1
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Kinos S, Hagman H, Halonen P, Soveri LM, O'Reilly M, Pfeiffer P, Frödin JE, Sorbye H, Heervä E, Liposits G, Kallio R, Ålgars A, Ristamäki R, Salminen T, Bärlund M, Shah CH, McDermott R, Röckert R, Flygare P, Kwakman J, Teske A, Punt C, Glimelius B, Österlund P. Detailed analysis of metastatic colorectal cancer patients who developed cardiotoxicity on another fluoropyrimidine and switched to S-1 treatment (subgroup analysis of the CardioSwitch-study). Acta Oncol 2024; 63:248-258. [PMID: 38698698 DOI: 10.2340/1651-226x.2024.24023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/16/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND AND PURPOSE The CardioSwitch-study demonstrated that patients with solid tumors who develop cardiotoxicity on capecitabine or 5-fluorouracil (5-FU) treatment can be safely switched to S-1, an alternative fluoropyrimidine (FP). In light of the European Medicines Agency approval of S-1 in metastatic colorectal cancer (mCRC), this analysis provides more detailed safety and efficacy information, and data regarding metastasectomy and/or local ablative therapy (LAT), on the mCRC patients from the original study. MATERIALS AND METHODS This retrospective cohort study was conducted at 12 European centers. The primary endpoint was recurrence of cardiotoxicity after switch. For this analysis, safety data are reported for 78 mCRC patients from the CardioSwitch cohort (N = 200). Detailed efficacy and outcomes data were available for 66 mCRC patients. RESULTS Data for the safety of S-1 in mCRC patients were similar to the original CardioSwitch cohort and that expected for FP-based treatment, with no new concerns. Recurrent cardiotoxicity (all grade 1) with S-1-based treatment occurred in 4/78 (5%) mCRC patients; all were able to complete FP treatment. Median progression-free survival from initiation of S-1-based treatment was 9.0 months and median overall survival 26.7 months. Metastasectomy and/or LAT was performed in 33/66 (50%) patients, and S-1 was successfully used in recommended neoadjuvant/conversion or adjuvant-like combination regimens and schedules as for standard FPs. INTERPRETATION S-1 is a safe and effective FP alternative when mCRC patients are forced to discontinue 5-FU or capecitabine due to cardiotoxicity and can be safely used in the standard recommended regimens, settings, and schedules.
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Affiliation(s)
- Sampsa Kinos
- Department of Oncology, Tays Cancer Center, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Helga Hagman
- Department of Oncology, Skåne University Hospital, Malmö, Sweden
| | - Päivi Halonen
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Leena-Maija Soveri
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mary O'Reilly
- Department of Oncology, St Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jan-Erik Frödin
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Halfdan Sorbye
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Eetu Heervä
- Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
| | - Gabor Liposits
- Department of Oncology, Regional Hospital West Jutland, Hjørring, Denmark
| | - Raija Kallio
- Department of Oncology, Oulu University and University Hospital, Oulu, Finland
| | - Annika Ålgars
- Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
| | - Raija Ristamäki
- Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
| | - Tapio Salminen
- Department of Oncology, Tays Cancer Center, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Maarit Bärlund
- Department of Oncology, Tays Cancer Center, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Carl-Henrik Shah
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Ray McDermott
- Department of Oncology, St Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | | | - Petra Flygare
- Department of Oncology, Sundsvall Hospital, Sundsvall, Sweden
| | - Johannes Kwakman
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Arco Teske
- Department of Cardiology, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Cornelis Punt
- Depatment of Epidemiology, Jules Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherland
| | | | - Pia Österlund
- Department of Oncology, Tays Cancer Center, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland; Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; rTema Cancer, Department of GI-cancer, Karolinska University Hospital, Stockholm, Sweden.
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2
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Kuhnl A, Roddie C, Kirkwood AA, Chaganti S, Norman J, Lugthart S, Osborne W, Gibb A, Gonzalez Arias C, Latif A, Uttenthal B, Seymour F, Jones C, Springell D, Brady JL, Illidge T, Stevens A, Alexander E, Hawley L, O'Rourke N, Bedi C, Prestwich R, Frew J, Burns D, O'Reilly M, Sanderson R, Sivabalasingham S, Mikhaeel NG. Outcome and feasibility of radiotherapy bridging in large B-cell lymphoma patients receiving CD19 CAR T in the UK. Br J Haematol 2024. [PMID: 38594876 DOI: 10.1111/bjh.19453] [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: 02/06/2024] [Revised: 03/07/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
Radiotherapy (RT) has potential synergistic effects with chimeric antigen receptor (CAR) T but is not widely used as bridging therapy due to logistical challenges and lack of standardised protocols. We analysed RT bridging in a multicentre national cohort of large B-cell lymphoma patients approved for 3L axicabtagene ciloleucel or tisagenlecleucel across 12 UK centres. Of 763 approved patients, 722 were leukapheresed, 717 had data available on bridging therapy. 169/717 (24%) received RT bridging, 129 as single modality and 40 as combined modality treatment (CMT). Of 169 patients, 65.7% had advanced stage, 36.9% bulky disease, 86.5% elevated LDH, 41.7% international prognostic index (IPI) ≥3 and 15.2% double/triple hit at the time of approval. Use of RT bridging varied from 11% to 32% between centres and increased over time. Vein-to-vein time and infusion rate did not differ between bridging modalities. RT-bridged patients had favourable outcomes with 1-year progression-free survival (PFS) of 56% for single modality and 47% for CMT (1-year PFS 43% for systemic bridging). This is the largest cohort of LBCL patients receiving RT bridging prior to CAR T reported to date. Our results show that RT bridging can be safely and effectively used even in advanced stage and high-risk disease, with low dropout rates and excellent outcomes.
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Affiliation(s)
- A Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - C Roddie
- University College London Hospitals, London, UK
- UCL Cancer Institute, University College London, London, UK
| | - A A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, UCL, London, UK
| | - S Chaganti
- Queen Elizabeth Hospital, Birmingham, UK
| | - J Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - S Lugthart
- University Hospitals Bristol and Weston, Bristol, UK
| | - W Osborne
- Freeman Hospital, Newcastle, UK
- Newcastle University, Newcastle, UK
| | - A Gibb
- Department of Medical Oncology, The Christie Hospital, Manchester, UK
| | | | - A Latif
- Queen Elizabeth University Hospital, Glasgow, UK
| | - B Uttenthal
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | | | - C Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - D Springell
- University College London Hospitals, London, UK
| | - J L Brady
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - T Illidge
- Cancer Sciences, University of Manchester Christie NHS Trust, Manchester NIHR BRC, Manchester, UK
| | - A Stevens
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - L Hawley
- University Hospitals Bristol and Weston, Bristol, UK
| | - N O'Rourke
- Queen Elizabeth University Hospital, Glasgow, UK
| | - C Bedi
- Western General Hospital, Edinburgh, UK
| | | | - J Frew
- Freeman Hospital, Newcastle, UK
| | - D Burns
- Queen Elizabeth Hospital, Birmingham, UK
| | - M O'Reilly
- University College London Hospitals, London, UK
| | - R Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | | | - N G Mikhaeel
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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3
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Boyle S, Roddie C, O'Reilly M, Menne T, Norman J, Gibb A, Lugthart S, Chaganti S, Gonzalez Arias C, Jones C, Latif A, Uttenthal BJ, Seymour F, Osborne W, Springell D, Hardefeldt P, Yallop D, Thoulouli E, Bloor A, Besley C, Mathew A, Burns D, Cwynarski K, Sanderson R, Kuhnl A. Improved outcomes of large B-cell lymphoma patients treated with CD19 CAR T in the UK over time. Br J Haematol 2024; 204:507-513. [PMID: 37848384 DOI: 10.1111/bjh.19157] [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: 07/08/2023] [Revised: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
The success of CD19 Chimeric antigen receptor (CAR) T-cell therapy in large B-cell lymphoma (LBCL) has been partially offset by toxicity and logistical challenges, which off-the-shelf agents like CD20xCD3 bispecific antibodies might potentially overcome. However, when using CAR T outcomes as the 'standard-of-care comparator̕ for relapsed/refractory (r/r) LBCL, a potential learning curve with implementing a novel, complex therapy like CAR T needs to be considered. To address this, we analysed 726 UK patients intended to be treated with CD19 CAR T for r/r LBCL and compared outcomes between the first year of the national CAR T programme (Era 1; 2019) and the more recent treatment era (Era 2; 2020-2022). We identified significant improvements for Era 2 versus Era 1 in dropout rate (17% vs. 27%, p = 0.001), progression-free survival (1-year PFS 50% vs. 32%, p < 0.001) and overall survival (1-year OS 60% vs. 40%, p < 0.001). We also observed increased use of bridging therapy, improvement in bridging outcomes, more tocilizumab/corticosteroid use, reduced high-grade cytokine release syndrome (4% vs. 9%, p = 0.01) and intensive care unit admissions (20% vs. 32%, p = 0.001). Our results demonstrate significant improvement in CAR T outcomes over time, highlighting the importance of using up-to-date clinical data when comparing CAR T against new treatment options for r/r LBCL.
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Affiliation(s)
- S Boyle
- Department of Haematology, King's College Hospital, London, UK
| | - C Roddie
- Department of Haematology, University College London Hospitals, London, UK
| | - M O'Reilly
- Department of Haematology, University College London Hospitals, London, UK
- Department of Haematology, UCL Cancer Institute, University College London, London, UK
| | - T Menne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - J Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Gibb
- Department of Medical Oncology, The Christie Hospital, Manchester, UK
| | - S Lugthart
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - S Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | | | - C Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - A Latif
- Department of Haematology, Queen Elizabeth II Hospital, Glasgow, UK
| | - B J Uttenthal
- Department of Haematology, Cambridge University Hospitals, Cambridge, UK
| | - F Seymour
- Department of Haematology, Leeds Teaching Hospitals, Leeds, UK
| | - W Osborne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - D Springell
- Department of Haematology, University College London Hospitals, London, UK
| | - P Hardefeldt
- Department of Haematology, King's College Hospital, London, UK
| | - D Yallop
- Department of Haematology, King's College Hospital, London, UK
| | - E Thoulouli
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Bloor
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - C Besley
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - A Mathew
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - D Burns
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - K Cwynarski
- Department of Haematology, University College London Hospitals, London, UK
| | - R Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | - A Kuhnl
- Department of Haematology, King's College Hospital, London, UK
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4
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Donnelly M, Ryan OK, Ryan ÉJ, Creavin B, O'Reilly M, McDermott R, Kennelly R, Hanly A, Martin ST, Winter DC. Total neoadjuvant therapy versus standard neoadjuvant treatment strategies for the management of locally advanced rectal cancer: network meta-analysis of randomized clinical trials. Br J Surg 2023; 110:1316-1330. [PMID: 37330950 DOI: 10.1093/bjs/znad177] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/10/2023] [Accepted: 05/20/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND This study compared the advantages and disadvantages of total neoadjuvant therapy (TNT) strategies for patients with locally advanced rectal cancer, compared with the more traditional multimodal neoadjuvant management strategies of long-course chemoradiotherapy (LCRT) or short-course radiotherapy (SCRT). METHODS A systematic review and network meta-analysis of exclusively RCTs was undertaken, comparing survival, recurrence, pathological, radiological, and oncological outcomes. The last date of the search was 14 December 2022. RESULTS In total, 15 RCTs involving 4602 patients with locally advanced rectal cancer, conducted between 2004 and 2022, were included. TNT improved overall survival compared with LCRT (HR 0.73, 95 per cent credible interval 0.60 to 0.92) and SCRT (HR 0.67, 0.47 to 0.95). TNT also improved rates of distant metastasis compared with LCRT (HR 0.81, 0.69 to 0.97). Reduced overall recurrence was observed for TNT compared with LCRT (HR 0.87, 0.76 to 0.99). TNT showed an improved pCR compared with both LCRT (risk ratio (RR) 1.60, 1.36 to 1.90) and SCRT (RR 11.32, 5.00 to 30.73). TNT also showed an improvement in cCR compared with LCRT (RR 1.68, 1.08 to 2.64). There was no difference between treatments in disease-free survival, local recurrence, R0 resection, treatment toxicity or treatment compliance. CONCLUSION This study provides further evidence that TNT has improved survival and recurrence benefits compared with current standards of care, and may increase the number of patients suitable for organ preservation, without negatively influencing treatment toxicity or compliance.
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Affiliation(s)
- Mark Donnelly
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College, Dublin, Ireland
| | - Odhrán K Ryan
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College, Dublin, Ireland
| | - Éanna J Ryan
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Ben Creavin
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Mary O'Reilly
- Department of Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Ray McDermott
- School of Medicine, University College, Dublin, Ireland
- Department of Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Rory Kennelly
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Ann Hanly
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Seán T Martin
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Des C Winter
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College, Dublin, Ireland
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
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5
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Groves AM, Johnston CJ, Beutner G, Dahlstrom JE, Koina M, O'Reilly M, Marples B, Porter G, Brophy PD, Kent AL. Effects of photobiomodulation and caffeine treatment on acute kidney injury in a hypoxic ischemic neonatal rat model. Physiol Rep 2023; 11:e15773. [PMID: 37549967 PMCID: PMC10406568 DOI: 10.14814/phy2.15773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 08/09/2023] Open
Abstract
Hypoxic ischemic encephalopathy (HIE) occurs in 2-5/1000 births, with acute kidney injury (AKI) occurring in 40%. AKI increases morbidity and mortality. Caffeine, an adenosine receptor antagonist, and photobiomodulation (PBM), working on cytochrome c oxidase, are potential treatments for AKI. To examine effects of caffeine and PBM on AKI in rats, Day 7 pups underwent a HIE intervention (Modified Rice-Vannucci model) replicating pathology observed in humans. Caffeine was administered for 3 days and/or PBM for 5 days following HIE. Weights and urine for biomarkers (NGAL, albumin, KIM-1, osteopontin) were collected prior to HIE, daily post intervention and at sacrifice. Both treatments reduced kidney injury seen on electron microscopy, but not when combined. HIE elevated urinary NGAL and albumin on Days 1-3 post-HIE, before returning to control levels. This elevation was significantly reduced by PBM or caffeine. KIM-1 was significantly elevated for 7 days post-HIE and was reduced by both treatments. Osteopontin was not altered by HIE or the treatments. Treatments, individually but not in combination, improved HIE-induced reductions in the enzymatic activity of mitochondrial complexes II-III. PBM and caffeine also improved weight gain. PBM and caffeine reduces AKI diagnosed by urinary biomarkers and confirmed by EM findings.
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Affiliation(s)
- A. M. Groves
- Department of Radiation OncologyUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - C. J. Johnston
- Department of PediatricsUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - G. Beutner
- Department of Pediatrics, Division of CardiologyUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - J. E. Dahlstrom
- Department of Anatomical PathologyCanberra HospitalWodenAustralian Capital TerritoryAustralia
- College of Health and Medicine, Australian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - M. Koina
- Department of Anatomical PathologyCanberra HospitalWodenAustralian Capital TerritoryAustralia
- College of Health and Medicine, Australian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - M. O'Reilly
- Department of PediatricsUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - B. Marples
- Department of Radiation OncologyUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - G. Porter
- Department of Pediatrics, Division of CardiologyUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - P. D. Brophy
- Department of PediatricsUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - A. L. Kent
- Department of PediatricsUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
- College of Health and Medicine, Australian National UniversityCanberraAustralian Capital TerritoryAustralia
- Department of Neonatology, Women's and Babies DivisionWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
- University of Adelaide, School of MedicineAdelaideSouth AustraliaAustralia
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Dahlin JL, Hua BK, Zucconi BE, Nelson SD, Singh S, Carpenter AE, Shrimp JH, Lima-Fernandes E, Wawer MJ, Chung LPW, Agrawal A, O'Reilly M, Barsyte-Lovejoy D, Szewczyk M, Li F, Lak P, Cuellar M, Cole PA, Meier JL, Thomas T, Baell JB, Brown PJ, Walters MA, Clemons PA, Schreiber SL, Wagner BK. Reference compounds for characterizing cellular injury in high-content cellular morphology assays. Nat Commun 2023; 14:1364. [PMID: 36914634 PMCID: PMC10011410 DOI: 10.1038/s41467-023-36829-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/01/2022] [Accepted: 02/20/2023] [Indexed: 03/16/2023] Open
Abstract
Robust, generalizable approaches to identify compounds efficiently with undesirable mechanisms of action in complex cellular assays remain elusive. Such a process would be useful for hit triage during high-throughput screening and, ultimately, predictive toxicology during drug development. Here we generate cell painting and cellular health profiles for 218 prototypical cytotoxic and nuisance compounds in U-2 OS cells in a concentration-response format. A diversity of compounds that cause cellular damage produces bioactive cell painting morphologies, including cytoskeletal poisons, genotoxins, nonspecific electrophiles, and redox-active compounds. Further, we show that lower quality lysine acetyltransferase inhibitors and nonspecific electrophiles can be distinguished from more selective counterparts. We propose that the purposeful inclusion of cytotoxic and nuisance reference compounds such as those profiled in this resource will help with assay optimization and compound prioritization in complex cellular assays like cell painting.
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Grants
- R35 GM127045 NIGMS NIH HHS
- U01 CA272612 NCI NIH HHS
- T32 HL007627 NHLBI NIH HHS
- R37 GM062437 NIGMS NIH HHS
- S10 OD026839 NIH HHS
- R35 GM122481 NIGMS NIH HHS
- U01 DK123717 NIDDK NIH HHS
- Wellcome Trust
- R35 GM122547 NIGMS NIH HHS
- U01 CA217848 NCI NIH HHS
- K99 GM124357 NIGMS NIH HHS
- R35 GM149229 NIGMS NIH HHS
- This study was supported by the Ono Pharma Breakthrough Science Initiative Award (to BKW). Authors acknowledge the following financial support: JLD (NIH NHLBI, T32-HL007627); BKH (National Science Foundation, DGE1144152 and DGE1745303); BEZ (NIH NIGMS, K99-GM124357); SDN (Harvard University’s Graduate Prize Fellowship, Eli Lilly Graduate Fellowship in Chemistry); PA Cole (NIH NIGMS, R37-GM62437); SLS (NIGMS, R35-GM127045); BKW (Ono Pharma Foundation; NIH NIDDK, U01-DK123717); SS (NIH NIGMS, R35-GM122547). The authors gratefully acknowledge the use of the Opera Phenix High-Content/High-Throughput imaging system at the Broad Institute, funded by the NIH S10 grant OD026839. This research was supported in part by the Intramural/Extramural research program of the NCATS, NIH.
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Affiliation(s)
- Jayme L Dahlin
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD, USA.
- Chemical Biology and Therapeutics Science Program, Broad Institute, Cambridge, MA, USA.
| | - Bruce K Hua
- Chemical Biology and Therapeutics Science Program, Broad Institute, Cambridge, MA, USA
| | - Beth E Zucconi
- Division of Genetics, Departments of Medicine and Biological Chemistry and Molecular Pharmacology, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | - Jonathan H Shrimp
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | | | - Mathias J Wawer
- Chemical Biology and Therapeutics Science Program, Broad Institute, Cambridge, MA, USA
| | - Lawrence P W Chung
- Chemical Biology and Therapeutics Science Program, Broad Institute, Cambridge, MA, USA
| | - Ayushi Agrawal
- Chemical Biology and Therapeutics Science Program, Broad Institute, Cambridge, MA, USA
| | | | | | - Magdalena Szewczyk
- Structural Genomics Consortium, University of Toronto, Toronto, ON, Canada
| | - Fengling Li
- Structural Genomics Consortium, University of Toronto, Toronto, ON, Canada
| | - Parnian Lak
- Department of Pharmaceutical Chemistry and Quantitative Biology Institute, University of California San Francisco, San Francisco, CA, USA
| | - Matthew Cuellar
- Institute for Therapeutics Discovery and Development, University of Minnesota, Minneapolis, MN, USA
| | - Philip A Cole
- Division of Genetics, Departments of Medicine and Biological Chemistry and Molecular Pharmacology, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Jordan L Meier
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - Tim Thomas
- Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Jonathan B Baell
- Medicinal Chemistry Theme, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Peter J Brown
- Structural Genomics Consortium, University of Toronto, Toronto, ON, Canada
| | - Michael A Walters
- Institute for Therapeutics Discovery and Development, University of Minnesota, Minneapolis, MN, USA
| | - Paul A Clemons
- Chemical Biology and Therapeutics Science Program, Broad Institute, Cambridge, MA, USA
| | - Stuart L Schreiber
- Chemical Biology and Therapeutics Science Program, Broad Institute, Cambridge, MA, USA
| | - Bridget K Wagner
- Chemical Biology and Therapeutics Science Program, Broad Institute, Cambridge, MA, USA.
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7
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Hughes H, O'Reilly M, McVeigh N, Ryan R. The top 100 most cited articles on artificial intelligence in radiology: a bibliometric analysis. Clin Radiol 2023; 78:99-106. [PMID: 36639176 DOI: 10.1016/j.crad.2022.09.133] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 01/12/2023]
Abstract
AIM To identify the most influential publications relating to artificial intelligence (AI) in radiology in order to identify current trends in the literature and to highlight areas requiring further research. MATERIALS AND METHODS A retrospective bibliometric analysis was performed of the top 100 most cited articles on this topic. Data pertaining to year of publication, publishing journal, journal impact factor, authorship, article title, institution, country, type of article, article subject, and keywords were collected. RESULTS The number of citations per article for the top 100 list ranged from 254 to 3,576 (median 353). The number of citations per year, per article ranged from 10.4 to 894 (median 65.6). The majority of articles (n=62) were published within the last 10 years. The USA was the most common country of origin (n=44). The journal with the greatest number of articles was IEEE Transactions On Medical Imaging (n=38). University Medical Center Utrecht contributed the greatest number of articles (n=6). There were 92 original research articles, 52 of which were clinical studies. The most common clinical subjects were neuroimaging (n=25) and oncology (n=16). The most common keyword used was "deep learning" (n=34). CONCLUSION This study provides an in-depth analysis of the top 100 most-cited papers on the use of AI in radiology. It also provides researchers with detailed insight into the current influential papers in this field, the characteristics of those studies, as well as potential future trends in this fast-developing area of radiology.
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Affiliation(s)
- H Hughes
- Department of Radiology, St Vincent's University Hospital, Dublin, 4, Ireland.
| | - M O'Reilly
- Department of Radiology, Cork University Hospital, Wilton, Co. Cork, Ireland
| | - N McVeigh
- Department of Radiology, St Vincent's University Hospital, Dublin, 4, Ireland
| | - R Ryan
- Department of Radiology, St Vincent's University Hospital, Dublin, 4, Ireland
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8
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Drumm C, O'Reilly M, McCartney Y, O'Kane M. Myeloma-associated AL amyloidosis presenting with nail dystrophy and scleroderma-like skin changes. Clin Exp Dermatol 2021; 47:491-493. [PMID: 34779033 DOI: 10.1111/ced.14983] [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] [Received: 08/01/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- C Drumm
- Dermatology, Beaumont Hospital, Dublin, Ireland
| | - M O'Reilly
- Dermatology, Beaumont Hospital, Dublin, Ireland
| | - Y McCartney
- Histopathology, Beaumont Hospital, Dublin, Ireland
| | - M O'Kane
- Dermatology, Beaumont Hospital, Dublin, Ireland
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9
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Tariq S, Stroiescu A, Mannion J, Caples N, O'Callaghan P, O'Reilly M, Ryan A, Owens P. Protection of bone mineral density in heart failure patients:audit on current clinical practice in a busy tertiary care hospital cardiology department in Ireland. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The strong association between heart failure (HF) and osteoporosis is well recognised. Heart failure, due to its multiple risk factors and common pathogenesis with osteoporosis can lead to low bone mineral density (BMD) and increase the risk of fragility fractures. The mortality of HF patients following these fractures is high. Current National Osteoporosis Foundation Guidelines recommend that pharmacological therapy should be reserved for postmenopausal women and men aged 50 years or older who present with a hip or vertebral fracture, where the vertebral fractures may be clinical or identified on a radiograph alone.
Methods
Most HF patients have frequent chest radiographs over their course years. We aimed to audit the prevalence of osteoporosis and current practice of prescribing BMD-protection in patients attending the HF clinic in a busy tertiary care hospital in Ireland. 100 patients attending the clinic in the last one year were randomly selected and clinical, medication and chest radiograph information on this cohort was collected via the hospital electronic information system. All those patients with Radiologist confirmed vertebral compression fractures (VCF) on their plain chest radiographs were audited regarding osteoporosis screening and bone protection prescription.
Results
Due to limited penetration,18 out of 100 chest radiographs were inconclusive,reducing the sample size to 82. 9 out of the remaining 82 patients had radiologist confirmed VCF on their plain chest radiographs whereas 2 patients had VCF incidentally picked up on their lumbar spine x-rays. All patients were aged more than 50. 4 were female and 7 male. Median ejection fraction calculated was 35%. 3 out of 11 were smokers,8 had atrial fibrillation and were on anticoagulation,4 had DM-II and 2 had CKD. 10 were on loop diuretics. Of note,4 patients were on calcium and vitamin D supplements but only 1 patient was on antiresorptive therapy for osteoporosis.
Conclusion
Despite its strong association with heart failure,Osteoporosis remains undertreated in this patient cohort.Due to the significant mortality and morbidity associated with major osteoporotic fractures, doctors should carefully assess and screen heart failure patients for osteoporosis and initiate specific therapy where indicated.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Tariq
- University Hospital Waterford, Cardiology, Waterford, Ireland
| | - A Stroiescu
- University Hospital Waterford, Radiology, Waterford, Ireland
| | - J Mannion
- University Hospital Waterford, Cardiology, Waterford, Ireland
| | - N Caples
- University Hospital Waterford, Cardiology, Waterford, Ireland
| | - P O'Callaghan
- University Hospital Waterford, Cardiology, Waterford, Ireland
| | - M O'Reilly
- University Hospital Waterford, Cardiology, Waterford, Ireland
| | - A Ryan
- University Hospital Waterford, Radiology, Waterford, Ireland
| | - P Owens
- University Hospital Waterford, Cardiology, Waterford, Ireland
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10
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Brockman DG, Petronio L, Dron JS, Kwon BC, Vosburg T, Nip L, Tang A, O'Reilly M, Lennon N, Wong B, Ng K, Huang KH, Fahed AC, Khera AV. Design and user experience testing of a polygenic score report: a qualitative study of prospective users. BMC Med Genomics 2021; 14:238. [PMID: 34598685 PMCID: PMC8485114 DOI: 10.1186/s12920-021-01056-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 07/25/2021] [Accepted: 08/12/2021] [Indexed: 12/28/2022] Open
Abstract
Background Polygenic scores—which quantify inherited risk by integrating information from many common sites of DNA variation—may enable a tailored approach to clinical medicine. However, alongside considerable enthusiasm, we and others have highlighted a lack of standardized approaches for score disclosure. Here, we review the landscape of polygenic score reporting and describe a generalizable approach for development of a polygenic score disclosure tool for coronary artery disease. Methods We assembled a working group of clinicians, geneticists, data visualization specialists, and software developers. The group reviewed existing polygenic score reports and then designed a two-page mock report for coronary artery disease. We then conducted a qualitative user-experience study with this report using an interview guide focused on comprehension, experience, and attitudes. Interviews were transcribed and analyzed for themes identification to inform report revision. Results Review of nine existing polygenic score reports from commercial and academic groups demonstrated significant heterogeneity, reinforcing the need for additional efforts to study and standardize score disclosure. Using a newly developed mock score report, we conducted interviews with ten adult individuals (50% females, 70% without prior genetic testing experience, age range 20–70 years) recruited via an online platform. We identified three themes from interviews: (1) visual elements, such as color and simple graphics, enable participants to interpret, relate to, and contextualize their polygenic score, (2) word-based descriptions of risk and polygenic scores presented as percentiles were the best recognized and understood, (3) participants had varying levels of interest in understanding complex genomic information and therefore would benefit from additional resources that can adapt to their individual needs in real time. In response to user feedback, colors used for communicating risk were modified to minimize unintended color associations and odds ratios were removed. All 10 participants expressed interest in receiving a polygenic score report based on their personal genomic information. Conclusions Our findings describe a generalizable approach to develop a polygenic score report understandable by potential patients. Although additional studies are needed across a wider spectrum of patient populations, these results are likely to inform ongoing efforts related to polygenic score disclosure within clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-021-01056-0.
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Affiliation(s)
- Deanna G Brockman
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, 185 Cambridge Street, Simches Research Building
- CPZN 6.256, Boston, MA, 02114, USA.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Lia Petronio
- Pattern Visualization Team, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jacqueline S Dron
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Bum Chul Kwon
- Center for Computational Health, IBM Research, Cambridge, MA, USA
| | - Trish Vosburg
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Genomics Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Lisa Nip
- Pattern Visualization Team, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Andrew Tang
- Pattern Visualization Team, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Mary O'Reilly
- Pattern Visualization Team, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Niall Lennon
- Genomics Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Bang Wong
- Pattern Visualization Team, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kenney Ng
- Center for Computational Health, IBM Research, Cambridge, MA, USA
| | - Katherine H Huang
- Pattern Visualization Team, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Akl C Fahed
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, 185 Cambridge Street, Simches Research Building
- CPZN 6.256, Boston, MA, 02114, USA.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Amit V Khera
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, 185 Cambridge Street, Simches Research Building
- CPZN 6.256, Boston, MA, 02114, USA. .,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA.
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11
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O'Reilly M, Keane F, Mc Dermott R. Synchronous Melanoma and Pancreas Malignancies Leading to a Discovery of a CDKN2A Mutation in a Patient with No Known Family History. Case Rep Oncol 2021; 14:333-337. [PMID: 33776725 PMCID: PMC7983569 DOI: 10.1159/000512999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 11/19/2022] Open
Abstract
We report a case of a 60-year-old male with metachronous primary malignancies, pancreatic cancer and malignant melanoma which recurred simultaneously. Both cancers were challenging to diagnose and throughout the case at different times, the presence of two active malignancies obscured the clinical picture. A bleeding gastric lesion found in the stomach 6 months after a distal pancreatectomy for pancreatic adenocarcinoma revealed metastatic melanoma, presumed secondary from a melanoma excised from the patient's back 2 years previously. During surgery intended to resect the gastric lesion, peritoneal nodularity was identified, with histology confirming metastatic pancreas cancer. This case highlights two main points of interest. Firstly it emphasises the role for consideration of a genetic predisposition in young patients with more than one primary malignancy. The man in this case was not informed of his family history as he was adopted. If he had knowledge of previous family history, he may have been able to provide information to expedite arrival at the diagnosis of a CDKN2A mutation (melanoma-pancreatic carcinoma syndrome). In addition, this case also raises the issue of the challenges we face when treating synchronous primary malignancies. The two malignancies here behaved equally aggressively and posed obstacles for treatment as there is no mutual method of carcinogenesis that could be targeted with treatment; therefore, treatment modalities had to be chosen to treat each malignancy separately. To date, studies evaluating the role for targeted therapy in the setting of CDKN2A mutations have not conclusively provided meaningful benefits to patients.
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Affiliation(s)
| | - Fergus Keane
- St Vincent's University Hospital, Dublin, Ireland
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12
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Keeling E, O'Reilly M, Gulmann C, Ní Raghallaigh S. Review of cutaneous metastases from internal malignancies: a 20-year review from a regional cancer treatment centre. Clin Exp Dermatol 2021; 46:923-924. [PMID: 33484597 DOI: 10.1111/ced.14570] [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] [Received: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- E Keeling
- Departments of, Dermatology, Beaumont Hospital, Dublin, Ireland
| | - M O'Reilly
- Departments of, Dermatology, Beaumont Hospital, Dublin, Ireland
| | - C Gulmann
- Pathology, Beaumont Hospital, Dublin, Ireland
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13
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O'Reilly M, Mellotte G, Ryan B, O'Connor A. Gastrointestinal side effects of cancer treatments. Ther Adv Chronic Dis 2020; 11:2040622320970354. [PMID: 33294145 PMCID: PMC7705778 DOI: 10.1177/2040622320970354] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022] Open
Abstract
Cancer survival rates have significantly improved over the last number of
years due to advancements in cancer therapies. Unfortunately this has
come at a cost. Therapeutic side effects are feared complications of
therapy that may result in decreased quality of life and early
cessation of the therapy, which can have knock-on effects on outcomes.
This article outlines the main gastrointestinal side effects seen with
radiation therapy, chemotherapy and immunotherapy, and discusses
appropriate investigation and management.
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Affiliation(s)
- Mary O'Reilly
- Department of Gastroenterology, Tallaght University Hospital/Trinity College Dublin, Ireland
| | - Gregory Mellotte
- Department of Gastroenterology, Tallaght University Hospital/Trinity College Dublin, Ireland
| | - Barbara Ryan
- Department of Gastroenterology, Tallaght University Hospital/Trinity College Dublin, Ireland
| | - Anthony O'Connor
- Department of Gastroenterology, Tallaght University Hospital/Trinity College Dublin, Belgard Road, Tallaght, Dublin, D24NR0A, Ireland
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14
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Abstract
Aim: Primary gastric melanoma is a rare clinical presentation. The purpose of this review was to compare the 1-year survival in patients who underwent surgery with patients who did not receive treatment. Patients & methods: A systematic search of databases for case reports and case series of primary gastric melanoma was conducted. Results: The mean survival of patients was 22 months. One-year survival was 56.5% with surgery, rising to 66% with adjuvant therapy. Mean survival of the surgical group was 21.05 months (±20.2) versus 4.5 months (±3.61) in the nonsurgical group. Conclusion: Primary gastric melanoma has a poor prognosis but early surgical intervention can have a significant impact on patient outcome. We reviewed the biology and clinical diagnosis of gastrointestinal melanoma and the current management options available.
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Affiliation(s)
- Gregory S Mellotte
- Department of Gastroenterology, Tallaght University Hospital, Dublin, D24 NR04, Ireland.,Department of Clinical Medicine, Trinity College Dublin, D02 PN40, Ireland
| | - Diya Sabu
- Department of Oncology, Tallaght University Hospital, Dublin, D24 NR04, Ireland
| | - Mary O'Reilly
- Department of Gastroenterology, Tallaght University Hospital, Dublin, D24 NR04, Ireland
| | - Ray McDermott
- Department of Oncology, Tallaght University Hospital, Dublin, D24 NR04, Ireland
| | - Anthony O'Connor
- Department of Gastroenterology, Tallaght University Hospital, Dublin, D24 NR04, Ireland.,Department of Clinical Medicine, Trinity College Dublin, D02 PN40, Ireland
| | - Barbara M Ryan
- Department of Gastroenterology, Tallaght University Hospital, Dublin, D24 NR04, Ireland.,Department of Clinical Medicine, Trinity College Dublin, D02 PN40, Ireland
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15
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Doyle JS, van Santen DK, Iser D, Sasadeusz J, O'Reilly M, Harney B, Traeger MW, Roney J, Cutts JC, Bowring AL, Winter R, Medland N, Fairley CK, Moore R, Tee B, Asselin J, El-Hayek C, Hoy JF, Matthews GV, Prins M, Stoové MA, Hellard ME. Micro-elimination of hepatitis C among people with HIV coinfection: declining incidence and prevalence accompanying a multi-center treatment scale-up trial. Clin Infect Dis 2020; 73:e2164-e2172. [PMID: 33010149 DOI: 10.1093/cid/ciaa1500] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 04/26/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Gay and bisexual men (GBM) are a key population affected by HIV and hepatitis C (HCV) co-infection. Providing HCV treatment scale-up across specialist and non-hepatitis specialist settings may eliminate HCV in this population. We aimed to (1) deliver and measure HCV treatment effectiveness, and (2) determine the population impact of treatment on HCV prevalence and incidence longitudinally. METHODS The co-EC Study (Enhancing care and treatment among HCV/HIV co-infected individuals to Eliminate Hepatitis C transmission) was an implementation trial providing HCV direct-acting antiviral treatment in Melbourne, Australia, from 2016-2018. Individuals with HCV/HIV co-infection were prospectively enrolled from primary and tertiary-care services providing care for 85% of GBM with HIV in our jurisdiction. HCV-viraemic prevalence and HCV-antibody/viraemic incidence were measured using a state-wide, individually-linked, electronic surveillance system. RESULTS Among 200 participants recruited, 186 initiated treatment during the study period. Sustained virological response among primary care participants (98%, 95%CI:93-100%) was not different to tertiary care (98%, 95%CI:86-100%). From 2012-2019, between 2434 and 3476 GBM with HIV-infection attended our primary-care sites annually providing 13,801 person-years of follow-up; 50-60% received an HCV test annually, 10-14% were anti-HCV positive. Among those anti-HCV positive, viraemic prevalence declined 83% during the study (54% to 9%; 2016 to 2019). HCV incidence decreased 25% annually from 1.7/100 person-years in 2012 to 0.5/100 person-years in 2019 (incidence rate ratio 0.75; CI:0.68-0.83;p<0.001). CONCLUSION High treatment effectiveness by non-specialists demonstrates the feasibility of treatment scale-up in this population. Substantial declines in HCV incidence and prevalence among GBM with HIV-infection provides proof-of-concept for HCV micro-elimination. REGISTRATION ClinicalTrials.gov (Identifier: NCT02786758).
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Affiliation(s)
- J S Doyle
- Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - D K van Santen
- Burnet Institute, Melbourne, VIC, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - D Iser
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia.,Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - J Sasadeusz
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia.,Victorian Infectious Diseases Service at the Doherty Institute, Melbourne, VIC, Australia
| | - M O'Reilly
- Prahran Market Clinic, Melbourne, VIC, Australia
| | - B Harney
- Burnet Institute, Melbourne, VIC, Australia
| | | | - J Roney
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - J C Cutts
- Burnet Institute, Melbourne, VIC, Australia
| | | | - R Winter
- Burnet Institute, Melbourne, VIC, Australia
| | - N Medland
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia
| | - C K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia
| | - R Moore
- Northside Clinic, Fitzroy North, VIC, Australia
| | - B Tee
- Centre Clinic, Melbourne, VIC, Australia
| | - J Asselin
- Burnet Institute, Melbourne, VIC, Australia
| | - C El-Hayek
- Burnet Institute, Melbourne, VIC, Australia
| | - J F Hoy
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - G V Matthews
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - M Prins
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Infection and Immunity Institute Amsterdam, the Netherlands.,Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - M A Stoové
- Burnet Institute, Melbourne, VIC, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - M E Hellard
- Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Doherty Institute and Melbourne School of Population and Global Health, University of Melbourne
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16
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Friedman ND, Lim SM, James R, Ingram R, O'Reilly M, Pollard JGD, Koning S, George C, Rajkhowa A, Johnson DF, Buising KL. Measuring antimicrobial prescribing quality in outpatient parenteral antimicrobial therapy (OPAT) services: development and evaluation of a dedicated national antimicrobial prescribing survey. JAC Antimicrob Resist 2020; 2:dlaa058. [PMID: 34223015 PMCID: PMC8210186 DOI: 10.1093/jacamr/dlaa058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/11/2020] [Accepted: 06/21/2020] [Indexed: 12/21/2022] Open
Abstract
Background Antimicrobial stewardship programmes are important in driving safety and quality of antimicrobial prescribing. The National Antimicrobial Prescribing Survey (NAPS) is a point-prevalence audit of inpatient antimicrobial prescribing in Australian hospitals. Objectives To design and adapt the NAPS tool for use in the outpatient parenteral antimicrobial therapy (OPAT) and hospital-in-the-home (HITH) setting. Methods An inter-disciplinary working group with expertise in OPAT and HITH services was established to adapt the NAPS template for use in the OPAT setting—called HITH-NAPS. This was initially trialled in 5 HITH services, subsequently adapted following participant feedback, then offered nationally to 50 services in 2017. Results There were 1154 prescriptions for 715 patients audited via the HITH-NAPS. The most common antimicrobials prescribed were cefazolin (22%), flucloxacillin (12%), piperacillin/tazobactam (10%) and ceftriaxone (10%). The most common infections treated were cellulitis (30%) and respiratory tract infections (14%). Eighty-seven percent of prescriptions were assessed as appropriate, 11% inappropriate and 2% not assessable. Prolonged durations of antimicrobials and unnecessarily broad-spectrum antibiotics were used in 9% of prescriptions. Conclusions The HITH-NAPS pilot project revealed that auditing of this type is feasible in HITH. It showed that antibiotic use in these HITH services was generally appropriate, but there are some areas for improvement. A national OPAT/HITH-NAPS can facilitate benchmarking between services, identify potentially inappropriate prescribing and help guide quality improvement.
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Affiliation(s)
- N Deborah Friedman
- National Centre for Antimicrobial Stewardship, Melbourne, VIC, Australia.,Barwon Health, Geelong, VIC, Australia
| | - Seok M Lim
- Department of General Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Rodney James
- National Centre for Antimicrobial Stewardship, Melbourne, VIC, Australia
| | - Robyn Ingram
- National Centre for Antimicrobial Stewardship, Melbourne, VIC, Australia
| | | | - James G D Pollard
- Barwon Health, Geelong, VIC, Australia.,Cabrini Health, VIC, Australia
| | | | - Catherine George
- National Centre for Antimicrobial Stewardship, Melbourne, VIC, Australia.,Pharmacy Department, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Arjun Rajkhowa
- National Centre for Antimicrobial Stewardship, Melbourne, VIC, Australia
| | - Douglas F Johnson
- Department of General Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Kirsty L Buising
- National Centre for Antimicrobial Stewardship, Melbourne, VIC, Australia.,Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, VIC, Australia
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17
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O'Reilly M, Gillen C, Meehan C, Counihan I, Hassan T. Pulmonary Rehabilitation Programme: A Transcendence During Covid-19 Pandemic. Ir Med J 2020; 113:141. [PMID: 35603491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- M O'Reilly
- Our Lady of Lourdes Hospital, Drogheda, RCSI Hospital Group
| | - C Gillen
- Our Lady of Lourdes Hospital, Drogheda, RCSI Hospital Group
| | - C Meehan
- Our Lady of Lourdes Hospital, Drogheda, RCSI Hospital Group
| | - I Counihan
- Our Lady of Lourdes Hospital, Drogheda, RCSI Hospital Group
| | - T Hassan
- Our Lady of Lourdes Hospital, Drogheda, RCSI Hospital Group
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18
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Whitla L, Devins M, Molloy EJ, Twomey M, O'Reilly M, Balfe J. Children's Palliative Care; the identified Learning Needs of Paediatricians. Ir Med J 2020; 113:95. [PMID: 32816430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Aim To determine baseline learning needs of Paediatricians in Ireland when caring for children with palliative care needs. Methods A questionnaire based online survey was conducted. Results One hundred and fourteen paediatricians responded to the survey, the majority were Specialist Registrars but almost half were consultant paediatricians (46% n=52). Most had never had formal education in the paediatric palliative care (57% n=48). Areas of future training that were ranked as important or highly important (percentage of respondents) included: pain management (98% n=81), management of the dying child (96% n=80), palliative care resources (95%n=79), advanced care planning (95% n=79) and communication skills (86% n=71). Those surveyed were asked to comment on the challenges of recent clinical interactions, on analysis three overarching themes emerged; best interests of the child, inadequate training and confidence and co-ordinating care. Conclusion This survey highlights the learning needs of paediatricians and will inform the development of meaningful education sessions for doctors.
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Affiliation(s)
- L Whitla
- Department of Neurodisability and Developmental Paediatrics, Children's Health Ireland at Tallaght, Dublin, Ireland
| | - M Devins
- Department of Paediatric Palliative Care, Children's Health Ireland at Crumlin, Dublin, Ireland
- Palliative Medicine, Coombe Women and Infant's University Hospital, Dublin, Ireland
| | - E J Molloy
- Department of Neurodisability and Developmental Paediatrics, Children's Health Ireland at Tallaght, Dublin, Ireland
- Discipline of Paediatrics and Child Health, the University of Dublin Trinity College, Ireland
- Department of Neonatology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - M Twomey
- Department of Paediatric Palliative Care, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - M O'Reilly
- Department of Paediatric Palliative Care, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - J Balfe
- Department of Neurodisability and Developmental Paediatrics, Children's Health Ireland at Tallaght, Dublin, Ireland
- Discipline of Paediatrics and Child Health, the University of Dublin Trinity College, Ireland
- LauraLynn Children's Hospice, Dublin, Ireland
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19
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Harding KE, Robertson N, Snowdon DA, Watts JJ, Karimi L, O'Reilly M, Kotis M, Taylor NF. Are wait lists inevitable in subacute ambulatory and community health services? A qualitative analysis. AUST HEALTH REV 2019; 42:93-99. [PMID: 28131111 DOI: 10.1071/ah16145] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 12/09/2016] [Indexed: 11/23/2022]
Abstract
Objectives Wait lists are common in ambulatory and community-based services. The aim of the present study was to explore managers' perceptions of factors that contribute to wait times. Methods A qualitative study was conducted using semi-structured interviews with managers and team leaders of ambulatory and community health services within a large health network. Interviews were transcribed and coded, and the codes were then grouped into themes and subthemes. Results Representatives from 26 services participated in the project. Four major themes were identified. Three themes related to reasons and factors contributing to increased wait time for services (inefficient intake and scheduling processes; service disruptions due to human resource issues; and high service demand). A fourth theme related to staff attitudes towards wait times and acceptance and acknowledgement of wait lists. Conclusions Service providers perceive high demand to be a key driver of wait times, but a range of other factors also contributes and may represent opportunities for improving access to care. These other factors include improving process efficiencies, greater consistency of service delivery through more efficient management of human resources and shifting to more consumer-centred approaches in measuring wait times in order to drive improvements in patient flow. What is known about the topic? Wait times are common in out-patient and ambulatory services. These services experience high demand, which is likely to continue to grow as health service delivery shifts from hospital to community settings. What does this paper add? Although demand is an important driver of wait times, there are other modifiable factors that also contribute, including process inefficiencies and service disruption related to human resource issues. An underlying staff attitude of acceptance of wait times appears to be an additional barrier to improving access. What are the implications for practitioners? The findings of the present study suggest that there are opportunities for improving access to ambulatory and community health services through more efficient use of existing resources. However, a more consumer-focused approach regarding acceptability of wait times is needed to help drive change.
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Affiliation(s)
| | - Nicole Robertson
- Eastern Health, 5 Arnold Street, Box Hill, Vic. 3128, Australia.
| | - David A Snowdon
- Eastern Health, 5 Arnold Street, Box Hill, Vic. 3128, Australia.
| | - Jennifer J Watts
- Centre for Population Health Research, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia. Email
| | - Leila Karimi
- La Trobe University, Kingsbury Drive, Bundoora, Vic. 3086, Australia.
| | - Mary O'Reilly
- Eastern Health, 5 Arnold Street, Box Hill, Vic. 3128, Australia.
| | - Michelle Kotis
- Victorian Department of Health and Human Services, 50 Lonsdale Street, Melbourne, Vic. 3000, Australia. Email
| | - Nicholas F Taylor
- La Trobe University, Kingsbury Drive, Bundoora, Vic. 3086, Australia.
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Goulopoulos A, Rofe O, Kong D, Maclean A, O'Reilly M. Attitudes and beliefs of Australian emergency department clinicians on antimicrobial stewardship in the emergency department: A qualitative study. Emerg Med Australas 2019; 31:787-796. [PMID: 30920181 DOI: 10.1111/1742-6723.13251] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 09/18/2018] [Revised: 12/31/2018] [Accepted: 01/20/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore the attitudes and beliefs of Australian ED clinicians towards antimicrobial stewardship in the ED. METHODS Semi-structured one-to-one interviews were conducted with ED clinicians between March and October 2015. Participants were identified via purposive and snowball sampling. Questionnaires were developed using the literature. Interviews were audio-recorded, transcribed and analysed using thematic analysis via the framework approach. Two researchers coded independently, with one using QSR International's NVivo 10 software and the other manually. Emergent themes were identified and classified. RESULTS Twenty-two clinicians (eight doctors, eight nurses and six pharmacists) from seven institutions participated. Participants were aware and concerned about antimicrobial resistance. Clinicians were divided based on their opinion on whether antimicrobials are prescribed appropriately and judiciously in the ED, with many perceiving prescribing to be inappropriate. Prior knowledge of the term 'Antimicrobial Stewardship' was demonstrated by doctors and pharmacists, with a relative lack of awareness by nurses. Four main themes were identified as both barriers and facilitators to antimicrobial stewardship in the ED: individual healthcare provider, resource, organisational and cultural. Uncertainty of diagnosis, time and resource pressures, reliance on previous experience and lack of access to expert opinion were perceived barriers. To facilitate appropriate prescribing, clinicians emphasised the need for routine education and feedback, adequate staffing, robust guidelines, senior medical clinician advocacy and multidisciplinary support. CONCLUSIONS Australian ED clinicians were aware of antimicrobial resistance. Many perceive injudicious antimicrobial use as problematic. Consideration of ED clinicians' perceived barriers and facilitators might enhance implementation of antimicrobial stewardship programmes in EDs.
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Affiliation(s)
- Anne Goulopoulos
- Pharmacy Department, Eastern Health, Melbourne, Victoria, Australia
| | - Olivia Rofe
- Pharmacy Department, Eastern Health, Melbourne, Victoria, Australia
| | - David Kong
- Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia.,Ballarat Health Services, Ballarat, Victoria, Australia.,The National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Andrew Maclean
- Emergency Services, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia
| | - Mary O'Reilly
- Monash University, Melbourne, Victoria, Australia.,Infectious Diseases Department, Eastern Health, Melbourne, Victoria, Australia
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21
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O'Reilly M. Christmas TV highlights for the dental team. Br Dent J 2018. [DOI: 10.1038/sj.bdj.2018.1099] [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: 11/09/2022]
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22
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Harding KE, Leggat SG, Watts JJ, Kent B, Prendergast L, Kotis M, O'Reilly M, Karimi L, Lewis AK, Snowdon DA, Taylor NF. A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial. BMC Med 2018; 16:182. [PMID: 30336784 PMCID: PMC6194740 DOI: 10.1186/s12916-018-1170-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long waiting times are associated with public community outpatient health services. This trial aimed to determine if a new model of care based on evidence-based strategies that improved patient flow in two small pilot trials could be used to reduce waiting time across a variety of services. The key principle of the Specific Timely Appointments for Triage (STAT) model is that patients are booked directly into protected assessment appointments and triage is combined with initial management as an alternative to a waiting list and triage system. METHODS A stepped wedge cluster randomised controlled trial was conducted between October 2015 and March 2017, involving 3116 patients at eight sites across a major Australian metropolitan health network. RESULTS The intervention reduced waiting time to first appointment by 33.8% (IRR = 0.663, 95% CI 0.516 to 0.852, P = 0.001). Median waiting time decreased from a median of 42 days (IQR 19 to 86) in the control period to a median of 24 days (IQR 13 to 48) in the intervention period. A substantial reduction in variability was also noted. The model did not impact on most secondary outcomes, including time to second appointment, likelihood of discharge by 12 weeks and number of appointments provided, but was associated with a small increase in the rate of missed appointments. CONCLUSIONS Broad-scale implementation of a model of access and triage that combined triage with initial management and actively managed the relationship between supply and demand achieved substantial reductions in waiting time without adversely impacting on other aspects of care. The reductions in waiting time are likely to have been driven, primarily, by substantial reductions for those patients previously considered low priority. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12615001016527 registration date: 29/09/2015.
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Affiliation(s)
- Katherine E Harding
- Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia. .,La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia.
| | - Sandra G Leggat
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia
| | - Jennifer J Watts
- Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Bridie Kent
- University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA, UK
| | - Luke Prendergast
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia
| | - Michelle Kotis
- Victorian Department of Health and Human Services, 50 Lonsdale Street, Melbourne, VIC, 3000, Australia
| | - Mary O'Reilly
- Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia
| | - Leila Karimi
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia
| | - Annie K Lewis
- Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia.,La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia
| | - David A Snowdon
- Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia.,La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia
| | - Nicholas F Taylor
- Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia.,La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia
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Liew K, Bartolo C, O'Reilly M, Lim L. Targeting antimicrobial stewardship in hospitalised patients with community-acquired pneumonia within 24 h of admission. Infect Dis Health 2018. [DOI: 10.1016/j.idh.2018.03.002] [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]
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24
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Commons RJ, Raby E, Athan E, Bhally H, Chen S, Guy S, Ingram PR, Lai K, Lemoh C, Lim LL, Manning L, Miyakis S, O'Reilly M, Roberts A, Sehu M, Torda A, Vicaretti M, Lazzarini PA. Managing diabetic foot infections: a survey of Australasian infectious diseases clinicians. J Foot Ankle Res 2018; 11:13. [PMID: 29651304 PMCID: PMC5894166 DOI: 10.1186/s13047-018-0256-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/29/2018] [Indexed: 11/10/2022] Open
Abstract
Background Diabetic foot infections (DFI) present a major morbidity, mortality and economic challenge for the tertiary health sector. However, lack of high quality evidence for specific treatment regimens for patients with DFIs may result in inconsistent management. This study aimed to identify DFI caseload proportion and patterns of clinical practice of Infectious Diseases (ID) Physicians and Trainees within Australia and New Zealand. Methods A cross-sectional online survey of Australian and New Zealand ID Physicians and Trainees was undertaken, to estimate the overall ID caseload devoted to patients with DFIs and assess clinicians' management practices of patients with DFIs. Results Approximately 28% (142/499) of ID Physicians and Trainees from Australia and New Zealand responded to the survey. DFI made up 19.2% of all ID consultations. Involvement in multidisciplinary teams (MDT) was common as 77.5% (93/120) of those responding indicated their patients had access to an inpatient or outpatient MDT. Significant heterogeneity of antimicrobial treatments was reported, with 82 unique treatment regimens used by 102 respondents in one scenario and 76 unique treatment regimens used by 101 respondents in the second scenario. The duration of therapy and the choice of antibiotics for microorganisms isolated from superficial swabs also varied widely. Conclusions Patients with DFIs represent a significant proportion of an ID clinician's caseload. This should be reflected in the ID training program. Large heterogeneity in practice between clinicians reflects a lack of evidence from well-designed clinical trials for patients with DFI and highlights the need for management guidelines informed by future trials.
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Affiliation(s)
- Robert J Commons
- 1Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Tiwi, Casuarina, Northern Territory Australia
| | - Edward Raby
- 2Department of Infectious Diseases, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, WA Australia
| | - Eugene Athan
- 3Department of Infectious Diseases, Barwon Health, Deakin University, Geelong, VIC Australia
| | - Hasan Bhally
- 4Department of Infectious Diseases, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Sharon Chen
- 5Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, The University of Sydney, Westmead, NSW Australia
| | - Stephen Guy
- 6Department of Infectious Diseases, Western Health, 160 Gordon St, Footscray, VIC Australia.,7Department of Medicine, Melbourne Medical School - Western Precint, The University of Melbourne, St Albans, VIC Australia
| | - Paul R Ingram
- 2Department of Infectious Diseases, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, WA Australia.,8School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, WA Australia
| | - Katy Lai
- 9Department of Infectious Diseases, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW Australia
| | - Chris Lemoh
- 10Monash Infectious Diseases, Dandenong Hospital, 135 David St, Dandenong, VIC Australia
| | - Lyn-Li Lim
- 11Department of Infectious Diseases, Eastern Health, 8 Arnold St, Box Hill, VIC Australia
| | - Laurens Manning
- 12School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Research Institute, Fiona Stanley Hospital, PO Box 404, Bull Creek, WA Australia
| | - Spiros Miyakis
- 13Department of Infectious Diseases, The Wollongong Hospital, Loftus St, Wollongong, NSW Australia
| | - Mary O'Reilly
- 11Department of Infectious Diseases, Eastern Health, 8 Arnold St, Box Hill, VIC Australia
| | - Adam Roberts
- 14Department of Endocrinology, University Hospital Geelong, Bellerine St, Geelong, VIC Australia
| | - Marjoree Sehu
- 15Infection Management Service, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD Australia.,16University of Queensland, St Lucia, QLD Australia
| | - Adrienne Torda
- 17Department of Infectious Diseases, Prince of Wales Hospital, Barker St, Randwick, NSW Australia
| | - Mauro Vicaretti
- 18Department of Vascular Surgery, Westmead Hospital, Hawkesbury Rd & Darcy Rd, Westmead, NSW Australia
| | - Peter A Lazzarini
- 19School of Clinical Sciences, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD Australia
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Benghiat H, Sanghera P, Stange D, Nightingale P, Hartley A, O'Reilly M, Nundall N, Spooner D, Cruickshank G, Toogood A. EP-1192: Dexamethasone-related adrenal insufficiency in patients with brain and skull base tumours. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31502-0] [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: 10/14/2022]
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Wilke A, Bartolo C, O'Reilly M, Chisholm P. ‘Healthcare-associated infection time’: a novel strategy to engage doctors in preventing healthcare-associated infections on every ward round. J Hosp Infect 2018; 98:223-224. [DOI: 10.1016/j.jhin.2017.09.020] [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] [Received: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
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27
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Mcshane JA, Maclean A, Houston L, Marquand H, Smith M, O'Reilly M. Identifying potential influenza patients in a metropolitan emergency department. Infect Dis Health 2017. [DOI: 10.1016/j.idh.2017.09.044] [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]
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28
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Mcshane JA, Maclean A, Houston L, Marquand H, Smith M, O'Reilly M. Early identification and management of CPE risk in the emergency department. Infect Dis Health 2017. [DOI: 10.1016/j.idh.2017.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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O'Reilly M, O'Tuathaigh CMP, Doran K. Doctors' attitudes towards the introduction and clinical operation of do not resuscitate orders (DNRs) in Ireland. Ir J Med Sci 2017; 187:25-30. [PMID: 28508956 DOI: 10.1007/s11845-017-1628-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 07/18/2016] [Accepted: 04/27/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Do not resuscitate orders (DNRs) are documents which state that should a patient suffer from cardiopulmonary failure, resuscitation should not be attempted. Internationally, DNRs are often misunderstood and used inappropriately in a clinical setting. AIMS The aim of this paper was to determine the current understanding of DNRs and their clinical operation among hospital doctors in Ireland. METHODS A cross-sectional, questionnaire-based study was conducted involving doctors from the Cork teaching hospitals. The questionnaire sought information regarding understanding of DNRs and their clinical operation, as well as attitudes regarding the current absence of relevant Irish guidelines. The questionnaire also collected information regarding demographics, clinical specialty, and level of experience. RESULTS 45.9% (47/103) of all doctors stated that their clinical knowledge was sufficient to draft a DNR, but 48.7% of this group (n = 23) chose the incorrect definition for a DNR when provided with three separate options. Thirty-five percent (n = 36) of all doctors surveyed demonstrated an incorrect understanding of a DNR. Neither specialty nor experience level had any effect on level of understanding of DNRs (p > 0.05). 93.2% (n = 96) agreed that there is a need for introduction of domestic guidelines regarding DNRs. 57.6% (n = 59) would draft more DNRs in the event that such domestic guidelines were in place. CONCLUSIONS A substantial proportion of hospital doctors surveyed demonstrated an incomplete understanding of DNRs and their clinical operation. However, the overwhelming majority of the present sample believe that domestic guidelines are needed on the matter.
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Affiliation(s)
- M O'Reilly
- School of Medicine, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland
| | - C M P O'Tuathaigh
- School of Medicine, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland.
| | - K Doran
- School of Medicine, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland
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30
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Liew K, Lim L, O'Reilly M, Bartolo C, Krishneel D, Thakkar H. Targeting antimicrobial stewardship in hospitalized patients with community-acquired pneumonia within 24 h of admission. Intern Med J 2017. [DOI: 10.1111/imj.6_13463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K Liew
- Eastern Health; Victoria Australia
| | - L Lim
- Eastern Health; Victoria Australia
| | - M O'Reilly
- Eastern Health; Victoria Australia
- Monash University; Victoria Australia
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31
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Khalil H, Murrin C, O'Reilly M, Viljoen K, Segurado R, O'Brien J, Somerville R, McGillicuddy F, Kelleher CC. Total HDL cholesterol efflux capacity in healthy children - Associations with adiposity and dietary intakes of mother and child. Nutr Metab Cardiovasc Dis 2017; 27:70-77. [PMID: 27919542 DOI: 10.1016/j.numecd.2016.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 09/03/2016] [Accepted: 10/03/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS High-density lipoprotein (HDL) cholesterol efflux capacity in adults may be a measure of the atheroprotective property of HDL. Little however, is known about HDL cholesterol efflux capacity in childhood. We aimed to investigate the relationship between HDL cholesterol efflux capacity and childhood anthropometrics in a longitudinal study. METHODS AND RESULTS Seventy-five children (mean age = 9.4 ± 0.4 years) were followed from birth until the age of 9 years. HDL cholesterol efflux capacity was determined at age 9 by incubating serum-derived HDL-supernatants with 3H-cholesterol labeled J774 macrophages and percentage efflux determined. Mothers provided dietary information by completing food frequency questionnaires in early pregnancy and then 5 years later on behalf of themselves and their children. Pearson's correlations and multiple regression analyses were conducted to confirm independent associations with HDL efflux. There was a negative correlation between HDL cholesterol efflux capacity and waist circumference at age 5 (r = -0.3, p = 0.01) and age 9 (r = -0.24, p = 0.04) and BMI at age 5 (r = -0.45, p = 0.01) and age 9 (r = -0.19, p = 0.1). Multiple regression analysis showed that BMI at age 5 remained significantly associated with reduced HDL cholesterol efflux capacity (r = -0.45, p < 0.001). HDL-C was negatively correlated with energy-adjusted fat intake (r = -0.24, p = 0.04) and positively correlated with energy-adjusted protein (r = 0.24, p = 0.04) and starch (r = 0.29, p = 0.01) intakes during pregnancy. HDL-C was not significantly correlated with children dietary intake at age 5. There were no significant correlations between maternal or children dietary intake and HDL cholesterol efflux capacity. CONCLUSIONS This novel analysis shows that efflux capacity is negatively associated with adiposity in early childhood independent of HDL-C.
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Affiliation(s)
- H Khalil
- School of Public Health, Physiotherapy and Sports Science, Woodview House, Belfield, University College Dublin, Dublin 4, Ireland.
| | - C Murrin
- School of Public Health, Physiotherapy and Sports Science, Woodview House, Belfield, University College Dublin, Dublin 4, Ireland
| | | | - K Viljoen
- School of Public Health, Physiotherapy and Sports Science, Woodview House, Belfield, University College Dublin, Dublin 4, Ireland
| | - R Segurado
- School of Public Health, Physiotherapy and Sports Science, Woodview House, Belfield, University College Dublin, Dublin 4, Ireland
| | - J O'Brien
- School of Public Health, Physiotherapy and Sports Science, Woodview House, Belfield, University College Dublin, Dublin 4, Ireland
| | - R Somerville
- School of Public Health, Physiotherapy and Sports Science, Woodview House, Belfield, University College Dublin, Dublin 4, Ireland
| | - F McGillicuddy
- Nutrigenomics Research Group, Ireland; School of Medicine, UCD Conway Institute, Belfield, University College Dublin, Dublin 4, Ireland
| | - C C Kelleher
- School of Public Health, Physiotherapy and Sports Science, Woodview House, Belfield, University College Dublin, Dublin 4, Ireland
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Kelly O, O'Reilly M, Collins NC. A PRE-HOSPITAL ANALYSIS OF PAEDIATRIC MAJOR TRAUMA IN THE GREATER DUBLIN AREA. Arch Emerg Med 2016. [DOI: 10.1136/emermed-2016-206402.67] [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: 11/03/2022]
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Houston L, Stafford J, Marquand H, Bailey A, Carmichael R, O'Reilly M. What happens in the dirty utility should stay in the dirty utility. Infect Dis Health 2016. [DOI: 10.1016/j.idh.2016.09.131] [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: 11/24/2022]
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Lavu VL, O'Reilly M, Beckett C, Houston L. Analysis of occupational exposures among emergency department medical and nursing staff in a Victorian teaching hospital. Infect Dis Health 2016. [DOI: 10.1016/j.idh.2016.09.013] [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]
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O'Reilly M, Kiyimba N, Karim K. "This is a question we have to ask everyone": asking young people about self-harm and suicide. J Psychiatr Ment Health Nurs 2016; 23:479-488. [PMID: 27500689 DOI: 10.1111/jpm.12323] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: An essential part of the mental health assessment is to evaluate the risk of harm to self. Fundamentally this involves asking directly about self-harming behaviour and suicidal thoughts or urges, but practitioners often find it difficult to open up these conversations. This evaluation of risk is particularly important as self-harm and suicidal thoughts are frequently found in young people who attend mental health services. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Young people are not always routinely asked directly about self-harm or suicidal thoughts when they are assessed. There are two ways that mental health practitioners introduce this topic: first, by building up to it by initially asking about general feelings, and second by stating that it is a requirement to ask everyone. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: These questions should not be avoided by mental health practitioners just because they are difficult. We offer suggestions as to how to ask questions about self-harm and suicide based on real-world practice. ABSTRACT Introduction Questions about self-harm and suicide are essential in risk assessments with children and young people, yet little is known about how mental health practitioners do this. Aim The core aim was to examine how questions about self-harm and suicidal ideation are asked in real-world practice. Method A qualitative design was employed to analyse 28 video-recorded naturally occurring mental health assessments in a child and adolescent mental health service. Data were analysed using conversation analysis (CA). Results In 13 cases young people were asked about self-harm and suicide, but 15 were not. Analysis revealed how practitioners asked these questions. Two main styles were revealed. First was an incremental approach, beginning with inquiries about emotions and behaviours, building to asking about self-harm and suicidal intent. Second was to externalize the question as being required by outside agencies. Discussion The study concluded that the design of risk questions to young people had implications for how open they were to engaging with the practitioner. Implications for practice The study has implications for training and practice for psychiatric nurses and other mental health practitioners in feeling more confident in communicating with young people about self-harm and suicidal ideation.
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Affiliation(s)
- M O'Reilly
- Department of Neuroscience, Psychology and Behaviour, The Greenwood Institute of Child Health, University of Leicester, Leicester, UK.
| | - N Kiyimba
- Department of Social and Political Science, University of Chester, Chester, UK
| | - K Karim
- Department of Neuroscience, Psychology and Behaviour, The Greenwood Institute of Child Health, University of Leicester, Leicester, UK
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van Os S, Cheung PY, Kushniruk K, O'Reilly M, Aziz K, Schmölzer GM. Assessment of endotracheal tube placement in newborn infants: a randomized controlled trial. J Perinatol 2016; 36:796. [PMID: 27562185 DOI: 10.1038/jp.2016.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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O'Reilly M, Goodwin M, Ansmidte O, Roche H, McGillicuddy F. Inflammation potently suppresses abca1-mediated cholesterol efflux from macrophages, and not adipocytes, via activation of JAK/STAT pathway. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Harding KE, Watts JJ, Karimi L, O'Reilly M, Kent B, Kotis M, Leggat SG, Kearney J, Taylor NF. Improving access for community health and sub-acute outpatient services: protocol for a stepped wedge cluster randomised controlled trial. BMC Health Serv Res 2016; 16:364. [PMID: 27506923 PMCID: PMC4977711 DOI: 10.1186/s12913-016-1611-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/30/2016] [Indexed: 12/02/2022] Open
Abstract
Background Waiting lists for treatment are common in outpatient and community services, Existing methods for managing access and triage to these services can lead to inequities in service delivery, inefficiencies and divert resources from frontline care. Evidence from two controlled studies indicates that an alternative to the traditional “waitlist and triage” model known as STAT (Specific Timely Appointments for Triage) may be successful in reducing waiting times without adversely affecting other aspects of patient care. This trial aims to test whether the model is cost effective in reducing waiting time across multiple services, and to measure the impact on service provision, health-related quality of life and patient satisfaction. Methods/design A stepped wedge cluster randomised controlled trial has been designed to evaluate the impact of the STAT model in 8 community health and outpatient services. The primary outcome will be waiting time from referral to first appointment. Secondary outcomes will be nature and quantity of service received (collected from all patients attending the service during the study period and health-related quality of life (AQOL-8D), patient satisfaction, health care utilisation and cost data (collected from a subgroup of patients at initial assessment and after 12 weeks). Data will be analysed with a multiple multi-level random-effects regression model that allows for cluster effects. An economic evaluation will be undertaken alongside the clinical trial. Discussion This paper outlines the study protocol for a fully powered prospective stepped wedge cluster randomised controlled trial (SWCRCT) to establish whether the STAT model of access and triage can reduce waiting times applied across multiple settings, without increasing health service costs or adversely impacting on other aspects of patient care. If successful, it will provide evidence for the effectiveness of a practical model of access that can substantially reduce waiting time for outpatient and community services with subsequent benefits for both efficiency of health systems and patient care. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12615001016527. Approved 15/9/2015.
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Affiliation(s)
- Katherine E Harding
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia. .,Eastern Health, 5 Arnold Street, Box Hill, VIC, 3128, Australia.
| | - Jennifer J Watts
- Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Leila Karimi
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia
| | - Mary O'Reilly
- Eastern Health, 5 Arnold Street, Box Hill, VIC, 3128, Australia
| | - Bridie Kent
- Plymouth University, Drake Circus, Plymouth, Devon, PL4 8AA, UK
| | - Michelle Kotis
- Victorian Department of Health and Community Services, 50 Lonsdale Street, Melbourne, VIC, 3000, Australia
| | - Sandra G Leggat
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia
| | - Jackie Kearney
- Victorian Department of Health and Community Services, 50 Lonsdale Street, Melbourne, VIC, 3000, Australia
| | - Nicholas F Taylor
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia.,Eastern Health, 5 Arnold Street, Box Hill, VIC, 3128, Australia
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Lim LL, Ho SA, O'Reilly M. In-flight transmission of measles: Time to update the guidelines? Am J Infect Control 2016; 44:958-9. [PMID: 27040567 DOI: 10.1016/j.ajic.2016.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 02/01/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Lyn-Li Lim
- Eastern Health, Box Hill, VIC, Australia.
| | - Su Ann Ho
- Eastern Health, Box Hill, VIC, Australia
| | - Mary O'Reilly
- Eastern Health, Box Hill, VIC, Australia,; Monash University, Clayton, VIC, Australia
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Otome O, O'Reilly M, Lim L. Disseminated Mycobacterium haemophilum skeletal disease in a patient with interferon-gamma deficiency. Intern Med J 2016; 45:1073-6. [PMID: 26429217 DOI: 10.1111/imj.12875] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 03/23/2015] [Indexed: 11/29/2022]
Abstract
Disseminated non-tuberculous mycobacterial (NTM) infection is rare in immunocompetent adults. Anti-interferon-gamma (IFN-γ) autoantibodies have recently been associated with NTM infections, particularly in patients of Asian ethnicity. We describe a case of disseminated Mycobacterium haemophilum skeletal infection due to anti IFN-γ autoantibodies in a 71-year-old Cambodian man. He responded to a combination of anti-mycobacterial antibiotics without requirement for immunomodulator therapy. Testing for acquired IFN-γ deficiency due to IFN-γ autoantibodies should be considered when standard tests for immunodeficiency are negative in patients with unusual or severe opportunistic infections, including NTM.
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Affiliation(s)
- O Otome
- Department of Infectious Diseases, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia
| | - M O'Reilly
- Department of Infectious Diseases, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia
| | - L Lim
- Department of Infectious Diseases, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia
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Bhogal J, Solevag AL, O'Reilly M, Lee TF, Lu M, Joynt C, Hornberger L, Schmolzer G, Cheung PY. The Effects of High Frequency Oscillatory Ventilation (HFOV) with Volume Guarantee (VG) on Left Ventricular Function, Systemic and Regional Oxygenation, and Ventilation When Compared to HFOV and Conventional Mechanical Ventilation (CMV) in A Newborn Piglet Model of Respiratory Distress Syndrome (RDS). Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: RDS due to surfactant deficiency is commonly seen in preterm infants. These infants often require ventilatory support such as CMV and HFOV. HFOV with VG (HFOV+VG) is an alternative mode that delivers a set tidal volume. There is limited data on either HFOV mode regarding the effects on left ventricular (LV) function, systemic and regional oxygenation, and ventilation.
OBJECTIVES: We primarily compared the effects of CMV with VG, HFOV, and HFOV+VG on cardiac index (CI). Secondary parameters included heart rate (HR), mean arterial pressure (MAP), LV ejection fraction (EF), stroke volume (SV), dP/dt max, LV end-systolic volume and pressure (ESV, ESP), end-diastolic volume and pressure (EDV, EDP), and measures of oxygenation and ventilation. Oxygenation parameters included cerebral and renal near-infrared spectroscopy (NIRS), partial pressure of arterial oxygen (PaO2), and carotid artery flow index (CAFI). Ventilation parameters included partial pressure of arterial carbon dioxide (PaCO2) and minute ventilation (MV).
DESIGN/METHODS: Piglets (1.4-2.4 kg; 1-3 days old) were acutely anesthetized and instrumented with the placement of a right femoral arterial catheter for blood gas analysis, NIRS probes (Invos®), Transonic® flow probe on right common carotid artery, and Millar® catheter in the LV. Warm saline lung lavage was performed to achieve an AaDO2 of 300-450 mmHg to simulate moderate to severe RDS. Piglets were then block-randomized to CMV, HFOV or HFOV+VG for 4 hours using a Fabian HFO ventilator (Acutronic Medical Systems AG, Switzerland)(n=8 per group). Sham-operated piglets without RDS were monitored for the same duration under CMV (n=6). Two-way repeated measures ANOVA was used to analyze the data between modes or time points.
RESULTS: Piglets developed moderately severe RDS with comparable AaDO2 and Paw along with stable hemodynamic parameters. Both HFOV and HFOV+VG groups had similar PaCO2 whereas the CMV group had elevated PaCO2 when compared to that of the Sham (p<0.01). Switching to HFOV resulted in a higher MV than its baseline. HFOV+VG but not HFOV or CMV groups had lower regional oxygenation and CAFI than its respective normoxic baseline (all p<0.01). HFOV and HFOV+VG had higher CI, EF, and SV than CMV at 4 hours of recovery (p<0.05) with similar HR, MAP, dP/dt max, ESV, ESP, EDV and EDP.
CONCLUSION: In our piglet model of RDS, HFOV shows benefits to LV function and ventilation when compared to CMV. HFOV+VG does not show benefits compared to HFOV.
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Feeney A, Barry T, Hayden D, Higgins L, Kavanagh E, MacMahon P, O'Reilly M, Teeling SP, Kelly PJ, Murphy S. Pre-Hospital Fast Positive Cases Identified by DFB Ambulance Paramedics: Final Clinical Diagnosis. Ir Med J 2016; 109:397. [PMID: 27685491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ischaemic stroke clinical outcomes are improved by earlier treatment with intravenous thrombolysis. An existing pathway at the Mater University Hospital for assessment of suspected acute stroke in the Emergency Department was updated, aiming to shorten door-to-needle time. This study examines the final clinical diagnosis of Dublin Fire Brigade Ambulance Paramedic identified Face-Arm-Speech-Test (FAST) positive patients presenting to the Emergency Department over a 7 month period. A retrospective analysis was carried out of 177 consecutive FAST positive patients presenting between March and November 2014. The final clinical diagnosis was acute stroke in 57.1% (n=101) of patients. Of these, 76 were ischaemic strokes of whom 56.5% (n=43) were thrombolysed. In the pre-hospital setting Ambulance Paramedics can identify, with reasonable accuracy, acute stroke using the FAST test. Over half of the ischaemic stroke patients presenting via this pathway can be treated with intravenous thrombolysis.
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Affiliation(s)
- A Feeney
- Acute Stroke Service, Mater Misericordiae University Hospital
| | - T Barry
- Acute Stroke Service, Mater Misericordiae University Hospital
| | - D Hayden
- Acute Stroke Service, Mater Misericordiae University Hospital
| | - L Higgins
- Acute Stroke Service, Mater Misericordiae University Hospital
| | - E Kavanagh
- Department of Radiology, Mater Misericordiae University Hospital
| | - P MacMahon
- Department of Radiology, Mater Misericordiae University Hospital
| | - M O'Reilly
- Lean Health Academy, Mater Misericordiae University Hospital
| | - S P Teeling
- Dublin Fire Brigade (DFB) Ambulance Service, Dublin, Ireland
| | - P J Kelly
- Department of Respiratory Medicine and Irish Mycobacteria Reference Laboratory, St James Hospital, James St, Dublin 8
- Acute Stroke Service, Mater Misericordiae University Hospital
- UCD School of Medicine, Dublin, Ireland
| | - S Murphy
- Acute Stroke Service, Mater Misericordiae University Hospital
- Acute Stroke Service, Mater Misericordiae University Hospital
- UCD School of Medicine, Dublin, Ireland
- RCSI School of Medicine, Dublin, Ireland
- UCD School of Medicine, Dublin, Ireland
- RCSI School of Medicine, Dublin, Ireland
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Leahy OR, O'Reilly M, Dyer DR, Phillips D, Grummet JP. Response to Re: Transrectal ultrasound-guided biopsy sepsis and the rise in carbapenem antibiotic use. ANZ J Surg 2016; 86:316-7. [PMID: 27040749 DOI: 10.1111/ans.13476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/04/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Mary O'Reilly
- Cabrini Health, Melbourne, Victoria, Australia.,Eastern Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - David R Dyer
- Monash Health, Melbourne, Victoria, Australia and
| | | | - Jeremy P Grummet
- Alfred Health, Melbourne, Victoria, Australia.,Cabrini Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Epworth Healthcare, Melbourne, Victoria, Australia
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Palfi A, Chadderton N, O'Reilly M, Nagel-Wolfrum K, Wolfrum U, Bennett J, Humphries P, Kenna P, Millington-Ward S, Farrar J. Corrigendum to “Efficient gene delivery to photoreceptors using AAV2/rh10 and rescue of the Rho–/– mouse”. Mol Ther Methods Clin Dev 2016; 3:16032. [PMID: 27257610 PMCID: PMC4879991 DOI: 10.1038/mtm.2016.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cooley SM, Donnelly JC, Deering M, Raman A, O'Reilly M, Gannon G, Holland A, O'Shaughnessy F, Brady M, Hayes N, Ainle FN, Cleary B. 38: Thrombocalc: personalized postpartum VTE risk assessment in a high-throughput environment. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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DeVoe JD, Garrott RA, Rotella JJ, Challender SR, White PJ, O'Reilly M, Butler CJ. Summer range occupancy modeling of non-native mountain goats in the greater Yellowstone area. Ecosphere 2015. [DOI: 10.1890/es15-00273.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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O'Reilly M, Boland S, Slattery D, Ward F. A prospective, randomised, open labelled trial to examine the clinical efficacy of an oral nutritional supplement with regards to improving the nutritional status of undernourished children (2-10 years) in the hospital and community setting over 6 weeks. Clin Nutr ESPEN 2015; 10:e202-e203. [PMID: 28531528 DOI: 10.1016/j.clnesp.2015.03.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M O'Reilly
- Dept. of Nutrition & Dietetics Children's University Hospital, Ireland
| | - S Boland
- Dept. of Nutrition & Dietetics Children's University Hospital, Ireland
| | - D Slattery
- Respiratory Dept., Children's University Hospital, Ireland
| | - F Ward
- Dept. of Nutrition & Dietetics Children's University Hospital, Ireland
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O'Reilly M, Dillon E, Finucane O, McMorrow A, Murphy A, Lyons C, de la Llera Moya M, Reilly M, Roche H, McGillicuddy F. HDL proteomic quality, and not efflux capacity, reflects differential modulation of reverse cholesterol transport by saturated and monounsaturated fat diets. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Khalil H, Murrin C, Viljoen K, Segurado R, Somerville R, O'Brien J, O'Reilly M, McGillicuddy F, Kelleher C. high-density lipoprotein (HDL) efflux capacity and its relation to anthropometric measurements in the lifeways cross-generation cohort study children. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Schmolzer G, Mian Q, Cheung PY, O'Reilly M, Polglase G, Aziz K. 8: Tidal Volume Delivery During Mask Ventilation and Brain Injury in Newborns <29 Weeks Gestation. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e33b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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