated. Results: Mean monthly ALL-related hospitalizations were the same for patients receiving InO and Blina (PPPM = 0.8 stays); however, the length of ALL-related hospital stay was almost twice as long among patients receiving Blina versus InO (ALL-related: InO = 7.6 days; Blina = 14.1 days; p = 0.346). In multivariable models, total ALL-related costs were 43% lower for InO compared with Blina (PPPM costs: InO = $93,767; Blina = $163,470; p = 0.021). Conclusion: In the first R/R setting, patients who used InO had significantly lower all-cause and ALL-related costs compared with patients who used Blina, in part driven by hospitalization patterns.
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Affiliation(s)
| | - Louise Murphy
- Optum, Eden Prairie, MN 55344, USA
- Author for correspondence: Tel;
| | | | | | | | - Feng Cao
- Optum, Eden Prairie, MN 55344, USA
| | | | | | | | - Stephanie Dorman
- Global Medical Affairs, Pfizer Inc, Kirkland QC, H9J 2M5, Canada
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Staplin N, Haynes R, Judge PK, Wanner C, Green JB, Emberson J, Preiss D, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Seidi S, Landray MJ, Baigent C, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi R, Chukwu C, Chung K, Cianciolo G, Cipressa L, Clark S, Clarke H, Clarke R, Clarke S, Cleveland B, Cole E, Coles H, Condurache L, Connor A, Convery K, Cooper A, Cooper N, Cooper Z, Cooperman L, Cosgrove L, Coutts P, Cowley A, Craik R, Cui G, Cummins T, Dahl N, Dai H, Dajani L, D'Amelio A, Damian E, Damianik K, Danel L, Daniels C, Daniels T, Darbeau S, Darius H, Dasgupta T, Davies J, Davies L, Davis A, Davis J, Davis L, Dayanandan R, Dayi S, Dayrell R, De Nicola L, Debnath S, Deeb W, Degenhardt S, DeGoursey K, Delaney M, Deo R, DeRaad R, Derebail V, Dev D, Devaux M, Dhall P, Dhillon G, Dienes J, Dobre M, Doctolero E, Dodds V, Domingo D, Donaldson D, Donaldson P, Donhauser C, Donley V, Dorestin S, Dorey S, Doulton T, Draganova D, Draxlbauer K, Driver F, Du H, Dube F, Duck T, Dugal T, Dugas J, Dukka H, Dumann H, Durham W, Dursch M, Dykas R, Easow R, Eckrich E, Eden G, Edmerson E, Edwards H, Ee LW, Eguchi J, Ehrl Y, Eichstadt K, Eid W, Eilerman B, Ejima Y, Eldon H, Ellam T, Elliott L, Ellison R, Emberson J, Epp R, Er A, Espino-Obrero M, Estcourt S, Estienne L, Evans G, Evans J, Evans S, Fabbri G, Fajardo-Moser M, Falcone C, Fani F, Faria-Shayler P, Farnia F, Farrugia D, Fechter M, Fellowes D, Feng F, Fernandez J, Ferraro P, Field A, Fikry S, Finch J, Finn H, Fioretto P, Fish R, Fleischer A, Fleming-Brown D, Fletcher L, Flora R, Foellinger C, Foligno N, Forest S, Forghani Z, Forsyth K, Fottrell-Gould D, Fox P, Frankel A, Fraser D, Frazier R, Frederick K, Freking N, French H, Froment A, Fuchs B, Fuessl L, Fujii H, Fujimoto A, Fujita A, Fujita K, Fujita Y, Fukagawa M, Fukao Y, Fukasawa A, Fuller T, Funayama T, Fung E, Furukawa M, Furukawa Y, Furusho M, Gabel S, Gaidu J, Gaiser S, Gallo K, Galloway C, Gambaro G, Gan CC, Gangemi C, Gao M, Garcia K, Garcia M, Garofalo C, Garrity M, Garza A, Gasko S, Gavrila M, Gebeyehu B, Geddes A, Gentile G, George A, George J, Gesualdo L, Ghalli F, Ghanem A, Ghate T, Ghavampour S, Ghazi A, Gherman A, Giebeln-Hudnell U, Gill B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura S, Kiyosue A, Kiyota M, Klauser F, Klausmann G, Kmietschak W, Knapp K, Knight C, Knoppe A, Knott C, Kobayashi M, Kobayashi R, Kobayashi T, Koch M, Kodama S, Kodani N, Kogure E, Koizumi M, Kojima H, Kojo T, Kolhe N, Komaba H, Komiya T, Komori H, Kon SP, Kondo M, Kondo M, Kong W, Konishi M, Kono K, Koshino M, Kosugi T, Kothapalli B, Kozlowski T, Kraemer B, Kraemer-Guth A, Krappe J, Kraus D, Kriatselis C, Krieger C, Krish P, Kruger B, Ku Md Razi KR, Kuan Y, Kubota S, Kuhn S, Kumar P, Kume S, Kummer I, Kumuji R, Küpper A, Kuramae T, Kurian L, Kuribayashi C, Kurien R, Kuroda E, Kurose T, Kutschat A, Kuwabara N, Kuwata H, La Manna G, Lacey M, Lafferty K, LaFleur P, Lai V, Laity E, Lambert A, Landray MJ, Langlois M, Latif F, Latore E, Laundy E, Laurienti D, Lawson A, Lay M, Leal I, Leal I, Lee AK, Lee J, Lee KQ, Lee R, Lee SA, Lee YY, Lee-Barkey Y, Leonard N, Leoncini G, Leong CM, Lerario S, Leslie A, Levin A, Lewington A, Li J, Li N, Li X, Li Y, Liberti L, Liberti ME, Liew A, Liew YF, 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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura S, Kiyosue A, Kiyota M, Klauser F, Klausmann G, Kmietschak W, Knapp K, Knight C, Knoppe A, Knott C, Kobayashi M, Kobayashi R, Kobayashi T, Koch M, Kodama S, Kodani N, Kogure E, Koizumi M, Kojima H, Kojo T, Kolhe N, Komaba H, Komiya T, Komori H, Kon SP, Kondo M, Kondo M, Kong W, Konishi M, Kono K, Koshino M, Kosugi T, Kothapalli B, Kozlowski T, Kraemer B, Kraemer-Guth A, Krappe J, Kraus D, Kriatselis C, Krieger C, Krish P, Kruger B, Ku Md Razi KR, Kuan Y, Kubota S, Kuhn S, Kumar P, Kume S, Kummer I, Kumuji R, Küpper A, Kuramae T, Kurian L, Kuribayashi C, Kurien R, Kuroda E, Kurose T, Kutschat A, Kuwabara N, Kuwata H, La Manna G, Lacey M, Lafferty K, LaFleur P, Lai V, Laity E, Lambert A, Landray MJ, Langlois M, Latif F, Latore E, Laundy E, Laurienti D, Lawson A, Lay M, Leal I, Leal I, Lee AK, Lee J, Lee KQ, Lee R, Lee SA, Lee YY, Lee-Barkey Y, Leonard N, Leoncini G, Leong CM, Lerario S, Leslie A, Levin A, Lewington A, Li J, Li N, Li X, Li Y, Liberti L, Liberti ME, Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Brierley CK, Yip BH, Orlando G, Goyal H, Wen S, Wen J, Levine MF, Jakobsdottir GM, Rodriguez-Meira A, Adamo A, Bashton M, Hamblin A, Clark SA, O'Sullivan J, Murphy L, Olijnik AA, Cotton A, Narina S, Pruett-Miller SM, Enshaei A, Harrison C, Drummond M, Knapper S, Tefferi A, Antony-Debré I, Thongjuea S, Wedge DC, Constantinescu S, Papaemmanuil E, Psaila B, Crispino JD, Mead AJ. Chromothripsis orchestrates leukemic transformation in blast phase MPN through targetable amplification of DYRK1A. bioRxiv 2023:2023.12.08.570880. [PMID: 38106192 PMCID: PMC10723394 DOI: 10.1101/2023.12.08.570880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Chromothripsis, the process of catastrophic shattering and haphazard repair of chromosomes, is a common event in cancer. Whether chromothripsis might constitute an actionable molecular event amenable to therapeutic targeting remains an open question. We describe recurrent chromothripsis of chromosome 21 in a subset of patients in blast phase of a myeloproliferative neoplasm (BP-MPN), which alongside other structural variants leads to amplification of a region of chromosome 21 in ∼25% of patients ('chr21amp'). We report that chr21amp BP-MPN has a particularly aggressive and treatment-resistant phenotype. The chr21amp event is highly clonal and present throughout the hematopoietic hierarchy. DYRK1A , a serine threonine kinase and transcription factor, is the only gene in the 2.7Mb minimally amplified region which showed both increased expression and chromatin accessibility compared to non-chr21amp BP-MPN controls. We demonstrate that DYRK1A is a central node at the nexus of multiple cellular functions critical for BP-MPN development, including DNA repair, STAT signalling and BCL2 overexpression. DYRK1A is essential for BP-MPN cell proliferation in vitro and in vivo , and DYRK1A inhibition synergises with BCL2 targeting to induce BP-MPN cell apoptosis. Collectively, these findings define the chr21amp event as a prognostic biomarker in BP-MPN and link chromothripsis to a druggable target.
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Flanagan P, Dowling M, Sezgin D, Mereckiene J, Murphy L, Giltenane M, Carr P, Gethin G. The effectiveness of interventions to improve the seasonal influenza vaccination uptake among nurses: A systematic review. J Infect Prev 2023; 24:268-277. [PMID: 37969468 PMCID: PMC10638950 DOI: 10.1177/17571774231208115] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 09/30/2023] [Indexed: 11/17/2023] Open
Abstract
Background Seasonal influenza is a significant cause of mortality and morbidity worldwide. Despite annual recommendations, influenza vaccination uptake rates are disproportionately lower among nurses compared to other health care professionals, especially when compared to physicians. Nurses have an additional risk of exposure to influenza infection due to the nature of their work. Aim To determine the effectiveness of interventions in increasing seasonal influenza vaccination uptake among nurses. Methods Evidence on the effectiveness of interventions to improve seasonal influenza vaccination uptake among nurses was systematically reviewed. A comprehensive search of six electronic databases and grey literature was undertaken. A minimum of two reviewers completed study selection, data extraction and risk of bias assessment independently. Results One hundred and thirty-four studies were identified of which one cluster randomised trial met the inclusion criteria. The results of the included study found the implementation of an intervention with multiple components increased nurses' seasonal influenza vaccination rates during a single influenza season in geriatric healthcare settings in France. As the evidence in this review was very limited, it was not possible to make recommendations regarding which interventions were effective at increasing the seasonal influenza vaccination rate for nurses. Conclusion This systematic review highlights a lack of high-quality studies that assessed interventions to improve the seasonal influenza vaccination of nurses. In view of the likelihood of influenza and the coronavirus (COVID-19) pandemic occurring together, it is imperative to have evidence on effective interventions for the nursing workforce and for policy decision makers.
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Affiliation(s)
- Paula Flanagan
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Duygu Sezgin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | | | - Louise Murphy
- School of Nursing and Midwifery, University of Limerick, Galway, Ireland
| | - Martina Giltenane
- School of Nursing and Midwifery, University of Limerick, Galway, Ireland
| | - Peter Carr
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Georgina Gethin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
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Probst S, Gschwind G, Murphy L, Sezgin D, Carr P, McIntosh C, Gethin G. Patients 'acceptance' of chronic wound-associated pain - A qualitative descriptive study. J Tissue Viability 2023; 32:455-459. [PMID: 37451973 DOI: 10.1016/j.jtv.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/09/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023]
Abstract
Chronic wound-associated pain negatively impacts the quality of life of individuals and their families. To date, little research exists that has explored collectively how individuals describe wound pain, strategies they use to manage pain, and the perceived effectiveness of such strategies. Therefore, qualitative, semi-structured interviews were carried out between June and August 2021 with 13 individuals to gain a deeper understand of the experience and impact of chronic wound-associated pain in this population. Data were analyzed following Braun and Clarke's approach for reflexive thematic analysis using MAXQdA®. Two themes and subthemes were identified. Theme 1 reflects participants' characterization of pain and how wound-associated pain affected their daily life and how they learned to accept it. Participants felt functionally impaired. In theme 2, participants described how they accepted to live with such a pain even though they received support to manage their chronic wound-associated pain, especially during the dressing-changes. Patients depended on their health care professionals and family support networks to cope with the pain. Coping with pain is exhausting contributing to poorer quality of life. Health care professionals should be aware of wound-associated pain during dressing changes. Patients recommended the need for further research on dressings and not drugs to manage pain.
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Affiliation(s)
- Sebastian Probst
- Geneva School of Health Science, HES-SO University of Applied Sciences and Arts, Western Switzerland, Avenue Champel 47, 1206, Geneva, Switzerland; University Hospital Geneva, Switzerland; Faculty of Medicine Nursing and Health Sciences, Monash University, Australia; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; School of Nursing and Midwifery, University of Galway, Ireland.
| | - Géraldine Gschwind
- Geneva School of Health Science, HES-SO University of Applied Sciences and Arts, Western Switzerland, Avenue Champel 47, 1206, Geneva, Switzerland.
| | - Louise Murphy
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Department of Nursing and Midwifery, University of Limerick, Faculty of Education and Health Sciences, Limerick, Ireland.
| | - Duygu Sezgin
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; School of Nursing and Midwifery, University of Galway, Ireland.
| | - Peter Carr
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; School of Nursing and Midwifery, University of Galway, Ireland.
| | - Caroline McIntosh
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; School of Health Science, University of Galway, Ireland.
| | - Georgina Gethin
- Geneva School of Health Science, HES-SO University of Applied Sciences and Arts, Western Switzerland, Avenue Champel 47, 1206, Geneva, Switzerland; Faculty of Medicine Nursing and Health Sciences, Monash University, Australia; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; School of Nursing and Midwifery, University of Galway, Ireland.
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Gethin G, Murphy L, Sezgin D, Carr PJ, Mcintosh C, Probst S. Resigning oneself to a life of wound-related odour - A thematic analysis of patient experiences. J Tissue Viability 2023; 32:460-464. [PMID: 37495442 DOI: 10.1016/j.jtv.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/21/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023]
Abstract
AIMS To determine how patients with chronic wounds describe wound odour, identify what strategies they use to manage it and how effective these are. MATERIALS AND METHODS Using a qualitative descriptive approach, semi-structured interviews were conducted between July and August 2021 with seven patients living with an odorous chronic wound at home. Data were analysed using Braun and Clarke's thematic analysis framework. RESULTS The results were organised into two main themes: 1) becoming resigned to living with wound-related odour 2) strategies used to manage wound-related odour. Participants were sad, embarrassed and felt isolated but became resigned to living with this odour and accepting of it as a consequence of having a wound. Frequent dressing changes, household cleaning along with the use of sprays were the most frequently used tactics to manage odour none of which were deemed to be very effective. CONCLUSION This study highlights the problem of odour management in clinical practice and how individuals develop strategies to overcome odour. Sadly, patients were resigned to living with wound odour and were accepting of it as part of daily life. This highlights the importance for healthcare professionals to recognise, assess for and ensure a better understanding of how people experience wound odour, the impact it can have on them personally. Frequent dressing changes can help manage wound odour from the patient's perspective.
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Affiliation(s)
- G Gethin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Geneva School of Health Science, HES-SO University of Applied Sciences and Arts, Western Switzerland, Switzerland.
| | - L Murphy
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Department of Nursing and Midwifery, Health Research Institute, University of Limerick, Limerick, Ireland.
| | - D Sezgin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland.
| | - P J Carr
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; AVATAR Group Menzies Health Institute Queensland Griffith University, Australia.
| | - C Mcintosh
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Discipline of Podiatric Medicine, School of Health Science, University of Galway, Galway, Ireland.
| | - S Probst
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Geneva School of Health Science, HES-SO University of Applied Sciences and Arts, Western Switzerland, Switzerland; School of Nursing, Monash University, Australia.
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12
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O'Donnell C, Markey K, Murphy L, Turner J, Doody O. Cultivating support during COVID-19 through clinical supervision: A discussion article. Nurs Open 2023. [PMID: 37149892 DOI: 10.1002/nop2.1800] [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: 02/04/2022] [Revised: 03/06/2023] [Accepted: 04/20/2023] [Indexed: 05/09/2023] Open
Abstract
AIM This article aims to discuss how clinical supervision is an important approach in supporting frontline nurses and students during and post COVID-19 through the lens of the nursing metaparadigms. DESIGN Discussion article. METHODS Discourse of the literature considering the importance of working collaboratively with healthcare and educational organisations in operationalising clinical supervision. RESULTS The evidence base supporting clinical supervision as an effective support strategy for nurses exists, however, its implementation and practice has become sporadic. A resurgence is required to support student's and nurse's during this pandemic. It is timely for nurse educators to creatively engage with clinical partners in supporting clinical supervision to enhance both nurses and students pandemic practice experiences. Clinical supervision is proposed as one strategy to support and guide both nurses and students to develop, strengthen and challenge the effectiveness of their care during COVID-19.
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Affiliation(s)
- Claire O'Donnell
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kathleen Markey
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Louise Murphy
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - James Turner
- Department of Nursing and Midwifery, College of Health and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Owen Doody
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
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Gethin G, Vellinga A, McIntosh C, Sezgin D, Probst S, Murphy L, Carr P, Ivory J, Cunningham S, Oommen AM, Joshi L, Ffrench C. Systematic review of topical interventions for the management of odour in patients with chronic or malignant fungating wounds. J Tissue Viability 2023; 32:151-157. [PMID: 36376189 DOI: 10.1016/j.jtv.2022.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/06/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
Chronic wounds adversely affect the quality of life of individuals and odour is a well-recognised associated factor. Odour can affect sleep, well-being, social interactions, diet and potentially wound healing. This systematic review aims to examine the effectiveness of topical interventions in the management of odour associated with chronic and malignant fungating wounds. A systematic review guided by PRISMA recommendations of randomised controlled trials where odour intensity/odour is the primary outcome was undertaken. Inclusion criteria were adults (18 years and over) with chronic venous, arterial, diabetic or pressure ulcers or with malignant fungating wounds where odour has been managed through topical application of pharmacological/non-pharmacological agents. Searches were conducted in CENTRAL, CINAHL, EMBASE, MEDLINE, Scopus, and Web of Science. Eligibility screening, risk of bias assessment and data extraction was completed by authors working independently. Searches retrieved 171 titles and abstracts (157 post de-duplication). Thirteen studies were retained for full text review of which five (n = 137 individuals) examining the following treatments remained: metronidazole (n = 4), silver (n = 1). Meta-analysis was not possible but individual studies suggest improved outcomes (i.e., reduced odour) using metronidazole. Treatment options to manage wound odour are limited and hampered by lack of clinical trials, small sample sizes, and absence of standardised outcomes and consistent measurement. Whereas metronidazole and silver may have a role in controlling wound odour, robust and well-designed interventions with rigorous procedures and standardised odour outcomes are necessary to evaluate their contribution.
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Affiliation(s)
- G Gethin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Geneva School of Health Science, HES-SO University of Applied Sciences and Arts, Western, Switzerland; Faculty of Medicine Nursing and Health Sciences, Monash University, Australia; CÚRAM, SFI Research Centre for Medical Devices, Ireland.
| | - A Vellinga
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
| | - C McIntosh
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Discipline of Podiatric Medicine, School of Health Science, University of Galway, Galway, Ireland.
| | - D Sezgin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland.
| | - S Probst
- Geneva School of Health Science, HES-SO University of Applied Sciences and Arts, Western, Switzerland; Faculty of Medicine Nursing and Health Sciences, Monash University, Australia; Care Directorate, University Hospital Geneva, Switzerland.
| | - L Murphy
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - P Carr
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - J Ivory
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Irish Research Council (IRC), Government of Ireland, Dublin, Ireland; Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospital, Galway, Ireland
| | - S Cunningham
- Advance Glycoscience Research Cluster, School of Natural Sciences, University of Galway, Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, Ireland
| | - A M Oommen
- Advance Glycoscience Research Cluster, School of Natural Sciences, University of Galway, Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, Ireland
| | - Lokesh Joshi
- Advance Glycoscience Research Cluster, School of Natural Sciences, University of Galway, Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, Ireland
| | - C Ffrench
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, Ireland; Centre for Pain Research, University of Galway, Ireland.
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14
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Jones C, Sachdeva A, Murphy L, Murray M, Brown L, Brown J, Mc Closkey E, Attard G, Parmar M, James N, Sydes M, Clarke N. Clinical fracture incidence in metastatic hormone-sensitive prostate cancer and risk-reduction following addition of zoledronic acid to androgen deprivation therapy with or without docetaxel: Long-term results from the STAMPEDE trial. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01237-x] [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: 02/12/2023]
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McConkey RW, Kelly T, Dalton R, Rooney G, Healy M, Murphy L, Dowling M. Developing a culture of nursing research through clinical‐academic partnership. Int J of Uro Nursing 2022. [DOI: 10.1111/ijun.12339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | - Therese Kelly
- Urology Department University Hospital Galway Galway Ireland
| | - Rachael Dalton
- Urology Department University Hospital Galway Galway Ireland
| | | | - Michelle Healy
- Urology Department Roscommon University Hospital Roscommon Ireland
| | - Louise Murphy
- Department of Nursing & Midwifery University of Limerick Limerick Ireland
| | - Maura Dowling
- School of Nursing and Midwifery University of Galway Galway Ireland
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Moloney M, Murphy L, Kingston L, Markey K, Hennessy T, Meskell P, Atkinson S, Doody O. Final year undergraduate nursing and midwifery students’ perspectives on simulation-based education: a cross-sectional study. BMC Nurs 2022; 21:299. [PMID: 36335322 PMCID: PMC9637299 DOI: 10.1186/s12912-022-01084-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
Background Simulation-based education is a teaching and learning approach that can enhance learning experiences for students on healthcare programmes. Within undergraduate nursing and midwifery education, simulation can support students in developing graduate attributes necessary to become practice-ready professionals. This paper reports on the evaluation of a simulation-based education initiative, which was introduced to support final year undergraduate nursing and midwifery students in preparation for their upcoming clinical internship in practice. Methods This study aimed to evaluate a simulation-based education initiative from the perspectives of final year undergraduate nursing and midwifery students (N = 95). An online survey, using the validated Simulation Effectiveness Tool – Modified (SET-M), was distributed to final year nursing and midwifery students at one university in Ireland. This study was conducted and reported in line with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). Results The results of the study highlight final year nursing and midwifery students’ perceptions, experiences, and satisfaction with learning in a simulated environment. Students reported their simulation-based learning experiences as worthwhile, motivating, and as important opportunities to build on previous learning, increase confidence and gain experience in preparation for real-life practice. Students reported feeling more confident in their assessment skills, in providing care and interventions in responding to changes in a person’s health status. All students reported that the simulation-based learning experiences enabled them to think more critically about the clinical case scenarios and critically question their actions and decision-making processes. Pre-briefing and debriefing sessions were highlighted as important aspects of the simulation which helped to increase student confidence and cultivate meaningful learning. Conclusion Simulation-based education is a valuable teaching and learning modality, particularly for final year students who are transitioning to real-life clinical practice. Student-centred simulation-based learning experiences can cultivate professional development and support learners in their transition from university student to healthcare professional. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-01084-w.
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Murphy L, Alfano L, Brazzo K, Johnson N, Laurent J, Mathews K, Thiele S, Vissing J, Walter M, Woods L, Ørstavik K, Straub V. P.175 Global FKRP registry - the research database for limb girdle muscular dystrophy R9 (2I). Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.313] [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: 11/06/2022]
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18
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Simon SS, Fitzsimmons S, Murphy L, Muni-Lofra R, Blewit C, Group ASMARS, Bettolo CM. P.41 Adult SMA REACH: development and implementation data collection study in the UK Adult SMA population. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.077] [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]
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Murphy L, Nightingale J, Calder P. Difficulties associated with Reporting Radiographer working practices - A narrative evidence synthesis. Radiography (Lond) 2022; 28:1101-1109. [PMID: 36075163 DOI: 10.1016/j.radi.2022.08.007] [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: 06/01/2022] [Revised: 07/28/2022] [Accepted: 08/17/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This narrative synthesis of evidence identifies and explores issues that impact upon the expansion or effectiveness of Reporting Radiographers working in all diagnostic modalities within the United Kingdom (UK). The publication focuses on working practices affecting trainees and qualified Reporting Radiographers. KEY FINDINGS Fourteen studies informed the themes of this article, they were published between 2014 and 2021. Delays to commencement of reporting roles and variance in performance monitoring was common. Lack of formalisation, overly restrictive and out of date scopes of practice were also found. Whilst, staffing shortages contributed to underutilisation. Failure to utilise skills was most prevalent in cross sectional imaging modalities. Considerable variance in practice was also found between centres. Meanwhile, Reporting Radiographer involvement in professional development, education and research is far from universal and often dependant on individuals sacrificing their own time. CONCLUSION Governance in many centres would benefit from renewal and standardisation, particularly relating to scopes of practice and performance monitoring audits. Measures are also required to encourage compliance with guidance, address staffing issues and reduce variation between centres. Failure to address these issues has the potential to impair collaboration, delay patient care and increase economic inefficiencies whilst negatively impacting satisfaction for service users and staff. Lack of involvement in professional development, education and research suggests Reporting Radiographers are not accomplishing their full potential, educating the next generation of the reporting workforce and driving evidence-based change for further development of the specialism. IMPLICATIONS FOR PRACTICE Better use of the existing workforce is essential to increase productivity, value, and security of Reporting Radiographer services, which are essential to improve patient outcomes and efficiency.
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Affiliation(s)
- L Murphy
- Radiology Department, Newcastle Upon Tyne NHS Foundation Trust, UK.
| | - J Nightingale
- Dept of Allied Health Professions, Sheffield Hallam University, UK
| | - P Calder
- Radiology Department, Newcastle Upon Tyne NHS Foundation Trust, UK
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20
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Attard G, Murphy L, Clarke N, Cross W, Gillessen S, Amos C, Brawley C, Jones R, Pezaro C, Malik Z, Montazeri A, Millman R, Cook A, Gilbert D, Langley R, Parker C, Sydes M, Brown L, Parmar M, James N. LBA62 Comparison of abiraterone acetate and prednisolone (AAP) or combination enzalutamide (ENZ) + AAP for metastatic hormone sensitive prostate cancer (mHSPC) starting androgen deprivation therapy (ADT): Overall survival (OS) results of 2 randomised phase III trials from the STAMPEDE protocol. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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21
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Corvaro M, Johnson K, Himmelstein M, Bianchi E, Mingoia R, Bartels M, Reiss R, Terry C, LaRocca J, Murphy L, Gehen S. P06-13 Spinosad – mode of action and human relevance assessment of dystocia in rats. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Murphy L, Nightingale J, Calder P. Difficulties associated with access to training and clinical support for Reporting Radiographers - A narrative evidence synthesis. Radiography (Lond) 2022; 28:1071-1079. [PMID: 35998381 DOI: 10.1016/j.radi.2022.08.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This narrative synthesis of evidence identifies and explores issues that impact upon the expansion or effectiveness of Reporting Radiographers working in all diagnostic modalities within the United Kingdom (UK). The publication focuses on accessibility to training for prospective Reporting Radiographers as well as clinical support within and beyond training. KEY FINDINGS Fifteen studies informed the themes of this article, they were published between 2014 and 2021. Reporting Radiographers often found it difficult find support during training and once qualified, this was usually due to the availability and workload of supervising staff. Although resistance and obstruction were experienced by many. Concerns relating to pay, promotion and interest were expressed by some respondents whilst access to courses and finance were highlighted as areas of variance across the UK. CONCLUSION Inadequate support of Reporting Radiographers is impairing expansion of the specialism, whilst impacting capability and morale. This increases risk of patient harm, delays to care and inefficiency, it also threatens the sustainability of services. Negative interactions between Reporting Radiographers and Radiologists or managers is disappointing considering development of the specialism; evidence of Reporting Radiographer effectiveness and current collaboration between Royal College of Radiologists and Society of Radiographers. Issues raised in relation to pay/promotion and litigation could be clarified with ease, this should be considered when guidance is updated. Access to finance and courses is a major barrier in some regions of the UK. Scope exists for further exploration of training. England has used grants to facilitate uptake, these may prove to be an important tool in other countries. IMPLICATIONS FOR PRACTICE Drivers to increase recruitment should be implemented alongside measures to facilitate accessibility to training and improvements to support infrastructure.
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Affiliation(s)
- L Murphy
- Radiology Department, Newcastle Upon Tyne NHS Foundation Trust, UK.
| | - J Nightingale
- Dept of Allied Health Professions, Sheffield Hallam University, UK
| | - P Calder
- Radiology Department, Newcastle Upon Tyne NHS Foundation Trust, UK
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Flavin A, O'Toole E, Murphy L, Ryan R, McClean B, Faul C, McGibney C, Coyne S, O'Boyle G, Small C, Sims C, Kearney M, Coffey M, O'Donovan A. A National Cyberattack Affecting Radiation Therapy: The Irish Experience. Adv Radiat Oncol 2022; 7:100914. [PMID: 36148382 PMCID: PMC9486432 DOI: 10.1016/j.adro.2022.100914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/23/2022] [Indexed: 11/05/2022] Open
Abstract
On Friday, May 14, 2021, the Health Service Executive, the organization providing public health services in the Republic of Ireland, was the victim of a significant cyberattack on its information technology systems. All systems were subsequently shut down to prevent further damage and to allow cybersecurity experts to investigate the attack. As a result, oncology services were severely disrupted, with the cessation of radiation therapy treatments in all public radiation therapy departments. Ireland has 5 large public and 6 smaller private radiation therapy centers in total. Because of the widespread adoption of electronic medical records in radiation therapy departments, it wasn't possible to retrieve patient details of those who were undergoing radiation therapy at the time of the cyberattack. In total, 513 patients nationally had their radiation therapy interrupted. A national radiation therapy cyberattack response team was formed immediately to oversee the response to the attack. The immediate concerns were radiation therapy emergencies and category 1 patients where gaps in treatment would have an adverse effect on outcome. Communication with patients and the public was also established as a priority and agreements were reached with the private sector for the treatment of patients affected by the cyberattack. The national media was used to alert patients of the need to communicate with their radiation therapy department. Dedicated phone lines were established. Locally, radiation therapy departments held daily crisis meetings with key staff members, including information technology personnel. Individual centers employed different technologies for treatment planning and data storage, so local solutions to the cyberattack to reestablish radiation therapy for patients were developed. In addition, national documentation on prioritization of patients to resume treatment was produced and a national approach was made to compensate for gaps in treatment caused by the attack. All 5 centers had reestablished radiation therapy by May 30, although there has been a long aftermath to the cyberattack. In this article, we provide an overview of the effects of the cyberattack on our national radiation therapy service and our strategy to resume patient treatment in a timely fashion.
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Murphy L. Systemic lupus erythematosus: overview, management and COVID-19. Br J Nurs 2022; 31:348-355. [PMID: 35404655 DOI: 10.12968/bjon.2022.31.7.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Systemic lupus erythematosus is a complex multi-system disease affecting various systems of the body. The aetiology remains unclear; however, it is thought that immune system dysregulation, environmental factors and viral susceptibility can trigger the disease. Mortality remains high due to cardiovascular disease, infection and lupus nephritis. Clinical assessment should comprise an extensive history, detailed physical examination and relevant laboratory tests. Management begins with an in-depth understanding of disease-specific complications and associated comorbidities. Treatments should be based on a shared decision-making process between the patient and the clinician. Review by a specialist nurse is vital for ongoing support and education. Current treatments can increase the risk of COVID-19 infection and disease severity, so caution is needed in the current climate. New treatments are emerging and offer hope to those with refractory disease.
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Affiliation(s)
- Louise Murphy
- Registered Advanced Nurse Practitioner in Rheumatology, Department of Rheumatology, Cork University Hospital, Ireland
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25
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Hunter A, Barrett N, Gallen A, Conway G, Brennan A, Giltenane M, Murphy L. Collaborative identification and prioritisation of mental health nursing care process metrics and indicators: a Delphi consensus study. BMC Health Serv Res 2022; 22:350. [PMID: 35296308 PMCID: PMC8925169 DOI: 10.1186/s12913-022-07659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Irish Office of Nursing & Midwifery Services Director (ONMSD) commissioned the development an updated suite of mental health nursing metrics and indicators for implementation in Irish mental health clinical settings. While measuring care processes does offer the potential to improve care quality, the choice of which mental health nursing metrics to measure presents a significant challenge, both in Ireland and internationally. The provision of safe and high-quality mental health nursing care stems from nurses' expertise, skills and overall capacity to provide recovery focused care across a range of health care settings. Accordingly, efforts to measure what mental health nurses do depends on the identification of those care processes that contribute to mental health nursing practice. This paper reports on the identification, development and prioritisation of a national suite of Quality Care Metrics (QCM), along with their associated indicators, for mental health nursing care processes in Ireland. METHODS The study was undertaken over four phases; i) a systematic literature review to identify mental health care process metrics and their associated indicators of measurement; ii) a two-round, online Delphi survey of mental health nurses to develop consensus on the suit of mental health nursing care process metrics; iii) a two-round online Delphi survey of mental health nurses to develop consensus on the indicators to be used to measure the agreed metrics; and iv) a face-to-face consensus meeting with mental health nurses and service user representatives to develop consensus on the final suite of metrics and indicators. RESULTS Following these four phases 9 metrics and their 71 associated indicators were agreed for inclusion in the final suite of Mental Health Nursing QCM. These metrics are applicable across the life span and the range of mental health nursing health care settings. CONCLUSION The development of this suite of Mental Health Nursing QCM and their indicators represents an opportunity for the measurement of safe and high-quality mental health nursing care for application in Ireland and internationally. This initial development of metrics and indicators should be followed by a rigorous baseline review of QCM uptake and implementation amongst mental health nurses as part of an ongoing evaluation.
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Affiliation(s)
- Andrew Hunter
- School of Nursing and Midwifery, National University Ireland Galway, Galway, Ireland.
| | - Nora Barrett
- School of Nursing and Midwifery, National University Ireland Galway, Galway, Ireland
| | - Anne Gallen
- Nursing and Midwifery Planning and Development Unit, Health Services Executive, North-West, Dublin, Ireland
| | - Gillian Conway
- Nursing and Midwifery Planning and Development Unit, Health Services Executive, West/Mid-West, Dublin,, Ireland
| | - Anne Brennan
- Nursing and Midwifery Planning and Development Unit, Health Services Executive, North East, Dublin, Ireland
| | - Martina Giltenane
- School of Nursing and Midwifery, National University Ireland Galway, Galway, Ireland
| | - Louise Murphy
- School of Nursing and Midwifery, National University Ireland Galway, Galway, Ireland
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Bengesser SA, Hohenberger H, Tropper B, Dalkner N, Birner A, Fellendorf FT, Platzer M, Rieger A, Maget A, Hamm C, Queissner R, Pilz R, Bauer K, Lenger M, Mörkl S, Wagner-Skacel J, Kapfhammer HP, Meier-Allard N, Stracke A, Holasek SJ, Murphy L, Reininghaus EZ. Gene expression analysis of MAOA and the clock gene ARNTL in individuals with bipolar disorder compared to healthy controls. World J Biol Psychiatry 2022; 23:287-294. [PMID: 34468263 DOI: 10.1080/15622975.2021.1973816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/30/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Circadian rhythms are associated with bipolar disorder (BD). This cross-sectional study aimed at investigating ARNTL and MAOA gene expression differences (1) between individuals with BD and controls, (2) between affective episodes, and (3) the relationship between ARNTL and MAOA expression. METHODS ARNTL and MAOA gene expression in peripheral mononuclear blood cells were analysed from fasting blood samples (BD n = 81, controls n = 54) with quantitative real-time PCR operating on TaqMan® assays (normalised to 18S RNA expression). ANCOVAs corrected for age, sex, body mass index, and medication was used to evaluate expression differences and correlation analyses for the relation between ARNTL and MAOA expression. RESULTS ARNTL gene expression differed between affective episodes (F(2,78) = 3.198, p = 0.047, Partial Eta2= 0.083), but not between BD and controls (n.s.). ARNTL and MAOA expression correlated positively in BD (r = 0.704, p < 0.001) and in controls (r = 0.932, p < 0.001). MAOA expression differed neither between BD and controls nor between affective episodes (n.s.). DISCUSSION Clock gene expression changes were observed in different affective states of BD. More precisely, ARNTL gene expression was significantly higher in euthymia than in depression. ARNTL and MAOA gene expression correlated significantly in BD and in controls, which emphasises the strong concatenation between circadian rhythms and neurotransmitter breakdown.
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Affiliation(s)
- S A Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - H Hohenberger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - B Tropper
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - N Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - A Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - F T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - M Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - A Rieger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - A Maget
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - C Hamm
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - R Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - R Pilz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - K Bauer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - M Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - S Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - J Wagner-Skacel
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - H P Kapfhammer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - N Meier-Allard
- Otto Loewi Research Center, Chair of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
| | - A Stracke
- Otto Loewi Research Center, Chair of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
| | - S J Holasek
- Otto Loewi Research Center, Chair of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
| | - L Murphy
- CAMH Pharmacogenetic Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - E Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
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Murphy L. Cardiovascular disease risk in rheumatoid arthritis. Br J Nurs 2022; 31:190-192. [PMID: 35220731 DOI: 10.12968/bjon.2022.31.4.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Louise Murphy
- Registered Nurse Prescriber and Registered Advanced Nurse Practitioner in Rheumatology, Department of Rheumatology, Cork University Hospital, Ireland
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Kearney A, Ashford PA, Butlin L, Conway T, Cragg WJ, Devane D, Gardner H, Gaunt DM, Gillies K, Harman NL, Hunter A, Lane AJ, McWilliams C, Murphy L, O'Nions C, Stanhope EN, Vellinga A, Williamson PR, Gamble C. Developing an online, searchable database to systematically map and organise current literature on retention research (ORRCA2). Clin Trials 2022; 19:71-80. [PMID: 34693794 PMCID: PMC8847754 DOI: 10.1177/17407745211053803] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Addressing recruitment and retention challenges in trials is a key priority for methods research, but navigating the literature is difficult and time-consuming. In 2016, ORRCA (www.orrca.org.uk) launched a free, searchable database of recruitment research that has been widely accessed and used to support the update of systematic reviews and the selection of recruitment strategies for clinical trials. ORRCA2 aims to create a similar database to map the growing volume and importance of retention research. METHODS Searches of Medline (Ovid), CINAHL, PsycINFO, Scopus, Web of Science Core Collection and the Cochrane Library, restricted to English language and publications up to the end of 2017. Hand searches of key systematic reviews were undertaken and randomised evaluations of recruitment interventions within the ORRCA database on 1 October 2020 were also reviewed for any secondary retention outcomes. Records were screened by title and abstract before obtaining the full text of potentially relevant articles. Studies reporting or evaluating strategies, methods and study designs to improve retention within healthcare research were eligible. Case reports describing retention challenges or successes and studies evaluating participant reported reasons for withdrawal or losses were also included. Studies assessing adherence to treatments, attendance at appointments outside of research and statistical analysis methods for missing data were excluded. Eligible articles were categorised into one of the following evidence types: randomised evaluations, non-randomised evaluations, application of retention strategies without evaluation and observations of factors affecting retention. Articles were also mapped against a retention domain framework. Additional data were extracted on research outcomes, methods and host study context. RESULTS Of the 72,904 abstracts screened, 4,364 full texts were obtained, and 1,167 articles were eligible. Of these, 165 (14%) were randomised evaluations, 99 (8%) non-randomised evaluations, 319 (27%) strategies without evaluation and 584 (50%) observations of factors affecting retention. Eighty-four percent (n = 979) of studies assessed the numbers of participants retained, 27% (n = 317) assessed demographic differences between retained and lost participants, while only 4% (n = 44) assessed the cost of retention strategies. The most frequently reported domains within the 165 studies categorised as 'randomised evaluations of retention strategies' were participant monetary incentives (32%), participant reminders and prompts (30%), questionnaire design (30%) and data collection location and method (26%). CONCLUSION ORRCA2 builds on the success of ORRCA extending the database to organise the growing volume of retention research. Less than 15% of articles were randomised evaluations of retention strategies. Mapping of the literature highlights several areas for future research such as the role of research sites, clinical staff and study design in enhancing retention. Future studies should also include cost-benefit analysis of retention strategies.
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Affiliation(s)
- Anna Kearney
- Health Data Science, University of Liverpool, Liverpool, UK
| | | | - Laura Butlin
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Thomas Conway
- HRB-Trials Methodology Research Network and Evidence Synthesis Ireland
| | - William J Cragg
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Declan Devane
- HRB-Trials Methodology Research Network, School of Nursing and Midwifery, NUI Galway, Galway, Ireland.,School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Heidi Gardner
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Daisy M Gaunt
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Andrew Hunter
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Athene J Lane
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Louise Murphy
- National University of Ireland Galway, Galway, Ireland
| | - Carrie O'Nions
- Health Data Science, University of Liverpool, Liverpool, UK
| | - Edward N Stanhope
- University College Birmingham, Birmingham, UK.,Staffordshire University, Stoke-on-Trent, UK
| | - Akke Vellinga
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | | | - Carrol Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
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Swan L, Horgan F, Cummins V, Doyle F, Galvin R, Burton E, Sorensen J, Jabakhanji SB, Skelton D, Townley B, Rooney D, Jackson G, Murphy L, Warters A, O'Sullivan M. 199 EMBEDDING PHYSICAL ACTIVITY WITHIN HOME CARE SERVICES FOR OLDER ADULTS IN IRELAND—A QUALITATIVE STUDY OF BARRIERS AND FACILITATORS. Age Ageing 2021. [DOI: 10.1093/ageing/afab216.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
In Ireland, over 53,000 older adults are supported in their community by formal home support, amounting to an estimated 19 million care hours annually. There is a growing need to move beyond care, to more proactive approaches to maintain physical function. In a feasibility study, we delivered the ‘Care to Move’ (CTM) programme through existing home support services. The aim of the present qualitative study was to explore the experience and perceptions of Health Care Assistants (HCAs), who were trained in, and delivered the CTM programme.
Methods
We conducted semi-structured telephone interviews with 22 HCAs involved in the delivery of the programme among older adults [n = 35, mean age 82.8 (7.8) years]. Interview transcripts were coded and analysed thematically to capture barriers and facilitators to programme delivery.
Results
Barriers and facilitators were identified under three main themes i) the programme ii) the care setting, iii) the clients. Overall, there was a positive perception of the programme’s focus on ‘movement prompts and motivators’, the ‘fit’ within home support services, and the training provided. Practical challenges of limited time and the task-orientation nature of home support were reported as recurring barriers for CTM. Many HCAs commented on the value and perceived positive benefits of the programme for their clients. Though negative perceptions of older adult’s motivation or ability to engage with physical activity also emerged. Risk, such as injury or pain, was identified but was not a dominant theme.
Conclusion
Our preliminary findings suggest that embedding physical activity initiatives within home support services could be feasible. Restructuring of services, engaging HCAs, and moving beyond traditional ‘task-oriented' care models to more personalised proactive approaches may facilitate this initiative and support ageing in place.
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Affiliation(s)
- L Swan
- Trinity College Dublin , Dublin, Ireland
| | - F Horgan
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | - V Cummins
- Health Service Executive , Dublin, Ireland
| | - F Doyle
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | - R Galvin
- University of Limerick , Limerick, Ireland
| | - E Burton
- Curtin University , Curtin, Australia
| | - J Sorensen
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | | | - D Skelton
- Glasgow Caledonian University , Glasglow, United Kingdom
- Later Life Training, Northumberland , United Kingdom
| | - B Townley
- Later Life Training, Northumberland , United Kingdom
| | - D Rooney
- North Dublin Home Care , Dublin, Ireland
| | - G Jackson
- North Dublin Home Care , Dublin, Ireland
| | - L Murphy
- North Dublin Home Care , Dublin, Ireland
| | - A Warters
- Health Service Executive , Dublin, Ireland
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Tuohy D, Fahy A, Murphy L. Student nurses and midwives' experiences of teaching and learning about 'making every contact count' health behaviour change programme: Descriptive qualitative study. Nurse Educ Pract 2021; 57:103246. [PMID: 34717167 DOI: 10.1016/j.nepr.2021.103246] [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: 10/15/2020] [Revised: 10/01/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
AIM/OBJECTIVE To explore nursing/midwifery students' experiences of the teaching and learning of units one and two of a national undergraduate curriculum. BACKGROUND The 'National Undergraduate Curriculum for Chronic Disease Prevention and Management: Making Every Contact Count' (MECC) is part of Ireland's national policy to support the prevention of chronic disease by promoting health behaviour change. This is being implemented as a programme within the Irish Health Service and is also being delivered, for the first time in undergraduate medical, allied health and nursing/midwifery education by tertiary education institutes. DESIGN Qualitative descriptive research. METHODS Purposeful sampling was used to recruit participants (n = 17) from an undergraduate nursing/midwifery programme (n = 131) in one tertiary level Irish institution. Four focus groups were undertaken by two members of the research team, who were not part of the module teaching team. Each focus group was guided by a semi-structured interview guide, recorded and transcribed verbatim. Thematic data analysis was undertaken. RESULTS Three main themes were identified, namely: Building foundations and making connections; Personal responsibility and the Ah factor: now I understand. CONCLUSION Findings indicate that students had a positive learning experience whilst also highlighting the students' transition to lifelong learning encompassing adult learning and personal responsibility.
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Affiliation(s)
- Dympna Tuohy
- Department of Nursing and Midwifery, Health Sciences Building, University of Limerick, Limerick, V94 T9PX, Ireland.
| | - Anne Fahy
- Department of Nursing and Midwifery, Health Sciences Building, University of Limerick, Limerick, V94 T9PX, Ireland.
| | - Louise Murphy
- School of Nursing and Midwifery, Áras Moyola, National University of Ireland Galway, Galway, Ireland.
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Murphy L, Moore S, Swan J, Hehir D, Ryan J. Examining the impact of video-based outpatient education on patient demand for a rheumatology CNS service. Br J Nurs 2021; 30:1056-1064. [PMID: 34645352 DOI: 10.12968/bjon.2021.30.18.1056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patient demand for education and access to the clinical nurse specialists (CNSs) during the rheumatology clinic at one hospital in Ireland was increasing. Alternative methods of providing patient education had to be examined. AIMS To explore the efficacy of video-based outpatient education, and its impact on demand for the CNSs. METHODS A video was produced to play in a rheumatology outpatient department. A representative sample of 240 patients (120 non-exposed and 120 exposed to the video) attending the clinic was selected to complete a questionnaire exploring the effect of the video. Data were analysed using chi-square tests with Yates' continuity correction. FINDINGS Demand for the CNSs was six times higher in the non-exposed group compared with the exposed group (non-exposed: 25%, exposed: 4.8%) (χ2=15.7, P=0.00007), representing a significant decrease in resource demand. CONCLUSION High-quality educational videos on view in the rheumatology outpatient department provide patients with information sufficient to meet their educational needs, thus releasing CNS resources.
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Affiliation(s)
- Louise Murphy
- Advanced Nurse Practitioner in Rheumatology, Department of Rheumatology, Cork University Hospital, Ireland
| | - Stephen Moore
- Lecturer in Economics, Centre for Policy Studies, University College Cork, Ireland
| | - Joan Swan
- Clinical Nurse Specialist in Rheumatology, Department of Rheumatology, Cork University Hospital, Ireland, when this article was written and has since retired
| | - Davida Hehir
- Clinical Nurse Specialist in Rheumatology, Department of Rheumatology, Cork University Hospital, Ireland
| | - John Ryan
- Consultant Rheumatologist, Department of Rheumatology, Cork University Hospital, Ireland
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Muni-Lofra R, Murphy L, Adcock K, Farrugia M, Irwin J, Lilleker J, McConville J, Merrison A, Parton M, Ryburn L, Scoto M, Marini-Bettolo C, Mayhew A. SMA – OUTCOME MEASURES AND REGISTRIES. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Annoussamy M, Eggenspieler D, Camino E, Porter B, Bullivant J, Imber L, Murphy L, Hughes Z, Hughes W, Servais L. OUTCOME MEASURES. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bullivant J, Porter B, Murphy L, Render L, Bellgard M, Lennox A, Spring M, Hollander A, Bönnemann C, Jungbluth H, Buj-Bello A, Dowling J, Marini-Bettolo C. CONGENITAL MYOPATHIES – CENTRONUCLEAR MYOPATHIES. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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James E, Joffe J, Huddart R, Rustin G, Sohaib S, Murphy L, Noor D, Wade S, Schiavone F, Kaplan R, Cafferty F. 714P Prognostic factors in stage I seminoma: Data from the phase III, randomised TRial of Imaging and Surveillance in Seminoma Testis (TRISST). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Attard G, Brown L, Clarke N, Murphy L, Cross W, Jones R, Gillessen S, Russell J, Cook A, Bowen J, Lydon A, Pedley I, Parikh O, Chowdhury S, Malik Z, Matheson D, Parker C, Sydes M, Parmar M, James N. LBA4 Abiraterone acetate plus prednisolone (AAP) with or without enzalutamide (ENZ) added to androgen deprivation therapy (ADT) compared to ADT alone for men with high-risk non-metastatic (M0) prostate cancer (PCa): Combined analysis from two comparisons in the STAMPEDE platform protocol. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2098] [Citation(s) in RCA: 3] [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: 10/20/2022] Open
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Murphy L, Markey K, O' Donnell C, Moloney M, Doody O. The impact of the COVID-19 pandemic and its related restrictions on people with pre-existent mental health conditions: A scoping review. Arch Psychiatr Nurs 2021; 35:375-394. [PMID: 34176579 PMCID: PMC9759111 DOI: 10.1016/j.apnu.2021.05.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/26/2021] [Accepted: 05/01/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Globally, governments have introduced a variety of public health measures including restrictions and reducing face-to-face contact, to control the spread of COVID-19. This has implications for mental health services in terms of support and treatment for vulnerable groups such as people with pre-existent mental health conditions. However, there is limited evidence of the impact of COVID-19 and its related restrictions on people with pre-existent mental health conditions. OBJECTIVES To identify the impact of COVID-19 and its related restrictions on people with pre-existent mental health conditions. METHODS A scoping review of the literature was employed. Eight electronic databases (PsycINFO, Cochrane, Web of Science, MEDLINE, EMBASE, CINAHL, Scopus, Academic Search Complete) were searched and 2566 papers identified. 30 papers met the criteria for this review and findings were summarised under three key review questions. RESULTS COVID-19 and its related restrictions have had a notable effect on people with pre-existent mental health conditions. Public health restrictions have contributed to increased levels of social isolation, loneliness, and reduced opportunities for people to connect with others. Reduced access to health services and treatments has compounded matters for those seeking support. Exacerbation and deterioration of symptoms are commonly reported and can lead to greater susceptibility to COVID-19 infection. IMPLICATIONS The importance of proactive planning, alternative accessible healthcare services and supports for vulnerable and at-risk groups is illuminated. Increased monitoring, early intervention and individually tailored care strategies are advocated. Recommendations revolve around the need for enhanced provision of remote support strategies facilitated using technology enhanced resources. ACCESSIBLE SUMMARY.
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Affiliation(s)
- Louise Murphy
- School of Nursing and Midwifery, National University of Ireland Galway, Aras Moyola, University Road, Galway, Ireland.
| | - Kathleen Markey
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Claire O' Donnell
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Mairead Moloney
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Owen Doody
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland.
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Wakeham K, Murray L, Muirhead R, Hawkins MA, Sebag-Montefiore D, Brown S, Murphy L, Thomas G, Bell S, Whibley M, Morgan C, Sleigh K, Gilbert DC. Multicentre Investigation of Prognostic Factors Incorporating p16 and Tumour Infiltrating Lymphocytes for Anal Cancer After Chemoradiotherapy. Clin Oncol (R Coll Radiol) 2021; 33:638-649. [PMID: 34024700 DOI: 10.1016/j.clon.2021.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/09/2021] [Accepted: 04/27/2021] [Indexed: 11/30/2022]
Abstract
AIMS Anal squamous cell carcinomas (ASCC) are strongly associated with human papillomaviruses. Standard of care is chemoradiotherapy at uniform doses with no treatment stratification. Immunohistochemical staining for p16INK4A (p16), a surrogate for human papillomaviruses, is prognostic for outcomes. We investigated this alongside clinical-pathological factors, including tumour infiltrating lymphocyte (TIL) scores. MATERIALS AND METHODS Using an independent, multicentre cohort of 257 ASCC treated with chemoradiotherapy, pretreatment biopsies were stained and scored for p16 and TIL. Kaplan-Meier curves were derived for outcomes (disease-free survival [DFS], overall survival and cancer-specific survival), by stage, p16 and TIL scores and Log-rank tests were carried out to investigate prognostic effect. A multivariate analysis was carried out using Cox regression. RESULTS Stage, sex, p16 and TILs were independently prognostic. Hazard ratios for death (overall survival) were 2.51 (95% confidence interval 1.36-4.63) for p16 negative versus p16 positive, 2.17 (1.34-3.5) for T3/4 versus T1/2, 2.42 (1.52-3.8) for males versus females and 3.30 (1.52-7.14) for TIL1 versus TIL3 (all P < 0.05). CONCLUSIONS We have refined prognostic factors in ASCC. p16 adds to stratification by stage with respect to DFS in early disease and overall survival/DFS in locally advanced cancers. Our data support the role of the host immune response in mediating outcomes. These factors will be prospectively evaluated in PLATO (ISRCTN88455282).
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Affiliation(s)
- K Wakeham
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - L Murray
- Leeds Institute of Medical Research, University of Leeds, Leeds Cancer Centre, Leeds, UK
| | - R Muirhead
- Oxford University Hospitals NHS Trust, Department of Oncology, Churchill Hospital, Oxford, UK
| | - M A Hawkins
- University College London, Medical Physics and Biomedical Engineering, London, UK
| | - D Sebag-Montefiore
- Leeds Institute of Medical Research, University of Leeds, Leeds Cancer Centre, Leeds, UK
| | - S Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - L Murphy
- MRC Clinical Trials Unit at UCL, London, UK
| | - G Thomas
- Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Cancer Sciences Unit, University of Southampton, Southampton, UK
| | - S Bell
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - M Whibley
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - C Morgan
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - K Sleigh
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - D C Gilbert
- MRC Clinical Trials Unit at UCL, London, UK.
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Markey K, Doody O, Kingston L, Moloney M, Murphy L. Cultural competence development: The importance of incorporating culturally responsive simulation in nurse education. Nurse Educ Pract 2021; 52:103021. [PMID: 33725580 DOI: 10.1016/j.nepr.2021.103021] [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: 10/14/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 11/27/2022]
Abstract
The continued reports of declining standards of care for culturally diverse patients, highlights the urgent need for nurse educators to critically examine how cultural competence development is facilitated in everyday teaching. Nurses frequently report experiencing difficulties when adapting caring practice to culturally diverse groups. Subsequently, there needs to be a rooting of continuous cultural competence development threaded throughout undergraduate curricula. Simulation pedagogy can be used as a vehicle for nurturing cultural competence, but this requires a review of how culturally responsive simulation is structured and designed. This paper focuses on culturally responsive simulation as a means of improving the preparation of nurses for working in a broadening culturally diverse healthcare context by outlining fundamental considerations when integrating cultural competence development in everyday simulation.
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Affiliation(s)
- Kathleen Markey
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Ireland.
| | - Owen Doody
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Ireland.
| | - Liz Kingston
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Ireland.
| | - Mairead Moloney
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Ireland.
| | - Louise Murphy
- School of Nursing and Midwifery, National University of Ireland Galway, Aras Moyola, University Road, Galway, Ireland.
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Gillies K, Kearney A, Keenan C, Treweek S, Hudson J, Brueton VC, Conway T, Hunter A, Murphy L, Carr PJ, Rait G, Manson P, Aceves-Martins M. Strategies to improve retention in randomised trials. Cochrane Database Syst Rev 2021; 3:MR000032. [PMID: 33675536 PMCID: PMC8092429 DOI: 10.1002/14651858.mr000032.pub3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Poor retention of participants in randomised trials can lead to missing outcome data which can introduce bias and reduce study power, affecting the generalisability, validity and reliability of results. Many strategies are used to improve retention but few have been formally evaluated. OBJECTIVES To quantify the effect of strategies to improve retention of participants in randomised trials and to investigate if the effect varied by trial setting. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Scopus, PsycINFO, CINAHL, Web of Science Core Collection (SCI-expanded, SSCI, CPSI-S, CPCI-SSH and ESCI) either directly with a specified search strategy or indirectly through the ORRCA database. We also searched the SWAT repository to identify ongoing or recently completed retention trials. We did our most recent searches in January 2020. SELECTION CRITERIA We included eligible randomised or quasi-randomised trials of evaluations of strategies to increase retention that were embedded in 'host' randomised trials from all disease areas and healthcare settings. We excluded studies aiming to increase treatment compliance. DATA COLLECTION AND ANALYSIS We extracted data on: the retention strategy being evaluated; location of study; host trial setting; method of randomisation; numbers and proportions in each intervention and comparator group. We used a risk difference (RD) and 95% confidence interval (CI) to estimate the effectiveness of the strategies to improve retention. We assessed heterogeneity between trials. We applied GRADE to determine the certainty of the evidence within each comparison. MAIN RESULTS We identified 70 eligible papers that reported data from 81 retention trials. We included 69 studies with more than 100,000 participants in the final meta-analyses, of which 67 studies evaluated interventions aimed at trial participants and two evaluated interventions aimed at trial staff involved in retention. All studies were in health care and most aimed to improve postal questionnaire response. Interventions were categorised into broad comparison groups: Data collection; Participants; Sites and site staff; Central study management; and Study design. These intervention groups consisted of 52 comparisons, none of which were supported by high-certainty evidence as determined by GRADE assessment. There were four comparisons presenting moderate-certainty evidence, three supporting retention (self-sampling kits, monetary reward together with reminder or prenotification and giving a pen at recruitment) and one reducing retention (inclusion of a diary with usual follow-up compared to usual follow-up alone). Of the remaining studies, 20 presented GRADE low-certainty evidence and 28 presented very low-certainty evidence. Our findings do provide a priority list for future replication studies, especially with regard to comparisons that currently rely on a single study. AUTHORS' CONCLUSIONS Most of the interventions we identified aimed to improve retention in the form of postal questionnaire response. There were few evaluations of ways to improve participants returning to trial sites for trial follow-up. None of the comparisons are supported by high-certainty evidence. Comparisons in the review where the evidence certainty could be improved with the addition of well-done studies should be the focus for future evaluations.
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Affiliation(s)
- Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Anna Kearney
- Dept. of Health Data Science, University of Liverpool, Liverpool, UK
| | - Ciara Keenan
- Campbell UK & Ireland, Centre for Evidence and Social Innovation, Queen's University, Belfast, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Valerie C Brueton
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College, London, UK
| | - Thomas Conway
- Clinical Research Facility Galway, National University of Ireland Galway, Galway, Ireland
| | - Andrew Hunter
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Louise Murphy
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Peter J Carr
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Paul Manson
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
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Nguyen U, Tinsley B, Sen Y, Stein J, Palacios Y, Ceballos A, Welch C, Nzenkue K, Penn A, Murphy L, Leodones K, Casiquin J, Ivory I, Ghenta K, Danziger K, Widman E, Newman J, Triplehorn M, Hindi Z, Mulligan K. Exposure to bisphenol A differentially impacts neurodevelopment and behavior in Drosophila melanogaster from distinct genetic backgrounds. Neurotoxicology 2020; 82:146-157. [PMID: 33309840 DOI: 10.1016/j.neuro.2020.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/30/2020] [Accepted: 12/06/2020] [Indexed: 12/13/2022]
Abstract
Bisphenol A (BPA) is a ubiquitous environmental chemical that has been linked to behavioral differences in children and shown to impact critical neurodevelopmental processes in animal models. Though data is emerging, we still have an incomplete picture of how BPA disrupts neurodevelopment; in particular, how its impacts may vary across different genetic backgrounds. Given the genetic tractability of Drosophila melanogaster, they present a valuable model to address this question. Fruit flies are increasingly being used for assessment of neurotoxicants because of their relatively simple brain structure and variety of measurable behaviors. Here we investigated the neurodevelopmental impacts of BPA across two genetic strains of Drosophila-w1118 (control) and the Fragile X Syndrome (FXS) model-by examining both behavioral and neuronal phenotypes. We show that BPA induces hyperactivity in larvae, increases repetitive grooming behavior in adults, reduces courtship behavior, impairs axon guidance in the mushroom body, and disrupts neural stem cell development in the w1118 genetic strain. Remarkably, for every behavioral and neuronal phenotype examined, the impact of BPA in FXS flies was either insignificant or contrasted with the phenotypes observed in the w1118 strain. This data indicates that the neurodevelopmental impacts of BPA can vary widely depending on genetic background and suggests BPA may elicit a gene-environment interaction with Drosophila fragile X mental retardation 1 (dFmr1)-the ortholog of human FMR1, which causes Fragile X Syndrome and is associated with autism spectrum disorder.
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Affiliation(s)
- U Nguyen
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - B Tinsley
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - Y Sen
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - J Stein
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - Y Palacios
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - A Ceballos
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - C Welch
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - K Nzenkue
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - A Penn
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - L Murphy
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - K Leodones
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - J Casiquin
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - I Ivory
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - K Ghenta
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - K Danziger
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - E Widman
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - J Newman
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - M Triplehorn
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - Z Hindi
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - K Mulligan
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States.
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Doody O, Murphy L, Moloney M. Clinical placements in intellectual disability nurse education: A scoping review. Nurse Educ Today 2020; 94:104593. [PMID: 32942244 DOI: 10.1016/j.nedt.2020.104593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/12/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
Intellectual disability undergraduate nurse education is provided in partnership between third level institutes and healthcare providers. The changing healthcare landscape has resulted in a reduction of the number of clinical placement's available to students, as persons with intellectual disabilities previously supported in institutional settings are now supported to live more independently and included within their community. This review aims to identify the range and efficacy of clinical placement's currently utilised within intellectual disability undergraduate nurse education. A scoping review framework was utilised to present a broad understanding and knowledge synthesis of the available literature. A systematic search strategy detected relevant papers across eight electronic databases. A total of 451 non-duplicate papers were identified. The review methods yielded ten papers for inclusion. Of these papers, nine were from the United Kingdom (UK) and one from Australia. Findings indicate that there is limited published literature on this topic and a notable absence of literature from Ireland, which is one of only two countries that have direct entry intellectual disability undergraduate nurse education. This review highlights the need to explore alternative placement options not traditionally considered/available to undergraduate nursing students and that further research is needed in this area.
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Affiliation(s)
- Owen Doody
- Department of Nursing and Midwifery. University of Limerick, Ireland.
| | - Louise Murphy
- School of Nursing and Midwifery, National University of Ireland, Galway.
| | - Mairead Moloney
- Department of Nursing and Midwifery. University of Limerick, Ireland.
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Gethin G, Vellinga A, Tawfick W, O'Loughlin A, McIntosh C, Mac Gilchrist C, Murphy L, Ejiugwo M, O'Regan M, Cameron A, Ivory JD. The profile of patients with venous leg ulcers: A systematic review and global perspective. J Tissue Viability 2020; 30:78-88. [PMID: 32839066 DOI: 10.1016/j.jtv.2020.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/11/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND A holistic profile that includes demographic, medical history and wound characteristics of individuals with venous leg ulceration is lacking. Lack of such a profile negatively impacts the ability to develop interventions to improve patient outcomes. OBJECTIVES To describe the profile of the patient population with venous leg ulceration from published observational (non-interventional) studies and to identify gaps in the knowledge base for future research in this area. METHODS A systematic review of observational studies that included more than 50 patients, from any world region, of any age and in any care setting. RESULTS twenty studies, involving 3395 patients, from all world regions met our criteria. Demographic characteristics were well reported and showed a female to male ratio of 1.2:1, average age of 47-65 years, high levels of co-morbidities including hypertension (53-71%) and diabetes (16-20%), and only one study reporting ethnicity. When reported, approximately 4-30% had high levels of depression. The average wound size was 18.6-43.39 cm2; mean wound duration was 13.8-65.5 months, mean number of recurrences was four. No study reported on demographic factors plus medical history plus wound characteristics together. CONCLUSION a comprehensive, holistic profile of the population with VLU is lacking. There is a critical need for more comprehensive profiling to enable the development of targeted interventions to improve outcomes.
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Affiliation(s)
- G Gethin
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland.
| | - A Vellinga
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - W Tawfick
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - A O'Loughlin
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - C McIntosh
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - C Mac Gilchrist
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - L Murphy
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - M Ejiugwo
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - M O'Regan
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - A Cameron
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
| | - J D Ivory
- National University of Ireland, Galway, Ireland; Alliance for Research & Innovation in Wounds (ARIW), Ireland
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Markey K, Murphy L, O'Donnell C, Turner J, Doody O. Clinical supervision: A panacea for missed care. J Nurs Manag 2020; 28:2113-2117. [DOI: 10.1111/jonm.13001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Kathleen Markey
- Department of Nursing and Midwifery Faculty of Education and Health Sciences University of Limerick Limerick Ireland
| | - Louise Murphy
- National University of Ireland Galway Galway Ireland
| | - Claire O'Donnell
- Department of Nursing and Midwifery Faculty of Education and Health Sciences University of Limerick Limerick Ireland
| | | | - Owen Doody
- Department of Nursing and Midwifery Faculty of Education and Health Sciences University of Limerick Limerick Ireland
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Giblin G, Murphy L, Mahon N, McCarthy J, Healy D, Chughtai Z, Keogan M, Egan J, McGuinness J, Nolke L, Joyce E, O'Neill J. Prevalence of Acute Cellular Rejection and Its Impact on Survival Post Heart Transplantation in the Contemporary Era. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.920] [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: 10/24/2022] Open
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Giblin G, Murphy L, Mahon N, Chughtai Z, McCarthy J, McGuinness J, Healy D, Egan J, Hannan M, Nolke L, O'Neill J, Joyce E. Survival Trends Post Cardiac Transplantation: A Comparative Analysis of Irish and International Data (1985-2019). J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bravata DM, Myers LJ, Homoya B, Miech EJ, Rattray NA, Perkins AJ, Zhang Y, Ferguson J, Myers J, Cheatham AJ, Murphy L, Giacherio B, Kumar M, Cheng E, Levine DA, Sico JJ, Ward MJ, Damush TM. The protocol-guided rapid evaluation of veterans experiencing new transient neurological symptoms (PREVENT) quality improvement program: rationale and methods. BMC Neurol 2019; 19:294. [PMID: 31747879 PMCID: PMC6865042 DOI: 10.1186/s12883-019-1517-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/28/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Transient ischemic attack (TIA) patients are at high risk of recurrent vascular events; timely management can reduce that risk by 70%. The Protocol-guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT) developed, implemented, and evaluated a TIA quality improvement (QI) intervention aligned with Learning Healthcare System principles. METHODS This stepped-wedge trial developed, implemented and evaluated a provider-facing, multi-component intervention to improve TIA care at six facilities. The unit of analysis was the medical center. The intervention was developed based on benchmarking data, staff interviews, literature, and electronic quality measures and included: performance data, clinical protocols, professional education, electronic health record tools, and QI support. The effectiveness outcome was the without-fail rate: the proportion of patients who receive all processes of care for which they are eligible among seven processes. The implementation outcomes were the number of implementation activities completed and final team organization level. The intervention effects on the without-fail rate were analyzed using generalized mixed-effects models with multilevel hierarchical random effects. Mixed methods were used to assess implementation, user satisfaction, and sustainability. DISCUSSION PREVENT advanced three aspects of a Learning Healthcare System. Learning from Data: teams examined and interacted with their performance data to explore hypotheses, plan QI activities, and evaluate change over time. Learning from Each Other: Teams participated in monthly virtual collaborative calls. Sharing Best Practices: Teams shared tools and best practices. The approach used to design and implement PREVENT may be generalizable to other clinical conditions where time-sensitive care spans clinical settings and medical disciplines. TRIAL REGISTRATION clinicaltrials.gov: NCT02769338 [May 11, 2016].
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Affiliation(s)
- D M Bravata
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, USA.
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, Indianapolis, IN, 46202, USA.
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.
- Regenstrief Institute, Indianapolis, IN, USA.
| | - L J Myers
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, Indianapolis, IN, 46202, USA
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Regenstrief Institute, Indianapolis, IN, USA
| | - B Homoya
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, Indianapolis, IN, 46202, USA
| | - E J Miech
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, Indianapolis, IN, 46202, USA
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Regenstrief Institute, Indianapolis, IN, USA
| | - N A Rattray
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, Indianapolis, IN, 46202, USA
- Regenstrief Institute, Indianapolis, IN, USA
| | - A J Perkins
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, USA
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Y Zhang
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, USA
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - J Ferguson
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, Indianapolis, IN, 46202, USA
| | - J Myers
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, Indianapolis, IN, 46202, USA
| | - A J Cheatham
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, Indianapolis, IN, 46202, USA
| | - L Murphy
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, Indianapolis, IN, 46202, USA
| | - B Giacherio
- Office of Healthcare Transformation (OHT), Veterans Health Administration (VHA), Washington, DC, USA
| | - M Kumar
- Office of Healthcare Transformation (OHT), Veterans Health Administration (VHA), Washington, DC, USA
| | - E Cheng
- Department of Neurology, VA Greater Los Angeles Healthcare System, California, Los Angeles, USA
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, California, Los Angeles, USA
| | - D A Levine
- Department of Internal Medicine and Neurology and Institute for Health Policy and Innovation, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - J J Sico
- Clinical Epidemiology Research Center and Neurology Service, VA Connecticut Healthcare System, West Haven, CT, USA
- Departments of Internal Medicine and Neurology and Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT, USA
| | - M J Ward
- VA Tennessee Valley Healthcare System, Nashville, TN, USA
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - T M Damush
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, Indianapolis, IN, 46202, USA
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Regenstrief Institute, Indianapolis, IN, USA
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Murphy L, Tysall L, Wellington L, Guthrie L, Inverarity D, Willocks L, Czarniak E, McCallum A, Gillies T. Carbapenemase-producing Enterobacteriaceae (CPE) patient notification exercise. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Issue
CPE has become endemic in many European countries. Scotland has few locally acquired cases at present and interventions are aimed at minimising transmission of CPE into acute hospital settings.
Description of the problem
NHS Lothian held an incident management team (IMT) following the transmission of CPE in an inpatient setting. Initial management of the incident included informing and screening all inpatient contacts, enhanced infection control precautions and staff education. The IMT considered whether to inform and screen patient contacts who had been discharged. A literature review was carried out and teams in the UK who had considered patient notification exercises for CPE were contacted. This highlighted variation in approach.
The IMT assessed whether a patient notification exercise was required and considered: The need to reduce the risk of CPE transmission in acute hospitals by screening and isolating community contacts on readmission to hospital.The ethics of raising patient anxiety around CPE transmission with limited options for effective treatment.Risk stratification to identify contacts at highest risk.Information Governance: electronic tagging of case notes if patients have not been informed.
Results
The IMT agreed that a patient notification was appropriate. Contacts were risk assessed to determine those at greatest risk of CPE transmission. After speaking to GPs, 33 patients were sent letters. No screening of community contacts was advised unless they were re-admitted to an acute hospital or resided in a care facility. No further CPE reports have been linked to the situation.
Lessons
The IMT worked through the issues systematically to protect the public’s health without infringing their rights. The IMT advised that the Scottish CPE toolkit should be revised to support future Incidents including how to analyse transmission pathways, undertake patient notification exercises and meet public health ethics standards.
Key messages
There needs to be clear guidance on how to manage contacts of patients with CPE once discharged from hospital. Team work between Public health and Infection control is essential in manageing incidents of CPE in hospitals.
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Affiliation(s)
- L Murphy
- Incident Management Team, NHS Lothian, Edinburgh, UK
| | - L Tysall
- Incident Management Team, NHS Lothian, Edinburgh, UK
| | - L Wellington
- Incident Management Team, NHS Lothian, Edinburgh, UK
| | - L Guthrie
- Incident Management Team, NHS Lothian, Edinburgh, UK
| | - D Inverarity
- Incident Management Team, NHS Lothian, Edinburgh, UK
| | - L Willocks
- Incident Management Team, NHS Lothian, Edinburgh, UK
| | - E Czarniak
- Incident Management Team, NHS Lothian, Edinburgh, UK
| | - A McCallum
- Incident Management Team, NHS Lothian, Edinburgh, UK
| | - T Gillies
- Incident Management Team, NHS Lothian, Edinburgh, UK
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Kim J, Balshaw R, Trevena C, Banerji S, Murphy L, Dawe D, Tan L, Srinathan S, Buduhan G, Kidane B, Qing G, Domaratzki M, Aliani M. P2.11-10 Discovery of Potential Biomarkers That Discriminate Early Stage NSCLC from Controls by Non-Targeted Metabolomics Profiling. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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50
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Gulak MA, Bornais C, Shin S, Murphy L, Smylie J, Pantarotto JR, Fung-Kee-Fung M, Maziak DE. Implementing a one-day testing model improves timeliness of workup for patients with lung cancer. ACTA ACUST UNITED AC 2019; 26:e651-e657. [PMID: 31708658 DOI: 10.3747/co.26.4927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Patients with lung cancer often experience stressful delays throughout the diagnostic phase of care. To address that situation, our multidisciplinary team created a "Navigation Day," during which patients partake in a single-day visit that comprises nurse-led teaching, social work, smoking cessation counselling, symptom control, and dedicated test slots for integrated positron-emission tomography and computed tomography (pet/ct), pulmonary function tests (pfts), and magnetic resonance imaging (mri) of the brain. We evaluated the effects of that program on wait times and patient satisfaction. Methods Patients with a suspicion of lung cancer on chest ct imaging referred during 3 time periods were reviewed: 1 year before launch of the Navigation Day, 1 year post-launch, and 2 years post-launch. Patients were further stratified according to concordance of their test date with a Navigation Day date. Mean wait times for pet/ct, pfts, and mri brain were calculated for each group. Patient satisfaction was measured using a standardized provincial survey. The Student t-test and analysis of variance were used to assess for significance. Results After implementation, mean wait times in the first year improved to 9.2 days from 15.5 days for pet/ct (p < 0.0001), to 9.6 days from 15.7 days for pfts (p < 0.0001), and to 10.2 days from 16.0 days for mri brain (p < 0.0001). Patients who used a dedicated test slot experienced the shortest wait times, at 5.8 days for pet/ct, 5.8 days for pfts, and 6.3 days for mri brain (p < 0.0001). Those improvements were sustained at 2 years post-launch. Patient satisfaction in the categories of assistance, emotional support, and clarity remained high post-launch. Conclusions Navigation Day significantly improved the timeliness of diagnostic testing services in patients with suspected lung cancer.
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Affiliation(s)
- M A Gulak
- Faculty of Medicine, University of Ottawa, Ottawa, ON.,The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON
| | - C Bornais
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON
| | - S Shin
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON
| | - L Murphy
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON
| | - J Smylie
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON
| | - J R Pantarotto
- Faculty of Medicine, University of Ottawa, Ottawa, ON.,The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON.,Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON
| | - M Fung-Kee-Fung
- Faculty of Medicine, University of Ottawa, Ottawa, ON.,The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON.,Division of Gynecologic Oncology, The Ottawa Hospital, Ottawa, ON
| | - D E Maziak
- Faculty of Medicine, University of Ottawa, Ottawa, ON.,The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON.,Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, ON
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