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Hanidu A, Djongianto TU, Kovalenko M, Gupta E, Jansen M, Usman S, Joash K, Challacombe FL, Lees C. Determining psychological impact of delivery mode prediction using ultrasound and clinical assessment. Ultrasound Obstet Gynecol 2024. [PMID: 38308853 DOI: 10.1002/uog.27601] [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] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Affiliation(s)
- A Hanidu
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - T U Djongianto
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M Kovalenko
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - E Gupta
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M Jansen
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S Usman
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - K Joash
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - F L Challacombe
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - C Lees
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Kuil LE, Varkevisser TMCK, Huisman MH, Jansen M, Bunt J, Compter A, Ket H, Schagen SB, Meeteren AYNSV, Partanen M. Artificial and natural interventions for chemotherapy- and / or radiotherapy-induced cognitive impairment: A systematic review of animal studies. Neurosci Biobehav Rev 2024; 157:105514. [PMID: 38135266 DOI: 10.1016/j.neubiorev.2023.105514] [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: 11/02/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Cancer survivors frequently experience cognitive impairments. This systematic review assessed animal literature to identify artificial (pharmaceutical) or natural interventions (plant/endogenously-derived) to reduce treatment-related cognitive impairments. METHODS PubMed, EMBASE, PsycINFO, Web of Science, and Scopus were searched and SYRCLE's tool was used for risk of bias assessment of the 134 included articles. RESULTS High variability was observed and risk of bias analysis showed overall poor quality of reporting. Results generally showed positive effects in the intervention group versus cancer-therapy only group (67% of 156 cognitive measures), with only 15 (7%) measures reporting cognitive impairment despite intervention. Both artificial (61%) and natural (75%) interventions prevented cognitive impairment. Artificial interventions involving GSK3B inhibitors, PLX5622, and NMDA receptor antagonists, and natural interventions utilizing melatonin, curcumin, and N-acetylcysteine, showed most consistent outcomes. CONCLUSIONS Both artificial and natural interventions may prevent cognitive impairment in rodents, which merit consideration in future clinical trials. Greater consistency in design is needed to enhance the generalizability across studies, including timing of cognitive tests and description of treatments and interventions.
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Affiliation(s)
- L E Kuil
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Division of Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - T M C K Varkevisser
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands
| | - M H Huisman
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands
| | - M Jansen
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands
| | - J Bunt
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands
| | - A Compter
- Department of Neuro-Oncology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - H Ket
- Universiteitsbibliotheek, Vrije Universiteit Amsterdam, de Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - S B Schagen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | | | - M Partanen
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands.
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Georgiou AC, Jansen M, van der Waal SV. [The assessment of the endodontic foundation]. Ned Tijdschr Tandheelkd 2024; 131:51-58. [PMID: 38318630 DOI: 10.5177/2024.02.23043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
The diagnosis of an endodontic disease requires thorough research, collecting both clinical and radiographic information. The clinical examination includes history taking, visual inspection of the tooth and surrounding tissues, palpation of the soft and hard tissues, periodontal examination and percussion. The radiographic examination provides valuable information, but can never stand alone in arriving at a diagnosis. It is important to link the findings of the radiographic examination to other information. Sometimes, invasive examination is necessary, during which the coronal restoration is removed to allow better assessment of the tooth. This can provide additional information about the presence of caries, fractures, leakage of the restoration or other reasons for failure of the initial root canal treatment. A good diagnosis is essential for planning successful follow-up treatment.
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Wilms JN, Ghaffari MH, Darani PS, Jansen M, Sauerwein H, Steele MA, Martín-Tereso J, Leal LN. Postprandial metabolism and gut permeability in calves fed milk replacer with different macronutrient profiles or a whole milk powder. J Dairy Sci 2024; 107:184-201. [PMID: 37641288 DOI: 10.3168/jds.2023-23368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/04/2023] [Indexed: 08/31/2023]
Abstract
Significant differences exist in the composition of current milk replacers (MR) and bovine whole milk. This study investigated how the macronutrient profile of 3 different MR formulations containing varying amounts of fat, lactose, and protein, and a whole milk powder (WP), affect postprandial metabolism and gut permeability in male Holstein calves. Sixty-four calves (45.4 ± 4.19 kg [mean ± SD] and 1.8 ± 0.62 d of age) were blocked in order of arrival to the facility and within each block, calves were randomly assigned to 1 of 4 treatments. Treatments included a high-fat MR (HF: 25.0% dry matter [DM] fat, 22.5% protein, 38.6% lactose; n = 14), a high-lactose MR (HL: 44.6% lactose, 22.5% protein, 18.0% fat; n = 17), a high-protein MR (HP: 26.0% protein, 18.0% fat, 41.5% lactose; n = 17), and WP (26.0% fat, 24.5% protein, 38.0% lactose; n = 16). Calves were fed 3.0 L (135 g/L) 3 times daily at 0600, 1200, and 1800 h with a teat bucket. Milk intake was recorded daily for the first 28 d after arrival, and blood sampling and body weight measurements were performed at arrival and on d 7, 14, 21, and 27. Gut permeability was estimated from fractional urinary excretion of indigestible markers (Cr-EDTA, lactulose, and d-mannitol) administered as a single dose on d 21 instead of the morning milk meal. Digestibility was determined simultaneously from a total collection of feces over 24 h. Postprandial dynamics were measured on d 28 by sequential blood sampling over 7.5 h. Dry matter intake of MR over 28 d was slightly greater in calves fed HL and HP than in WP. Recovery of Cr-EDTA and d-mannitol over a 24-h urine collection was greater in calves fed WP and HP than HL calves. Apparent total-tract digestibility of crude ash, protein, and fat did not differ among treatments; however, DM digestibility was lower in calves fed WP than in other treatment groups. In addition, abomasal emptying, as indicated by the area under the curve (AUC) for acetaminophen, was slower in calves fed WP than in calves fed HF and HL. The AUC for postprandial plasma glucose was lower in calves fed HL than WP and HF and lower in calves fed HP than WP. The AUC for postprandial serum insulin was greater in calves fed HP than WP and HF, whereas calves fed HL did not differ from the other treatments. Postprandial triglycerides were greater in calves fed WP, and postprandial adiponectin was higher in calves fed HL than other treatments. The high content of lactose and protein in MR had a major effect on postprandial metabolism. This raises the possibility of optimizing MR formulations to maintain metabolic homeostasis and influence development.
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Affiliation(s)
- J N Wilms
- Trouw Nutrition R&D, 3800 AG, Amersfoort, the Netherlands; Department of Animal Biosciences, Animal Science and Nutrition, University of Guelph, Guelph, ON, Canada N1G 1W2.
| | - M H Ghaffari
- Institute of Animal Science, University of Bonn, 53115 Bonn, Germany
| | | | - M Jansen
- Trouw Nutrition R&D, 3800 AG, Amersfoort, the Netherlands; Animal Nutrition Group, Wageningen University, 6700 AH Wageningen, the Netherlands
| | - H Sauerwein
- Institute of Animal Science, University of Bonn, 53115 Bonn, Germany
| | - M A Steele
- Department of Animal Biosciences, Animal Science and Nutrition, University of Guelph, Guelph, ON, Canada N1G 1W2
| | | | - L N Leal
- Trouw Nutrition R&D, 3800 AG, Amersfoort, the Netherlands
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Abstract
This paper provides a new rationale for equating brain death with the death of the human organism, in light of well-known criticisms made by Alan D Shewmon, Franklin Miller and Robert Truog and a number of other writers. We claim that these criticisms can be answered, but only if we accept that we have slightly redefined the concept of death when equating brain death with death simpliciter. Accordingly, much of the paper defends the legitimacy of redefining death against objections, before turning to the specific task of defending a new rationale for equating brain death with death as slightly redefined.
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Affiliation(s)
- Andrew McGee
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Australia
| | - Dale Gardiner
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Melanie Jansen
- Gold Coast University Hospital, Gold Coast, Australia and Queensland Children's Hospital, Brisbane, Australia
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Cassinotti E, Al-Taher M, Antoniou SA, Arezzo A, Baldari L, Boni L, Bonino MA, Bouvy ND, Brodie R, Carus T, Chand M, Diana M, Eussen MMM, Francis N, Guida A, Gontero P, Haney CM, Jansen M, Mintz Y, Morales-Conde S, Muller-Stich BP, Nakajima K, Nickel F, Oderda M, Parise P, Rosati R, Schijven MP, Silecchia G, Soares AS, Urakawa S, Vettoretto N. European Association for Endoscopic Surgery (EAES) consensus on Indocyanine Green (ICG) fluorescence-guided surgery. Surg Endosc 2023; 37:1629-1648. [PMID: 36781468 PMCID: PMC10017637 DOI: 10.1007/s00464-023-09928-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 12/30/2022] [Accepted: 01/28/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND In recent years, the use of Indocyanine Green (ICG) fluorescence-guided surgery during open and laparoscopic procedures has exponentially expanded across various clinical settings. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference on this topic with the aim of creating evidence-based statements and recommendations for the surgical community. METHODS An expert panel of surgeons has been selected and invited to participate to this project. Systematic reviews of the PubMed, Embase and Cochrane libraries were performed to identify evidence on potential benefits of ICG fluorescence-guided surgery on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by the panel; they were then submitted to all EAES members through a two-rounds online survey and results presented at the EAES annual congress, Barcelona, November 2021. RESULTS A total of 18,273 abstracts were screened with 117 articles included. 22 statements and 16 recommendations were generated and approved. In some areas, such as the use of ICG fluorescence-guided surgery during laparoscopic cholecystectomy, the perfusion assessment in colorectal surgery and the search for the sentinel lymph nodes in gynaecological malignancies, the large number of evidences in literature has allowed us to strongly recommend the use of ICG for a better anatomical definition and a reduction in post-operative complications. CONCLUSIONS Overall, from the systematic literature review performed by the experts panel and the survey extended to all EAES members, ICG fluorescence-guided surgery could be considered a safe and effective technology. Future robust clinical research is required to specifically validate multiple organ-specific applications and the potential benefits of this technique on clinical outcomes.
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Affiliation(s)
- E Cassinotti
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy.
| | - M Al-Taher
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - S A Antoniou
- Department of Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - A Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - L Baldari
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy
| | - L Boni
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy
| | - M A Bonino
- Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - N D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R Brodie
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - T Carus
- Niels-Stensen-Kliniken, Elisabeth-Hospital, Thuine, Germany
| | - M Chand
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - M Diana
- IHU Strasbourg, Institute of Image-Guided Surgery and IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - M M M Eussen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - N Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | - A Guida
- Department of Medico-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - P Gontero
- Division of Urology, Department of Surgical Science, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - C M Haney
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Jansen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Y Mintz
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General Surgery, University Hospital Virgen del Rocío, University of Sevilla, Seville, Spain
| | - B P Muller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - K Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - F Nickel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Oderda
- Division of Urology, Department of Surgical Science, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - P Parise
- U.O.C. Chirurgia Generale, Policlinico di Abano Terme, Abano Terme, PD, Italy
| | - R Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - M P Schijven
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, North Holland, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, North Holland, The Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam UMC, Amsterdam, North Holland, The Netherlands
| | - G Silecchia
- Department of Medico-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - A S Soares
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - S Urakawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - N Vettoretto
- U.O.C. Chirurgia Generale, ASST Spedali Civili di Brescia P.O. Montichiari, Ospedale di Montichiari, Montichiari, Italy
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Jansen M, Van der Does AJW, De Rover M, De Bruijn ERA, Hamstra DA. Hormonal status effects on the electrophysiological correlates of performance monitoring in women. Psychoneuroendocrinology 2023; 149:106006. [PMID: 36566721 DOI: 10.1016/j.psyneuen.2022.106006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/11/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
Fluctuations in ovarian hormones are thought to play a role in the increased prevalence of mood and anxiety disorders in women. Error-related negativity (ERN) and error positivity (Pe) are two putative electrophysiological biomarkers for these internalizing disorders. We investigated whether female hormonal status, specifically menstrual cycle phase and oral contraceptive (OC) use, impact ERN and Pe. Additionally, we examined whether the relationship between the ERN and negative affect (NA) was moderated by hormonal status and tested whether the ERN mediated the relation between ovarian hormones and NA. Participants were healthy, pre-menopausal women who were naturally cycling (NC) or using OCs. Using a counterbalanced within-subject design, all participants performed a speeded-choice reaction-time task twice while undergoing electroencephalography measurements. NC women (N = 42) performed this task during the early follicular and midluteal phase (when estrogen and progesterone are both low and both high, respectively), while OC users (N = 42) performed the task during active OC use and during their pill-free week. Estradiol and progesterone levels were assessed in saliva. Comparing the two cycle phases within NC women revealed no differences in the (Δ)ERN, (Δ)Pe or NA. We did observe a negative relation between phase-related changes in the ΔERN and changes in NA. Mediation analysis additionally showed that phase-related changes in estradiol were indirectly and negatively related to NA through a reduction of ΔERN amplitudes. When comparing active OC users with NC women, we observed increased ΔPe- but not (Δ)ERN amplitudes in the former group. No evidence was found for moderating effects of menstrual cycle phase or OC use on the relation between the ERN and NA. These findings suggest that hormonal status may impact the neural correlates of performance monitoring and error sensitivity, and that this could be a potential mechanism through which ovarian hormones influence mood.
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Affiliation(s)
- M Jansen
- Department of Clinical Psychology, Leiden University, the Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands.
| | - A J W Van der Does
- Department of Clinical Psychology, Leiden University, the Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
| | - M De Rover
- Department of Clinical Psychology, Leiden University, the Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
| | - E R A De Bruijn
- Department of Clinical Psychology, Leiden University, the Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
| | - D A Hamstra
- Department of Clinical Psychology, Leiden University, the Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
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Wirth W, Maschek S, Marijnissen ACA, Lalande A, Blanco FJ, Berenbaum F, van de Stadt LA, Kloppenburg M, Haugen IK, Ladel CH, Bacardit J, Wisser A, Eckstein F, Roemer FW, Lafeber FPJG, Weinans HH, Jansen M. Test-retest precision and longitudinal cartilage thickness loss in the IMI-APPROACH cohort. Osteoarthritis Cartilage 2023; 31:238-248. [PMID: 36336198 DOI: 10.1016/j.joca.2022.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/22/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the test-retest precision and to report the longitudinal change in cartilage thickness, the percentage of knees with progression and the predictive value of the machine-learning-estimated structural progression score (s-score) for cartilage thickness loss in the IMI-APPROACH cohort - an exploratory, 5-center, 2-year prospective follow-up cohort. DESIGN Quantitative cartilage morphology at baseline and at least one follow-up visit was available for 270 of the 297 IMI-APPROACH participants (78% females, age: 66.4 ± 7.1 years, body mass index (BMI): 28.1 ± 5.3 kg/m2, 55% with radiographic knee osteoarthritis (OA)) from 1.5T or 3T MRI. Test-retest precision (root mean square coefficient of variation) was assessed from 34 participants. To define progressor knees, smallest detectable change (SDC) thresholds were computed from 11 participants with longitudinal test-retest scans. Binary logistic regression was used to evaluate the odds of progression in femorotibial cartilage thickness (threshold: -211 μm) for the quartile with the highest vs the quartile with the lowest s-scores. RESULTS The test-retest precision was 69 μm for the entire femorotibial joint. Over 24 months, mean cartilage thickness loss in the entire femorotibial joint reached -174 μm (95% CI: [-207, -141] μm, 32.7% with progression). The s-score was not associated with 24-month progression rates by MRI (OR: 1.30, 95% CI: [0.52, 3.28]). CONCLUSION IMI-APPROACH successfully enrolled participants with substantial cartilage thickness loss, although the machine-learning-estimated s-score was not observed to be predictive of cartilage thickness loss. IMI-APPROACH data will be used in subsequent analyses to evaluate the impact of clinical, imaging, biomechanical and biochemical biomarkers on cartilage thickness loss and to refine the machine-learning-based s-score. CLINICALTRIALS GOV IDENTIFICATION NCT03883568.
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Affiliation(s)
- W Wirth
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Ludwig Boltzmann Inst. for Arthritis and Rehabilitation, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany.
| | - S Maschek
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany.
| | - A C A Marijnissen
- University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
| | - A Lalande
- Institut de Recherches Internationales Servier, Suresnes, France.
| | - F J Blanco
- Grupo de Investigación de Reumatología (GIR), INIBIC - Complejo Hospitalario Universitario de A Coruña, SERGAS. Centro de Investigación CICA, Departamento de Fisioterapia y Medicina, Universidad de A Coruña, A Coruña, Spain.
| | - F Berenbaum
- Department of Rheumatology, AP-HP Saint-Antoine Hospital, Paris, France; INSERM, Sorbonne University, Paris, France.
| | - L A van de Stadt
- Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.
| | - M Kloppenburg
- Rheumatology, Leiden University Medical Center, Leiden, the Netherlands; Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - I K Haugen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.
| | - C H Ladel
- CHL4special consultancy, Darmstadt, Germany.
| | - J Bacardit
- School of Computing, Newcastle University, Newcastle, United Kingdom.
| | - A Wisser
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Ludwig Boltzmann Inst. for Arthritis and Rehabilitation, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany.
| | - F Eckstein
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Ludwig Boltzmann Inst. for Arthritis and Rehabilitation, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany.
| | - F W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, Universitätsklinikum Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - F P J G Lafeber
- University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
| | - H H Weinans
- University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
| | - M Jansen
- University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
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Moynihan KM, Jansen M, Siegel BD, Taylor LS, Kirsch RE. Extracorporeal Membrane Oxygenation Candidacy Decisions: An Argument for a Process-Based Longitudinal Approach. Pediatr Crit Care Med 2022; 23:e434-e439. [PMID: 35609309 DOI: 10.1097/pcc.0000000000002991] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Are all children extracorporeal membrane oxygenation (ECMO) candidates? Navigating ECMO decisions represents an enormous challenge in pediatric critical care. ECMO cannulation should not be a default option as it will not confer benefit for "all" critically ill children; however, "all" children deserve well-considered decisions surrounding their ECMO candidacy. The complexity of the decision demands a systematic, "well-reasoned" and "dynamic" approach. Due to clinical urgency, this standard cannot always be met prior to initiation of ECMO. We challenge the paradigm of "candidacy" as a singular decision that must be defined prior to ECMO initiation. Rather, the determination as to whether ECMO is in the patient's best interest is applicable regardless of cannulation status. The priority should be on collaborative, interdisciplinary decision-making processes aligned with principles of transparency, relevant reasoning, accountability, review, and appeal. To ensure a robust process, it should not be temporally constrained by cannulation status. We advocate that this approach will decrease both the risk of not initiating ECMO in a patient who will benefit and the risk of prolonged, nonbeneficial support. We conclude that to ensure fair decisions are made in a patient's best interest, organizations should develop procedurally fair processes for ECMO decision-making that are not tied to a particular time point and are revisited along the management trajectory.
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Affiliation(s)
| | - Melanie Jansen
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Bryan D Siegel
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Lisa S Taylor
- Department of Pediatric Intensive Care, Children's Hospital at Westmead, Westmead, NSW, Australia
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Correa Y, Jansen M, Blanchet C, Roosen-Runge F, Pedersen J, Cárdenas M. Structural studies on LDL from patients with high and low lipoprotein (a). Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.394] [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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11
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Cocco A, Patel B, Jansen M, Ranse J. Expression of ethical principles in Australia's disaster plans. Emerg Med Australas 2022; 34:989-994. [PMID: 35748344 DOI: 10.1111/1742-6723.14035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This qualitative study explores whether Australian mass casualty and disaster plans explicitly acknowledge or implicitly draw upon ethical principles. METHODS Federal, state and territory governmental websites were searched to identify mass casualty incident and/or disaster plans. The authors examined the documents to identify whether ethical principles were overtly stated or implied, and what those values or principles were. RESULTS Ten governmental documents were identified - two federal and one for each of the eight States and Territories. One of the documents had an explicit statement of the ethical values that informed the mass casualty and disaster planning decisions which were present. Utilitarianism was the dominant ethical principle informing the document in another seven documents. CONCLUSION In Australian government documents for mass casualty and disaster management, although ethics is definitely considered, the ethical principles on which decisions are made are rarely explicit. Mass casualty and disaster decision-making could be improved by making the ethical basis for decision-making clear, transparent and comprehensively reasoned.
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Affiliation(s)
- Annelise Cocco
- Department of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Bhavik Patel
- Division of Trauma, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Melanie Jansen
- Department of Paediatrics, Westmead Children's Hospital, Sydney, New South Wales, Australia
| | - Jamie Ranse
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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12
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George S, Wake E, Jansen M, Roy J, Maconachie S, Paasilahti A, Wiseman G, Gibbons K, Winearls J. Fibrinogen Early In Severe paediatric Trauma studY (FEISTY junior): protocol for a randomised controlled trial. BMJ Open 2022; 12:e057780. [PMID: 35508351 PMCID: PMC9073392 DOI: 10.1136/bmjopen-2021-057780] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Trauma causes 40% of child deaths in high-income countries, with haemorrhage being a leading contributor to death in this population. There is a growing recognition that fibrinogen and platelets play a major role in trauma-induced coagulopathy (TIC) but the exact physiological mechanisms are poorly understood. METHODS AND ANALYSIS This is a prospective multicentre, open-label, randomised, two-arm parallel feasibility study conducted in the emergency departments, intensive care units and operating theatres of participating hospitals. Severely injured children, aged between 3 months and 18 years, presenting with traumatic haemorrhage requiring transfusion of blood products will be screened for inclusion.Sixty-eight patients will be recruited and will be allocated to fibrinogen replacement using fibrinogen concentrate (FC) or cryoprecipitate in a 1:1 ratio. Fibrinogen replacement will be administered to patients with a FIBTEM A5 of ≤10. All other aspects of the currently used rotational thromboelastometry-guided treatment algorithm and damage-control approach to trauma remain the same in both groups.The primary outcome is time to administration of fibrinogen replacement from time of identification of hypofibrinogenaemia. Clinical secondary outcomes and feasibility outcomes will also be analysed. ETHICS AND DISSEMINATION This study has received ethical clearance from the Children's Health Queensland Human Research Ethics Committee (HREC/17/QRCH/78). Equipment and consumables for sample testing have been provided to the study by Haemoview Diagnostics, Werfen Australia and Haemonetics Australia. FC has been provided by CSL Behring, Australia. The funding bodies and industry partners have had no input into the design of the study, and will not be involved in the preparation or submission of the manuscript for publication.The use of viscoelastic haemostatic assays and early fibrinogen replacement has the potential to improve outcomes in paediatric trauma through earlier recognition of TIC. This in turn may reduce transfusion volumes and downstream complications and reduce the reliance on donor blood products such as cryoprecipitate.The use of FC has implications for regional and remote centres who would not routinely have access to cryoprecipitate but could store FC easily. Access to early fibrinogen replacement in these centres could make a significant impact and assist in closing the gap in trauma care available to residents of these communities.Outcomes of this study will be submitted for publication in peer-reviewed journals and submitted for presentation at national and international scientific fora. TRIAL REGISTRATION NUMBER NCT03508141.
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Affiliation(s)
- Shane George
- Departments of Emergency Medicine and Children's Critical Care, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Elizabeth Wake
- Trauma Service, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medical Sciences, Griffith University, Southport, Queensland, Australia
| | - Melanie Jansen
- Paedatiatric Intensive Care Unit, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - John Roy
- Department of Haematology, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Sharon Maconachie
- Department of Anaesthesia, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Anni Paasilahti
- Department of Intensive Care, Mackay Base Hospital, Mackay, Queensland, Australia
| | - Greg Wiseman
- Paediatric Intensive Care Unit, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Kristen Gibbons
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - James Winearls
- School of Medical Sciences, Griffith University, Southport, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Department of Intensive Care Medicine, Gold Coast University Hospital, Southport, Queensland, Australia
- Department of Intensive Care Medicine, St Andrews War Memorial Hospital, Brisbane, Queensland, Australia
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13
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Ailoaei S, Wright P, Griffiths S, Jansen M, Ernst S. Telerobotic interventions from a distance: an initial experience in 3D phantom mapping. European Heart Journal - Digital Health 2021. [PMCID: PMC8755354 DOI: 10.1093/ehjdh/ztab104.3087] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction The current COVID-19 pandemic has fostered several accelerations in “remote” patient care such as video and telephone clinics, as well as multidisciplinary collaborations using online platforms with experts consulting the local teams from a distance. The next logical step would be to also offer remote-controlled interventions which the expert operator not on site, but in support of the local team. This is especially valuable for complex interventions when either patient or expert operator can not be present at the same place. Purpose We aimed to demonstrate that an expert operator located at far distance (Austria) could directly interact with the remote magnetic navigation system in London (UK) whilst mapping a 3D phantom using an electroanatomical mapping system. Method Two experienced operators of the magnetic navigation system were tasked with creating fast anatomic maps (FAM) of the atrial and ventricular chambers of a 3D phantom using remote magnetic navigation in combination with 3D electroanatomical mapping. One was located in the control room of the magnetic catheter lab (UK) and the second one was in Tirol, Austria and connected through a secure remote desktop connection (via high speed fibre optic cable). Using a solid tip magnetic catheter connected to a mechanical drive, all interactions with the system were carried out via the Odyssey platform. Acquisitions for right and left atrium, as well as right and left ventricles plus aorta was compared with regards to mapping duration, map completeness (as judged by the average distance of surface points from 3D CT scan reconstruction), total 3D map volume and need for additional radiation exposure during the mapping process. Results Mapping time and map completeness when performed by the distant operator was not inferior to the local operator and both did not require any additional radiation exposure during the mapping process. Table 1 demonstrates the mean parameters for each chamber, respectively. Figure 1 depicts the matched data for chamber completeness as compared for the LA (green= local operator, pink= distant operator) using a contrast CT scan as the gold standard. Conclusion Telerobotic 3D mapping of a 3D phantom from a distance was equally fast delivered from the control room as compared to an operator located 1200 km away without compromising on map completeness. This demonstrates the feasibility of telerobotic interventions and stress the need for remote collaboration which is especially valuable when travel of patients and/or physician experts is restricted. Funding Acknowledgement Type of funding sources: None.
Matched data for aorta ![]()
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Affiliation(s)
- S Ailoaei
- Royal Brompton and Harefield Hospital, Cardiology, London, United Kingdom
| | - P Wright
- Royal Brompton and Harefield Hospital, Cardiology, London, United Kingdom
| | - S Griffiths
- Royal Brompton and Harefield Hospital, Cardiology, London, United Kingdom
| | - M Jansen
- Royal Brompton and Harefield Hospital, Cardiology, London, United Kingdom
| | - S Ernst
- Royal Brompton Hospital Imperial College London, London, United Kingdom
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14
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Ailoaei S, Wright P, Griffiths S, Jansen M, Ernst S. Telerobotic interventions from a distance: an initial experience in 3D phantom mapping. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The current COVID-19 pandemic has fostered several accelerations in “remote” patient care such as video and telephone clinics, as well as multidisciplinary collaborations using online platforms with experts consulting the local teams from a distance. The next logical step would be to also offer remote-controlled interventions which the expert operator not on site, but in support of the local team. This is especially valuable for complex interventions when either patient or expert operator can not be present at the same place.
Purpose
We aimed to demonstrate that an expert operator located at far distance (Austria) could directly interact with the remote magnetic navigation system in London (UK) whilst mapping a 3D phantom using an electroanatomical mapping system.
Method
Two experienced operators of the magnetic navigation system were tasked with creating fast anatomic maps (FAM) of the atrial and ventricular chambers of a 3D phantom using remote magnetic navigation in combination with 3D electroanatomical mapping. One was located in the control room of the magnetic catheter lab (UK) and the second one was in Tirol, Austria and connected through a secure remote desktop connection (via high speed fibre optic cable). Using a solid tip magnetic catheter connected to a mechanical drive, all interactions with the system were carried out via the Odyssey platform. Acquisitions for right and left atrium, as well as right and left ventricles plus aorta was compared with regards to mapping duration, map completeness (as judged by the average distance of surface points from 3D CT scan reconstruction), total 3D map volume and need for additional radiation exposure during the mapping process.
Results
Mapping time and map completeness when performed by the distant operator was not inferior to the local operator and both did not require any additional radiation exposure during the mapping process. Table 1 demonstrates the mean parameters for each chamber, respectively. Figure 1 depicts the matched data for chamber completeness as compared for the LA (green= local operator, pink= distant operator) using a contrast CT scan as the gold standard.
Conclusion
Telerobotic 3D mapping of a 3D phantom from a distance was equally fast delivered from the control room as compared to an operator located 1200 km away without compromising on map completeness. This demonstrates the feasibility of telerobotic interventions and stress the need for remote collaboration which is especially valuable when travel of patients and/or physician experts is restricted.
Funding Acknowledgement
Type of funding sources: None. Matched data for aorta
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Affiliation(s)
- S Ailoaei
- Royal Brompton and Harefield Hospital, Cardiology, London, United Kingdom
| | - P Wright
- Royal Brompton and Harefield Hospital, Cardiology, London, United Kingdom
| | - S Griffiths
- Royal Brompton and Harefield Hospital, Cardiology, London, United Kingdom
| | - M Jansen
- Royal Brompton and Harefield Hospital, Cardiology, London, United Kingdom
| | - S Ernst
- Royal Brompton Hospital Imperial College London, London, United Kingdom
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15
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Houwen S, Heutinck L, Jansen M, Krom Y, Cup E, Hendriksen J, Willemsen M, Verschuuren J, Niks E, De Groot I. DMD – CLINICAL CARE. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Rationing in health care is controversial, and even more so in pediatrics. Children are an inherently vulnerable group because they are reliant on their parents and caregivers to make decisions in their best interests and have no political voice. Historically, there has been general acceptance of the need to ration healthcare at a systems level, however there is controversy over whether healthcare professionals should be involved in rationing at the bedside. The COVID-19 pandemic has highlighted that bedside rationing is unavoidable, at least in times of extreme resource scarcity. Internationally, there has been significant ethical analysis and guideline development to guide intensive care rationing decisions in the event that resources are overwhelmed. This paper explores the principles underlying distributive justice in healthcare rationing and discusses how these were operationalized in ethical guidelines for the COVID-19 pandemic. In fact, rationing is unavoidable and occurs constantly in everyday nursing and medical ICU practice, often in mundane and uncontroversial ways. Some argue that these everyday decisions are not true rationing decisions, but resource allocation, or stewardship decisions. We argue there are no clear lines between resource allocation and rationing decisions, rather that they occur on a spectrum. These everyday rationing decisions are particularly susceptible to personal biases that are often implicit. Due to the subtle and constant nature of most everyday rationing decisions, specific guideline development will rarely be practical or appropriate. However, it is possible to develop other processes to improve decision making. There are a variety of strategies we recommend for this including, encouraging reflective practice; developing explicit frameworks that promote collaborative decision making; being transparent about resource allocation and rationing decisions with colleagues, patients, and families; and promoting a workplace culture of speaking up and accessing support in identifying and managing everyday rationing decisions.
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Affiliation(s)
- Lynette Kirby
- Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Shreerupa Basu
- Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Eliana Close
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Melanie Jansen
- Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Faculty of Medicine, University of Queensland, Queensland, Australia
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Houwen-van Opstal SLS, van den Elzen YMEM, Jansen M, Willemsen MAAP, Cup EHC, De Groot IJM. Facilitators and Barriers to Wearing Hand Orthoses by Adults with Duchenne Muscular Dystrophy: A Mixed Methods Study Design. J Neuromuscul Dis 2021; 7:467-475. [PMID: 32568104 PMCID: PMC7592678 DOI: 10.3233/jnd-200506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: To retard shortening of finger flexors in patients with Duchenne muscular dystrophy (DMD), hand orthoses are prescribed. However, many patients do not wear the orthoses regularly. To optimize orthotic interventions, we need insight into the factors influencing compliance. Objective: To evaluate the compliance regarding hand orthoses in an adult DMD population and to explore experiences and perceptions of DMD patients wearing orthoses, and of their caregivers. Methods: Mixed methods observational study, combining quantitative and qualitative data from medical charts combined with qualitative semi-structured interviews using a constant comparative method and a short validated questionnaire (D-QUEST). Results: 65 medical charts were analyzed. 48 patients were assessed as needing hand orthoses, of whom 37.5 % were compliant. Qualitative data analyses revealed (1) motivation: preservation of hand function; (2) barriers: discomfort and impediments; (3) facilitators: good fit and personalized wearing schedule; (4) fitting process: satisfactory, but patients do not readily seek help when barriers appear. Conclusions: Patients are motivated to wear hand orthoses, but often discontinue use because of orthosis-and disease-specific barriers. The identification of these barriers leads to practical and feasible recommendations concerning the orthoses and the fitting process, such as less rigid material, preservation of some function while wearing the orthoses, and fixed evaluation points. The findings were confirmed by the D-QUEST.
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Affiliation(s)
- S L S Houwen-van Opstal
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.,Amalia Children Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Y M E M van den Elzen
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Jansen
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.,Amalia Children Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M A A P Willemsen
- Amalia Children Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E H C Cup
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - I J M De Groot
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.,Amalia Children Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
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Jansen M, Ooms A, Turmezei TD, Mackay JW, Mastbergen S, Lafeber F. POS1092 SUBCHONDRAL BONE NORMALIZATION AFTER KNEE JOINT DISTRACTION TREATMENT AS MEASURED WITH CT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:In addition to cartilage degeneration, knee osteoarthritis (OA) causes bone changes, including cortical bone thickening, subchondral bone density decrease, and bone shape changes as a result of widening and flattening condyles and osteophyte formation. Knee joint distraction (KJD) is a joint-preserving treatment for younger (<65 years) knee OA patients that has been shown to reverse OA cartilage degradation. On radiographs, KJD showed a decrease in subchondral bone density and an increase in osteophyte formation. However, these bone changes have never been evaluated with a 3D imaging technique.Objectives:To evaluate cortical bone thickness, subchondral trabecular bone density, and bone shape on CT scans before and one year after KJD treatment.Methods:19 KJD patients were included in an extended imaging protocol, undergoing a CT scan before and one year after treatment. Stradview v6.0 was used for semi-automatic tibia and femur segmentation from axial thin-slice (0.45mm) CT scans. Cortical bone thickness (mm) and trabecular bone density (Hounsfield units, HU) were measured with an automated algorithm. Osteophytes were excluded. Afterwards, wxRegSurf v18 was used for surface registration. Registration data was used for bone shape measurements. MATLAB R2020a and the SurfStat MATLAB package were used for data analysis and visualization. Two-tailed F-tests were used to calculate changes over time. Two separate linear regression models were used to show the influence of baseline Kellgren-Lawrence grade and sex on the changes over time. Statistical significance was calculated with statistical parametric mapping; a p-value <0.05 was considered statistically significant. Bone shape changes were explored visually using vertex by vertex displacements between baseline and follow-up. Patients were separated into two groups based on whether their most affected compartment (MAC) was medial or lateral. Only patients with axial CT scans at both time points available for analysis were included for evaluation.Results:3 Patients did not have complete CTs and in 1 patient the imaged femur was too short, leaving 16 patients for tibial analyses and 15 patients for femoral analyses. The MAC was predominantly the medial side (medial MAC n=14; lateral n=2). Before treatment, the MAC cortical bone was compared to the rest of the joint (Figure 1). One year after treatment, MAC cortical thickness decreased, although this decrease of up to approximately 0.25 mm was not statistically significant. The trabecular bone density was also higher before treatment in the MAC, and a decrease was seen throughout the entire joint, although statistically significant only for small areas on mostly the MAC where this decrease was up to approximately 80 HU (Figure 1). Female patients and patients with a higher Kellgren-Lawrence grade showed a somewhat larger decrease in cortical bone thickness. Trabecular density decreased less for patients with a higher Kellgren-Lawrence grade, and female patients showed a higher density decrease interiorly while male patients showed a higher decrease exteriorly. None of this was statistically significant. The central areas of both compartments showed an outward shape change, while the outer ring showed inward changes.Conclusion:MAC cortical bone thickness shows a partial decrease after KJD. Trabecular bone density decreased on both sides of the joint, likely as a direct result of the bicompartmental unloading. For both subchondral bone parameters, MAC values became more similar to the LAC, indicating (partial) subchondral bone normalization in the most affected parts of the joint. The bone shape changes may indicate a reversal of typical OA changes, although the inward difference that was seen on the outer edges may be a result of osteophyte-related changes that might have affected the bone segmentation. In conclusion, KJD treatment shows subchondral bone normalization in the first year after treatment, and longer follow-up might show whether these changes are a temporary result of joint unloading or indicate more prolonged bone changes.Disclosure of Interests:None declared.
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19
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Jansen M, Mastbergen S, Turmezei TD, Mackay JW, Lafeber F. POS1091 KNEE JOINT DISTRACTION RESULTS IN MRI CARTILAGE THICKNESS INCREASE UP TO TEN YEARS AFTER TREATMENT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Knee joint distraction (KJD) is a joint-preserving treatment option for younger (age <65 years) knee osteoarthritis (OA) patients. It has shown clinical improvement for up to nine years after treatment. Radiographs and MRI scans have previously shown cartilage regeneration activity, especially in the first two years after treatment. However, MRIs have not been evaluated more than five years after this treatment.Objectives:To evaluate MRI cartilage thickness up to ten years after KJD treatment.Methods:Patients (n=20) with end-stage knee OA, indicated for total knee arthroplasty (TKA) but <60 years old, were treated with KJD. 3T MRIs with 3D spoiled gradient recalled imaging sequence with fat suppression (SPGR-fs) were acquired before and one, two, five, seven and ten years after surgical treatment. Stradview v6.0 was used for semi-automatic cartilage segmentation; wxRegSurf v18 was used for surface registration. MATLAB R2020a and the SurfStat MATLAB package were used for data analysis and visualization. For changes over time, linear mixed models were used. Two separate linear regression models were used to show the influence of baseline Kellgren-Lawrence grade and sex on the changes over time. Statistical significance was calculated with statistical parametric mapping; a p-value <0.05 was considered statistically significant. Since KJD has previously shown significant results mostly in the patients’ most affected compartment (MAC), patients were separated in two groups based on whether their MAC was the medial or lateral compartment.Results:The MAC was predominantly the medial side (medial MAC n=18; lateral n=2). The 18 patients with a medial MAC all had MRI scans at baseline, one and two years after treatment. After two years, some patients were lost to follow-up, decreasing data availability at five (n=15), seven (n=11) and ten years (n=7). Figure 1 (top) shows the average cartilage thickness at the different time points for all medial MAC patients together. One and two years after treatment the cartilage in the medial weight-bearing region was on average thicker than before treatment. While from five years after treatment the cartilage thickness gradually decreased, even at ten years the medial cartilage thickness seemed slightly higher than pre-treatment. Figure 1 (bottom) shows cartilage thickness changes compared to baseline for patients with a medial MAC. Patients with a lateral MAC showed a similar pattern, with the biggest changes showing on the lateral side. As indicated by the dark blue areas, the medial femoral cartilage thickness increase, which was up to 0.5 mm after one year and 0.6 mm after two years, was largely statistically significant at both these time points. While the medial tibia showed an increase of up to 0.5 mm at these time points as well, this was not statistically significant at two years. Surprisingly, long-term results showed areas of the lateral (less affected) compartment were significantly thicker, up to 0.7 mm, compared to pre-treatment in both the femur and tibia compared to baseline. Kellgren-Lawrence grade and sex were shown to influence the changes, albeit not statistically significantly. Patients with a higher Kellgren-Lawrence grade and male sex showed a higher short-term (one and two year) but a lower long-term (seven and ten year) cartilage thickness increase.Conclusion:KJD treatment results in significant short-term cartilage regeneration in the most affected compartment. While after two years this initial gain in cartilage thickness is gradually lost, likely as a result of natural progression, even ten years after treatment the cartilage is thicker than before treatment. In the less affected compartment, a delayed cartilage response seems to take place, with significantly increased cartilage thickness in the long term. In conclusion, in these young OA patients indicated for TKA, KJD results in femoral and tibial cartilaginous tissue regeneration both short- and long-term and in both sides of the joint.Disclosure of Interests:None declared.
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Pei J, Schuldt M, Nagyova E, Gu Z, El Bouhaddani S, Yiangou L, Jansen M, Calis JJA, Dorsch LM, Blok CS, van den Dungen NAM, Lansu N, Boukens BJ, Efimov IR, Michels M, Verhaar MC, de Weger R, Vink A, van Steenbeek FG, Baas AF, Davis RP, Uh HW, Kuster DWD, Cheng C, Mokry M, van der Velden J, Asselbergs FW, Harakalova M. Multi-omics integration identifies key upstream regulators of pathomechanisms in hypertrophic cardiomyopathy due to truncating MYBPC3 mutations. Clin Epigenetics 2021; 13:61. [PMID: 33757590 PMCID: PMC7989210 DOI: 10.1186/s13148-021-01043-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/28/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is the most common genetic disease of the cardiac muscle, frequently caused by mutations in MYBPC3. However, little is known about the upstream pathways and key regulators causing the disease. Therefore, we employed a multi-omics approach to study the pathomechanisms underlying HCM comparing patient hearts harboring MYBPC3 mutations to control hearts. RESULTS Using H3K27ac ChIP-seq and RNA-seq we obtained 9310 differentially acetylated regions and 2033 differentially expressed genes, respectively, between 13 HCM and 10 control hearts. We obtained 441 differentially expressed proteins between 11 HCM and 8 control hearts using proteomics. By integrating multi-omics datasets, we identified a set of DNA regions and genes that differentiate HCM from control hearts and 53 protein-coding genes as the major contributors. This comprehensive analysis consistently points toward altered extracellular matrix formation, muscle contraction, and metabolism. Therefore, we studied enriched transcription factor (TF) binding motifs and identified 9 motif-encoded TFs, including KLF15, ETV4, AR, CLOCK, ETS2, GATA5, MEIS1, RXRA, and ZFX. Selected candidates were examined in stem cell-derived cardiomyocytes with and without mutated MYBPC3. Furthermore, we observed an abundance of acetylation signals and transcripts derived from cardiomyocytes compared to non-myocyte populations. CONCLUSIONS By integrating histone acetylome, transcriptome, and proteome profiles, we identified major effector genes and protein networks that drive the pathological changes in HCM with mutated MYBPC3. Our work identifies 38 highly affected protein-coding genes as potential plasma HCM biomarkers and 9 TFs as potential upstream regulators of these pathomechanisms that may serve as possible therapeutic targets.
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Affiliation(s)
- J Pei
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
- Regenerative Medicine Utrecht (RMU), University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
- Department of Nephrology and Hypertension, DIG-D, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - M Schuldt
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - E Nagyova
- Laboratory of Clinical Chemistry and Hematology, UMC Utrecht, Utrecht, The Netherlands
| | - Z Gu
- Department of Biostatistics and Research Support, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - S El Bouhaddani
- Department of Biostatistics and Research Support, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - L Yiangou
- Department of Anatomy and Embryology, LUMC, Leiden, The Netherlands
| | - M Jansen
- Department of Genetics, Division of Laboratories, Pharmacy and Biomedical Genetics, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - J J A Calis
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
- Regenerative Medicine Utrecht (RMU), University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
| | - L M Dorsch
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C Snijders Blok
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
| | - N A M van den Dungen
- Laboratory of Clinical Chemistry and Hematology, UMC Utrecht, Utrecht, The Netherlands
| | - N Lansu
- Laboratory of Clinical Chemistry and Hematology, UMC Utrecht, Utrecht, The Netherlands
| | - B J Boukens
- Department of Medical Biology, AMC, Amsterdam, The Netherlands
| | - I R Efimov
- Department of Biomedical Engineering, GWU, Washington, DC, USA
| | - M Michels
- Department of Cardiology, Thoraxcentre, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - M C Verhaar
- Regenerative Medicine Utrecht (RMU), University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
- Department of Nephrology and Hypertension, DIG-D, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - R de Weger
- Department of Pathology, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - A Vink
- Department of Pathology, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - F G van Steenbeek
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
- Regenerative Medicine Utrecht (RMU), University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Utrecht, Utrecht, The Netherlands
| | - A F Baas
- Department of Genetics, Division of Laboratories, Pharmacy and Biomedical Genetics, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - R P Davis
- Department of Anatomy and Embryology, LUMC, Leiden, The Netherlands
| | - H W Uh
- Department of Biostatistics and Research Support, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - D W D Kuster
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C Cheng
- Regenerative Medicine Utrecht (RMU), University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
- Department of Nephrology and Hypertension, DIG-D, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
- Department of Biomedical Engineering, GWU, Washington, DC, USA
| | - M Mokry
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
- Regenerative Medicine Utrecht (RMU), University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
- Laboratory of Clinical Chemistry and Hematology, UMC Utrecht, Utrecht, The Netherlands
- Division of Paediatrics, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - J van der Velden
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - F W Asselbergs
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands.
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK.
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK.
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Room E03.818, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - M Harakalova
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands.
- Regenerative Medicine Utrecht (RMU), University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands.
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21
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Jansen M, Christiaans I, van der Crabben SN, Michels M, Huurman R, Hoedemaekers YM, Dooijes D, Jongbloed JDH, Boven LG, Lekanne Deprez RH, Wilde AAM, Jans JJM, van der Velden J, de Boer RA, van Tintelen JP, Asselbergs FW, Baas AF. BIO FOr CARE: biomarkers of hypertrophic cardiomyopathy development and progression in carriers of Dutch founder truncating MYBPC3 variants-design and status. Neth Heart J 2021; 29:318-329. [PMID: 33532905 PMCID: PMC8160056 DOI: 10.1007/s12471-021-01539-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is the most prevalent monogenic heart disease, commonly caused by truncating variants in the MYBPC3 gene. HCM is an important cause of sudden cardiac death; however, overall prognosis is good and penetrance in genotype-positive individuals is incomplete. The underlying mechanisms are poorly understood and risk stratification remains limited. AIM To create a nationwide cohort of carriers of truncating MYBPC3 variants for identification of predictive biomarkers for HCM development and progression. METHODS In the multicentre, observational BIO FOr CARe (Identification of BIOmarkers of hypertrophic cardiomyopathy development and progression in Dutch MYBPC3 FOunder variant CARriers) cohort, carriers of the c.2373dupG, c.2827C > T, c.2864_2865delCT and c.3776delA MYBPC3 variants are included and prospectively undergo longitudinal blood collection. Clinical data are collected from first presentation onwards. The primary outcome constitutes a composite endpoint of HCM progression (maximum wall thickness ≥ 20 mm, septal reduction therapy, heart failure occurrence, sustained ventricular arrhythmia and sudden cardiac death). RESULTS So far, 250 subjects (median age 54.9 years (interquartile range 43.3, 66.6), 54.8% male) have been included. HCM was diagnosed in 169 subjects and dilated cardiomyopathy in 4. The primary outcome was met in 115 subjects. Blood samples were collected from 131 subjects. CONCLUSION BIO FOr CARe is a genetically homogeneous, phenotypically heterogeneous cohort incorporating a clinical data registry and longitudinal blood collection. This provides a unique opportunity to study biomarkers for HCM development and prognosis. The established infrastructure can be extended to study other genetic variants. Other centres are invited to join our consortium.
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Affiliation(s)
- M Jansen
- Department of Genetics, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - I Christiaans
- Department of Genetics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - S N van der Crabben
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M Michels
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - R Huurman
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Y M Hoedemaekers
- Department of Genetics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Clinical Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - D Dooijes
- Department of Genetics, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - J D H Jongbloed
- Department of Genetics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - L G Boven
- Department of Genetics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - R H Lekanne Deprez
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A A M Wilde
- Heart Centre, Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J J M Jans
- Department of Genetics, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - J van der Velden
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - R A de Boer
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J P van Tintelen
- Department of Genetics, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - F W Asselbergs
- Netherlands Heart Institute, Utrecht, The Netherlands
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - A F Baas
- Department of Genetics, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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22
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Moynihan KM, Taylor L, Crowe L, Balnaves MC, Irving H, Ozonoff A, Truog RD, Jansen M. Ethical climate in contemporary paediatric intensive care. J Med Ethics 2021; 47:medethics-2020-106818. [PMID: 33431646 DOI: 10.1136/medethics-2020-106818] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
Ethical climate (EC) has been broadly described as how well institutions respond to ethical issues. Developing a tool to study and evaluate EC that aims to achieve sustained improvements requires a contemporary framework with identified relevant drivers. An extensive literature review was performed, reviewing existing EC definitions, tools and areas where EC has been studied; ethical challenges and relevance of EC in contemporary paediatric intensive care (PIC); and relevant ethical theories. We surmised that existing EC definitions and tools designed to measure it fail to capture nuances of the PIC environment, and sought to address existing gaps by developing an EC framework for PIC founded on ethical theory. In this article, we propose a Paediatric Intensive Care Ethical Climate (PICEC) conceptual framework and four measurable domains to be captured by an assessment tool. We define PICEC as the collective felt experience of interdisciplinary team members arising from those factors that enable or constrain their ability to navigate ethical aspects of their work. PICEC both results from and is influenced by how well ethical issues are understood, identified, explored, reflected on, responded to and addressed in the workplace. PICEC encompasses four, core inter-related domains representing drivers of EC including: (1) organisational culture and leadership; (2) interdisciplinary team relationships and dynamics; (3) integrated child and family-centred care; and (4) ethics literacy. Future directions involve developing a PICEC measurement tool, with implications for benchmarking as well as guidance for, and evaluation of, targeted interventions to foster a healthy EC.
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Affiliation(s)
- Katie M Moynihan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Lisa Taylor
- Office of Ethics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Liz Crowe
- Department of Pediatric Intensive Care, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Mary-Claire Balnaves
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Helen Irving
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Centre for Children's Health Ethics and Law, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Al Ozonoff
- Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Robert D Truog
- Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Melanie Jansen
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Pediatric Intensive Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
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23
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Dawson A, Isaacs D, Jansen M, Jordens C, Kerridge I, Kihlbom U, Kilham H, Preisz A, Sheahan L, Skowronski G. An Ethics Framework for Making Resource Allocation Decisions Within Clinical Care: Responding to COVID-19. J Bioeth Inq 2020; 17:749-755. [PMID: 32840833 PMCID: PMC7445717 DOI: 10.1007/s11673-020-10007-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/03/2020] [Indexed: 05/13/2023]
Abstract
On March, 24, 2020, 818 cases of COVID-19 had been reported in New South Wales, Australia, and new cases were increasing at an exponential rate. In anticipation of resource constraints arising in clinical settings as a result of the COVID-19 pandemic, a working party of ten ethicists (seven clinicians and three full-time academics) was convened at the University of Sydney to draft an ethics framework to support resource allocation decisions. The framework guides decision-makers using a question-and-answer format, in language that avoids philosophical and medical technicality. The working party met five times over the following week and then submitted a draft Framework for consideration by two groups of intensivists and one group of academic ethicists. It was also presented to a panel on a national current affairs programme. The Framework was then revised on the basis of feedback from these sources and made publicly available online on April 3, ten days after the initial meeting. The framework is published here in full to stimulate ongoing discussion about rapid development of user-friendly clinical ethics resources in ongoing and future pandemics.
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Affiliation(s)
- Angus Dawson
- Sydney Health Ethics, The University of Sydney, Medical Foundation Building (K25), Sydney, NSW 2006 Australia
| | - David Isaacs
- Sydney Health Ethics, The University of Sydney, Medical Foundation Building (K25), Sydney, NSW 2006 Australia
- The Children’s Hospital Westmead, Sydney, Australia
| | | | - Christopher Jordens
- Sydney Health Ethics, The University of Sydney, Medical Foundation Building (K25), Sydney, NSW 2006 Australia
| | - Ian Kerridge
- Sydney Health Ethics, The University of Sydney, Medical Foundation Building (K25), Sydney, NSW 2006 Australia
- Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Ulrik Kihlbom
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | - Henry Kilham
- Sydney Health Ethics, The University of Sydney, Medical Foundation Building (K25), Sydney, NSW 2006 Australia
- The Children’s Hospital Westmead, Sydney, Australia
| | - Anne Preisz
- Sydney Health Ethics, The University of Sydney, Medical Foundation Building (K25), Sydney, NSW 2006 Australia
- The Sydney Children’s Hospitals Network, Sydney, Australia
| | - Linda Sheahan
- Sydney Health Ethics, The University of Sydney, Medical Foundation Building (K25), Sydney, NSW 2006 Australia
- St George Hospital, Sydney, Australia
- South East Sydney Local Health District, Sydney, Australia
| | - George Skowronski
- Sydney Health Ethics, The University of Sydney, Medical Foundation Building (K25), Sydney, NSW 2006 Australia
- St George Hospital, Sydney, Australia
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24
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Houwen-van Opstal S, van den Elzen Y, Jansen M, Willemsen M, Cup E, de Groot I. DMD & BMD – CLINICAL. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.056] [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: 10/23/2022]
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25
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Meisters R, Westra D, Putrik P, Bosma H, Ruwaard D, Jansen M. Costs of loneliness: the association between loneliness and healthcare expenditure. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1280] [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
Loneliness is a growing issue. It has been associated with a range of unhealthy behaviors, poorer health, and increased morbidity. However, the healthcare costs of loneliness are poorly understood as limited existing research on loneliness focused on older age populations, few expenditure categories, and controlled for just a few potential confounders. Our study aims to fill this evidence gap.
Methods
Multiple sources were combined into a dataset containing a nationally representative sample (n = 341,376) of Dutch adults (>18 y.o.). The association between loneliness and total, general practitioner (GP), specialized, pharmaceutical, and mental healthcare expenditure was tested using Poisson and Zero-inflated negative binomial models, controlling for numerous potential confounders (i.e. demographic, socioeconomic, lifestyle-related factors, self-perceived health, and psychological distress), for multiple age groups. Excess expenditure attributed to loneliness was extrapolated to the entire population.
Results
Controlling for demographic, socioeconomic, and lifestyle-related factors, loneliness was indirectly (via poorer health) associated with higher expenditure in all categories. In fully adjusted models, it showed a direct association with higher expenditure for GP and mental healthcare (0.5% and 11.1%, respectively). The association with mental healthcare expenditure was stronger in younger than in older adults (for ages 19-40, the contribution of loneliness represented 61.8% of the overall association).
Conclusions
Loneliness contributes to health expenditure both directly and indirectly, particularly in younger age groups. This implies a strong financial imperative to address this issue.
Key messages
Loneliness is associated with increased healthcare expenditure independent of demographic and socioeconomic factors. Excess healthcare expenditure related to loneliness are particularly apparent in mental healthcare and in younger age groups.
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Affiliation(s)
- R Meisters
- Health Services Research, CAPHRI, Maastricht University, Maastricht, Netherlands
| | - D Westra
- Health Services Research, CAPHRI, Maastricht University, Maastricht, Netherlands
| | - P Putrik
- Health Services Research, CAPHRI, Maastricht University, Maastricht, Netherlands
- Academic Collaborative Center for Public Health Limburg, GGD Zuid Limburg, Heerlen, Netherlands
| | - H Bosma
- Social Medicine, CAPHRI, Maastricht University, Maastricht, Netherlands
| | - D Ruwaard
- Health Services Research, CAPHRI, Maastricht University, Maastricht, Netherlands
| | - M Jansen
- Health Services Research, CAPHRI, Maastricht University, Maastricht, Netherlands
- Academic Collaborative Center for Public Health Limburg, GGD Zuid Limburg, Heerlen, Netherlands
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26
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Wealleans AL, Buyse J, Scholey D, Van Campenhout L, Burton E, Di Benedetto M, Pritchard S, Nuyens F, Jansen M. Lysolecithin, but not lecithin, improves nutrient digestibility and growth rates in young broilers. Br Poult Sci 2020; 61:414-423. [PMID: 32178525 DOI: 10.1080/00071668.2020.1736514] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/19/2020] [Indexed: 12/12/2022]
Abstract
1. The potential of lecithin and lysolecithin to improve lipid digestion and growth performance was investigated in three experiments: 1. an in vitro model that mimics the intestinal conditions of the chick, 2. a digestibility trial with chicks (5-7 days of age), and 3. a performance trial until 21 days of age. 2. In experiment 1, palm oil (PO), palm oil with lecithin (PO+L), and palm oil with lysolecithin (PO+LY) were subjected to in vitro hydrolysis and applied to Caco-2 monolayers to assess lipid absorption. 3. The in vitro hydrolysis rate of triglycerides was higher in PO+LY (k = 11.76 × 103/min) than in either PO (k = 9.73 × 103/min) or PO+L (k = 8.41 × 103/min), and the absorption of monoglycerides and free fatty acids was highest (P < 0.01) for PO+LY. In experiment 2, 90 broilers were assigned to three dietary treatments: a basal diet with 4% palm oil, and the basal diet supplemented with either 250 ppm lecithin or lysolecithin. 4. ATTD of crude fat was higher in broilers supplemented with lysolecithin, but was lower in broilers supplemented with lecithin. DM digestibility and AMEn in birds supplemented with lysolecithin were significantly higher (3.03% and 0.47 MJ/kg, respectively). 5. In experiment 3, 480 broilers were randomly allocated to four dietary treatments: basal diet with soybean oil (2%), basal diet with lecithin (2%), soybean oil diet with 250 ppm lysolecithin, or lecithin oil diet with 250 ppm lysolecithin. 6. Lecithin diets significantly reduced weight at day 10 and 21 compared with soybean oil. However, the addition of lysolecithin to lecithin-containing diets significantly improved bird performance. 7. The results of these studies showed that, in contrast to lecithin, lysolecithin was able to significantly improve the digestibility and energy values of feed in young broilers.
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Affiliation(s)
- A L Wealleans
- Kemin Animal Health and Nutrtion, Kemin Europa N.V , Herentals, Belgium
| | - J Buyse
- Division Animal and Human Health Engineering, Department of Biosystems, KU Leuven , Geel, Belgium
- Leuven Food Science and Nutrition Research Center (LFoRCe), KU Leuven , Leuven, Belgium
| | - D Scholey
- School of Animal, Rural and Environmental Sciences, Nottingham Trent University , Southwell, UK
| | - L Van Campenhout
- Leuven Food Science and Nutrition Research Center (LFoRCe), KU Leuven , Leuven, Belgium
- Lab4Food, Cluster for Bioengineering Technology (CBeT), Department of Microbial and Molecular Systems (M2S), KU Leuven , Geel, Belgium
| | - E Burton
- School of Animal, Rural and Environmental Sciences, Nottingham Trent University , Southwell, UK
| | - M Di Benedetto
- Kemin Animal Health and Nutrtion, Kemin Europa N.V , Herentals, Belgium
| | | | - F Nuyens
- Kemin Animal Health and Nutrtion, Kemin Europa N.V , Herentals, Belgium
| | - M Jansen
- Kemin Animal Health and Nutrtion, Kemin Europa N.V , Herentals, Belgium
- Division Animal and Human Health Engineering, Department of Biosystems, KU Leuven , Geel, Belgium
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27
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Jansen M, Khandige A, Kobeiter H, Vonken EJ, Hazenberg C, van Herwaarden J. Three Dimensional Visualisation of Endovascular Guidewires and Catheters Based on Laser Light instead of Fluoroscopy with Fiber Optic RealShape Technology: Preclinical Results. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.05.046] [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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Jansen M, Irving H, Gillam L, Sharwood E, Preisz A, Basu S, Delaney C, McDougall R, Johnston C, Isaacs D, Lister P. Ethical considerations for paediatrics during the COVID-19 pandemic: A discussion paper from the Australian Paediatric Clinical Ethics Collaboration. J Paediatr Child Health 2020; 56:847-851. [PMID: 32471008 PMCID: PMC7300784 DOI: 10.1111/jpc.14946] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/03/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Melanie Jansen
- Paediatric Intensive Care UnitChildren's Hospital at WestmeadSydneyNew South WalesAustralia,Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Helen Irving
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,Department of OncologyQueensland Children's HospitalBrisbaneQueenslandAustralia,Centre for Children's Health Ethics and LawChildren's Health QueenslandBrisbaneQueenslandAustralia
| | - Lynn Gillam
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia,Children's Bioethics CentreRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Erin Sharwood
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,Centre for Children's Health Ethics and LawChildren's Health QueenslandBrisbaneQueenslandAustralia,Departments of Endocrinology & OncologyChildren's Health QueenslandBrisbaneQueenslandAustralia
| | - Anne Preisz
- Clinical EthicsSydney Children's Hospital NetworkSydneyNew South WalesAustralia,Sydney Health EthicsUniversity of SydneySydneyNew South WalesAustralia,School of MedicineUniversity of Notre DameNotre DameIndianaUnited States
| | - Shreerupa Basu
- Paediatric Intensive Care UnitChildren's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Clare Delaney
- Children's Bioethics CentreRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Rosalind McDougall
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Carolyn Johnston
- Melbourne Law SchoolUniversity of MelbourneMelbourneVictoriaAustralia
| | - David Isaacs
- Infectious DiseasesChildren's Hospital at WestmeadSydneyNew South WalesAustralia,Paediatrics and Child HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Paula Lister
- Paediatric Critical CareSunshine Coast Hospital and Health ServiceSunshine CoastQueenslandAustralia,School of MedicineGriffith UniversityBrisbaneQueenslandAustralia
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29
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Jansen M, Maschek S, Van Heerwaarden R, Mastbergen S, Wirth W, Lafeber F, Eckstein F. OP0185 KNEE JOINT DISTRACTION IS MORE EFFICIENT IN RESTORING CARTILAGE THICKNESS THAN HIGH TIBIAL OSTEOTOMY IN PATIENTS WITH SEVERE KNEE OSTEOARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Both high tibial osteotomy (HTO) and knee joint distraction (KJD) are joint preserving surgical techniques unloading the affected femorotibial compartment in patients with knee osteoarthritis (OA). While HTO permanently unloads the more affected compartment (MAC) by overcorrecting the leg axis, KJD temporarily unloads the whole joint by separating the tibia and femur for 5 mm for 6 weeks. In a previous randomized controlled trial (RCT), comparable clinical benefit and radiographic joint space width (JSW) increase over 2 years follow-up were demonstrated for both treatments1. Yet, comparison of JSW before and after HTO may be unreliable, as pseudo-widening of the unloaded compartment may occur due to the induced leg axis change. Therefore, direct cartilage thickness measurements need to be compared between KJD and HTO, to accurately evaluate the efficacy of both treatment options on cartilage structure.Objectives:To compare two-year cartilage thickness changes after treatment with KJDvsHTO and identify factors predicting cartilage thickness restoration.Methods:Patients indicated for HTO were randomized to KJD (KJDHTO) or HTO treatment. Patients indicated for total knee arthroplasty received KJD (KJDTKA). Standardized semi-flexed weight-bearing radiographs and 3T MRIs with 3D spoiled gradient recalled imaging sequence with fat suppression (SPGR-fs) were acquired before and two years after surgical treatment. Cartilage thickness in the knee was measured using Chondrometrics Works 3.0 software. On the radiographs the mean JSW in the MAC were measured with KIDA software. Readers were blinded to the type of intervention and acquisition order. The primary and secondary outcomes were the mean MAC cartilage thickness (ThCtAB) and percentage of denuded bone area (dABp) change before and two years after treatment (MRI), with radiographic joint space width (JSW) used as a reference.Results:No statistically significant differences in the baseline characteristics were seen between KJDHTO(n=18) and HTO (n=33). The KJDTKAgroup (n=18) had a higher age and Kellgren-Lawrence grade (KLG) than the HTO and KJDHTOgroups.KJDHTOpatients did not show significant changes in MAC cartilage thickness, dABp, or JSW over time (all p>0.10; figure 1). HTO patients displayed a decrease in MAC cartilage thickness and an increase in dABp (both p<0.03), but an increase in JSW (p=0.006). KJDTKAshowed a significant increase in MAC cartilage thickness and JSW and decrease in dABp (all p<0.01). Baseline OA severity was the strongest predictor of cartilage restoration. KJD patients with severe OA (KJDsevere; KLG ≥3) showed significant restoration (all p<0.01; figure 2); mild OA patients (KJDmild; KLG ≤2) showed a slight deterioration. KJDsevereshowed a significantly greater cartilage restoration response in the MAC than HTOseverefor cartilage thickness (p=0.005) and dABp (p=0.003), but not JSW change (p=0.521). The changes in all three parameters did not differ significantly between KJDmildand HTOmild(all p>0.08).Conclusion:In patients with severe knee OA, KJD is more efficient in restoring cartilage thickness than HTO is. In these patients, KJD causes significant cartilage restoration while HTO, despite shifting the leg axis and demonstrating radiographic joint space widening, shows loss of cartilage as measured on MRI. In patients with mild knee OA, neither HTO nor KJD treatment results in significant cartilage restoration and both treatments show a slight deterioration that is likely the result of natural OA progression. As such, this research promotes the choice KJD as joint-preserving surgery in case of knee OA patients with more severe structural damage.References:[1]MP Jansenet al, Cartilage 2019.Disclosure of Interests:Mylène Jansen: None declared, Susanne Maschek Shareholder of: Stock/stock options at Condrometrics GmbH, Employee of: Employment at Condrometrics GmbH, Ronald Van Heerwaarden: None declared, Simon Mastbergen: None declared, Wolfgang Wirth Shareholder of: Stock/stock options at Condrometrics GmbH, Consultant of: Consultancy to Galapagos NV, Employee of: Employment at Condrometrics GmbH, Floris Lafeber Shareholder of: Co-founder and shareholder of ArthroSave BV, Felix Eckstein Shareholder of: Stock/stock options at Condrometrics GmbH, Consultant of: Consultancy at Merck KGaA, Samumed, Bioclinica, Galapagos, Servier, Novartis, Employee of: Employment at Condrometrics GmbH, Speakers bureau: Development of educational presentations for Medtronic
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Jansen M, Boymans T, Custers R, Van Geenen R, Van Heerwaarden R, Huizinga M, Nellensteijn J, Sollie R, Spruijt S, Mastbergen S. FRI0408 KNEE JOINT DISTRACTION AS TREATMENT FOR OSTEOARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Knee osteoarthritis (OA) is a common cause of invalidity and is often treated with a total knee arthroplasty (TKA). While TKA is cost-effective, reduces pain and improves function, it brings a greater risk of a future revision surgery when performed in younger patients. Knee joint distraction (KJD) is a joint-preserving OA treatment that may postpone TKA and possibly prevent a revision. In the past years, multiple studies have investigated this surgical treatment.Objectives:To evaluate short- and long-term clinical benefit and tissue structure changes after KJD treatment for knee OA.Methods:MEDLINE, EMBASE and Web of Science were searched for eligible clinical studies evaluating a change in at least one of: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Score of pain (VAS-pain), Knee injury and Osteoarthritis Outcome Score (KOOS), EuroQol-5D (EQ5D), radiographic joint space width (JSW) or MRI cartilage thickness after KJD. The primary clinical and structural outcome parameters were the WOMAC and minimum JSW, respectively. Random effects models were applied on all outcome parameters and outcomes were compared with control groups found in the included studies. For continuous data the mean difference (MD) and 95% confidence interval (95%CI) were calculated and for dichotomous data the risk difference and 95%CI, following the Cochrane handbook.Results:In total 11 articles reporting on 7 different KJD cohorts with in total 127 patients and 5 control groups at multiple follow-up moments were included, with 2 of the studies being randomized controlled trials (RCTs). The WOMAC (figure 1) was compared to pre-treatment in 3 cohorts after 1 year (patients n=62) and 2 years (n=59) and in 1 cohort after 5 years (n=20) and 9 years (n=8), showing a significant increase at all time points (all p<0.001). The VAS-pain showed similar results at the same 4 time points, as did the KOOS and EQ5D, which were evaluated only after 1 (n=42) and 2 (n=39) years.The minimum (figure 2) and mean JSW are reported in 3 cohorts after 1 (n=59) and 2 (n=59) years and in 1 cohort after 5 (n=20) and 7 (n=8) years. Both JSW measures were statistically significantly increased after 1 and 2 years, but after 5 and 7 years the JSW increase was no longer statistically significant. Similarly, the MRI cartilage thickness showed an increase at 1 and 2 years, but not at 5 years (all n=20).Complications were reported in 5 studies with 87 patients, with 57 patients developing one or more pin tract skin infections, giving a risk of pin tract infections of 63% (95%CI 45-81), the majority of which could be treated with oral antibiotics. Only a small amount of other complications occurred and were all treated successfully.Overall, clinical and structural outcomes were comparable with control groups, including high tibial osteotomy and TKA as compared after 1 and 2 years in the two RCTs. Apart from pin tract infections, complications were not different in severity and number between control groups and KJD.Conclusion:KJD causes clear benefit in clinical and structural parameters over time, short- and long-term. Although the total number of patients is limited, effect sizes are large. Longer follow-up with more patients is necessary and could improve patient selection for this intensive treatment, while preventing pin tract infections could lighten the patients’ treatment burden. Irrespectively, KJD provides an additional option in joint-preserving treatments for OA and a viable alternative to joint replacement, especially in younger patients.Figure:Disclosure of Interests:Mylène Jansen: None declared, Tim Boymans: None declared, Roel Custers: None declared, Rutger Van Geenen: None declared, Ronald Van Heerwaarden: None declared, Maarten Huizinga: None declared, Jorm Nellensteijn: None declared, Rob Sollie: None declared, Sander Spruijt Consultant of: Consultancy to Zimmer Biomet Inc., Simon Mastbergen: None declared
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Jansen M, Mastbergen S, Watt F, Willemse E, Vincent T, Spruijt S, Emans P, Custers R, Van Heerwaarden R, Lafeber F. FRI0406 CARTILAGE REPAIR ACTIVITY DURING JOINT-PRESERVING TREATMENT MAY BE ACCOMPANIED BY OSTEOPHYTE FORMATION. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Knee joint distraction (KJD) is a joint-preserving treatment to postpone total knee arthroplasty (TKA) and has shown cartilage repair and clinical improvement in patients with severe knee osteoarthritis (OA), as has high tibial osteotomy (HTO). The observed cartilage repair activity could be related to an increase in transforming growth factor-β1 (TGFβ-1), which increases in the synovial fluid (SF) during KJD treatment.1However, animal and ex vivo human studies have shown that TGFβ-1 also induce formation of osteophytes, generally seen as an OA severity hallmark. Similarly, interleukin-6 (IL-6) was observed to increase in SF during KJD treatment and may also be associated with osteophytosis.As such, we hypothesized that joint-preserving regenerative treatments demonstrating cartilage repair activity lead to general tissue (re)generation, including osteophytosis.Objectives:To analyze osteophytosis after KJD and compare this to HTO and natural progression in knee OA.Methods:63 KJD patients were included in several clinical trials, one of which was a randomized controlled trial comparing patients indicated for HTO, but treated with KJD (KJDHTO; n=23) vs. patients treated with HTO (n=46). All patients received standardized radiographs before and one and two years after treatment, used to measure osteophyte size. Only patients with measurements at baseline and two-year follow-up were included. As a control group for natural progression, untreated knee OA patients from Cohort Hip & Cohort Knee (CHECK; n=1002) were studied. Only patients who received a TKA during follow-up were included, using their last two measurements before treatment to reflect natural two-year progression (n=44).A separate group of 20 patients treated with KJD in regular care underwent SF aspirations before and after treatment, and TGFβ-1 and IL-6 levels were measured by immunoassay (Mesoscale Discovery). Unstandardized radiographs were acquired before and one year after treatment, used to score osteophytes with the revised Altman score, resulting in a 0 (normal) to 12 (severe) whole-joint score. Only patients with radiographs and SF aspirations at both baseline and one-year follow-up were included.Results:After two years, both KJD (n=58) and HTO (n=38) patients showed a significant increase in osteophyte size (+6.2mm2 and +7.0mm2 resp.; both p<0.003; figure 1), with no significant differences between the treatments (p>0.38). Untreated CHECK patients who underwent TKA did not show significant two-year osteophyte changes before treatment (+2.1mm2; p=0.207; figure 1) and showed significant differences compared with KJD and HTO groups (both p<0.044). In the KJD SF aspiration group (n=17), the Altman osteophyte score was not different at one year compared to baseline (+0.2 points; p=0.653) and there was no association between baseline biomarker values and the baseline Altman osteophyte score, or between changes in these parameters (all p≥0.28). Trichotomization of patients in groups with a decrease, no change or increase in total Altman osteophyte score indicated that there was a statistically significant difference between the three groups in changes in TGFβ-1 (p=0.044; figure 2A), but not IL-6 (p=0.898; figure 2B).Conclusion:After KJD treatment, joint space widening and clinical improvement are accompanied by osteophytosis. Similar results were observed after treatment with HTO, suggesting effects occur in regenerative joint-preserving treatments in general. The increased osteophytosis may be a bystander effect of cartilage repair activity related to intra-articular factors like TGFβ-1 and questions whether osteophytosis should necessarily be considered a hallmark of OA worsening.References:[1]Watt et al, Osteoarthritis Cartilage 2020Disclosure of Interests:Mylène Jansen: None declared, Simon Mastbergen: None declared, Fiona Watt: None declared, Elske Willemse: None declared, Tonia Vincent Consultant of: Ad hoc consultancy GSK, Mundipharma, UCB, Sander Spruijt Consultant of: Consultancy to Zimmer Biomet Inc., Pieter Emans Shareholder of: Shareholder and cofounder start-up company Chondropeptix, Roel Custers: None declared, Ronald Van Heerwaarden: None declared, Floris Lafeber Shareholder of: Co-founder and shareholder of ArthroSave BV
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Jansen M, Struik T, Mastbergen S, Custers R. FRI0407 USER-FRIENDLINESS OF A NOVEL DEDICATED KNEE JOINT DISTRACTION DEVICE: EXPERIENCES FROM CLINICAL PRACTICE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Knee joint distraction (KJD) is a validated surgical technique that aims to postpone arthroplasty for a prolonged time in younger knee osteoarthritis (OA) patients (<65 years). In absence of dedicated devices intended for KJD, this procedure has thus far been performed with general purpose external fixation devices.1The demonstrated clinical benefits of KJD raised a clinical demand for a dedicated device (DD), including a desire for increased user-friendliness and decreased treatment burden. As such, in a multi-disciplinary setting with clinicians, patients, and medical device experts, several desired device characteristics were determined. These included perpendicular positioning of bone pins relative to the longitudinal tibia axis, surgery time < 45 minutes, no protruding parts above the most proximal and below the most distal bone pins, and pin tracts that are accessible for pin tract care. Based on the desired characteristics, a dedicated distraction device was developed and made available for clinical application.Objectives:To compare user-friendliness between the developed DD and previously used concept device (CD) used in regular care.Methods:Patients were treated with either the CD (n=22) or DD (n=22) in clinical practice. For both devices, the surgical technique was identical: fixation to the tibia and femur with 8 bone pins (figure 1) and 5 mm distraction for 6 weeks. The intervention duration when placing the device (defined as time between first incision and the surgeon being finished) was registered for all patients. After treatment, patients were asked to fill out a custom questionnaire about user-friendliness of the device during treatment, consisting of 25 questions on difficulties performing activities regarding clothing, sleeping, device care, daily activities, movement and complications. Intervention duration was compared between groups using an independent t-test while for questionnaire answers Mann Whitney U tests were used. Chi-square tests were used when comparing (complication) occurrences between groups.Results:Intervention duration was on average shorter for the DD (44 vs 56 minutes; p<0.001). 34 Patients (16 CD, 18 DD) completed the questionnaire. Patient user-friendliness of the DD was higher rated for 6 questions (all p<0.05), and similar to the CD for the remaining questions (all p>0.01). Besides advantages in daily living activities with the use of the DD, also less pin tract infections were registered with this device (88% of patients with CD vs 56% with DD). Results of all questions are provided in figure 1. Three patients who were treated with both devices (left and right knee, separately and subsequently) generally rated the DD similar to be or slightly better than the CD.Conclusion:The dedicated KJD device provides user-friendly equipment for clinicians and patients, as indicated by the shorter intervention duration and patient questionnaire outcomes, and contributes to further implementation of KJD as treatment for end-stage knee OA.References:[1]MP Jansenet al, PLOS ONE 2020Disclosure of Interests:Mylène Jansen: None declared, Thijmen Struik Employee of: Employment by ArthroSave BV, Simon Mastbergen: None declared, Roel Custers: None declared
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Warrillow S, Austin D, Cheung W, Close E, Holley A, Horgan B, Jansen M, Joynt G, Lister P, Moodie S, Nichol A, Nicholls M, Peake S, Skowronski G, Streat S, White B, Willmott L. ANZICS guiding principles for complex decision making during the COVID-19 pandemic. CRIT CARE RESUSC 2020; 22:98-102. [PMID: 32294810 PMCID: PMC10692461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The global 2019 coronavirus disease (COVID-19) pandemic has led to major challenges in clinical decision making when the demand for intensive care exceeds local capacity. In order to promote consistent, transparent, objective and ethical decision making, the Australian and New Zealand Intensive Care Society (ANZICS) formed a committee to urgently develop guidelines outlining key principles that should be utilised during the pandemic. This guidance is intended to support the practice of intensive care specialists during the COVID-19 pandemic and to promote the development of local admission policies that should be endorsed by health care organisations and relevant local authorities.
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Affiliation(s)
- Stephen Warrillow
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia.
| | - Danielle Austin
- Intensive Care Unit, Liverpool Hospital, Sydney, NSW, Australia
| | - Winston Cheung
- Intensive Care Unit, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Eliana Close
- Faculty of Law, Queensland University of Technology, Brisbane, QLD, Australia
| | - Anthony Holley
- Department of Intensive Care, Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - Ben Horgan
- Western Australian Health Translation Network, Perth, WA, Australia
| | - Melanie Jansen
- Department of Intensive Care, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Gavin Joynt
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong, China
| | - Paula Lister
- Department of Paediatric Critical Care, Sunshine Coast Hospital and Health Service, Sunshine Coast, QLD, Australia
| | - Stewart Moodie
- Department of Intensive Care, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Alistair Nichol
- Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia
| | - Mark Nicholls
- Department of Intensive Care, St Vincent's Hospital, Sydney, NSW, Australia
| | - Sandra Peake
- Department of Intensive Care Medicine, Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - George Skowronski
- Department of Intensive Care Medicine, St George Hospital, Sydney, NSW, Australia
| | | | - Ben White
- Faculty of Law, Queensland University of Technology, Brisbane, QLD, Australia
| | - Lindy Willmott
- Faculty of Law, Queensland University of Technology, Brisbane, QLD, Australia
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van Dalen ASHM, Jansen M, van Haperen M, van Dieren S, Buskens CJ, Nieveen van Dijkum EJM, Bemelman WA, Grantcharov TP, Schijven MP. Implementing structured team debriefing using a Black Box in the operating room: surveying team satisfaction. Surg Endosc 2020; 35:1406-1419. [PMID: 32253558 PMCID: PMC7886753 DOI: 10.1007/s00464-020-07526-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/26/2020] [Indexed: 11/27/2022]
Abstract
Background Surgical safety may be improved using a medical data recorder (MDR) for the purpose of postoperative team debriefing. It provides the team in the operating room (OR) with the opportunity to look back upon their joint performance objectively to discuss and learn from suboptimal situations or possible adverse events. The aim of this study was to investigate the satisfaction of the OR team using an MDR, the OR Black Box®, in the OR as a tool providing output for structured team debriefing. Methods In this longitudinal survey study, 35 gastro-intestinal laparoscopic operations were recorded using the OR Black Box® and the output was subsequently debriefed with the operating team. Prior to study, a privacy impact assessment was conducted to ensure alignment with applicable legal and regulatory requirements. A structured debrief model and an OR Back Box® performance report was developed. A standardized survey was used to measure participant’s satisfaction with the team debriefing, the debrief model used and the performance report. Factor analysis was performed to assess the questionnaire’s quality and identified contributing satisfaction factors. Multivariable analysis was performed to identify variables associated with participants’ opinions. Results In total, 81 team members of various disciplines in the OR participated, comprising 35 laparoscopic procedures. Mean satisfaction with the OR Black Box® performance report and team debriefing was high for all 3 identified independent satisfaction factors. Of all participants, 98% recommend using the OR Black Box® and the outcome report in team debriefing. Conclusion The use of an MDR in the OR for the purpose of team debriefing is considered to be both beneficial and important. Team debriefing using the OR Black Box® outcome report is highly recommended by 98% of team members participating. Electronic supplementary material The online version of this article (10.1007/s00464-020-07526-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A S H M van Dalen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M Jansen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M van Haperen
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S van Dieren
- Clinical Research Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C J Buskens
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E J M Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - T P Grantcharov
- International Centre for Surgical Safety, St Michael's Hospital, Toronto, Canada
| | - M P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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Jansen M, Boymans T, Custers R, Van Geenen R, Van Heerwaarden R, Huizinga M, Nellensteijn J, Sollie R, Spruijt S. Knee joint distraction as treatment for osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2020. [DOI: 10.1016/j.joca.2020.02.602] [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: 02/19/2023]
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Warrillow S, Austin D, Cheung W, Close E, Holley A, Horgan B, Jansen M, Joynt G, Lister P, Moodie S, Nichol A, Nicholls M, Peake S, Skowronski G, Streat S, White B, Willmott L. ANZICS guiding principles for complex decision making during the COVID-19 pandemic. CRIT CARE RESUSC 2020. [DOI: 10.51893/2020.2.sa1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The global 2019 coronavirus disease (COVID-19) pandemic has led to major challenges in clinical decision making when the demand for intensive care exceeds local capacity. In order to promote consistent, transparent, objective and ethical decision making, the Australian and New Zealand Intensive Care Society (ANZICS) formed a committee to urgently develop guidelines outlining key principles that should be utilised during the pandemic. This guidance is intended to support the practice of intensive care specialists during the COVID-19 pandemic and to promote the development of local admission policies that should be endorsed by health care organisations and relevant local authorities.
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Maconachie S, Jansen M, Cottle E, Roy J, Ross B, Winearls J, George S. Viscoelastic haemostatic assays and fibrinogen in paediatric acute traumatic coagulopathy: A comprehensive review. Emerg Med Australas 2020; 32:313-319. [PMID: 32153133 DOI: 10.1111/1742-6723.13484] [Citation(s) in RCA: 4] [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: 09/10/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Haemorrhage in paediatric trauma remains a significant cause of morbidity and mortality. Over recent years there has been increasing attention to the role of fibrinogen in traumatic haemorrhage and the association of low fibrinogen levels with poor patient outcomes. In addition, there has been a move towards using viscoelastic haemostatic assays (VHAs) to rapidly assess coagulation status and guide clinicians in the replacement of coagulation factors, including fibrinogen. In the paediatric population, there has been limited uptake of these principles and a paucity of data to support a change in practice. This paper summarises the available evidence in the published literature through a systematic review, presented in narrative format. RESULTS There is limited high-quality prospective data on the use of VHA in the management of acute traumatic coagulopathy in the paediatric population. While the use of fibrinogen early in major haemorrhage is becoming standard practice, there are currently no randomised prospective studies comparing fibrinogen concentrate to cryoprecipitate. CONCLUSIONS The early identification of hypo-fibrinogenemia and acute traumatic coagulopathy in paediatric trauma using VHA testing and subsequent early fibrinogen replacement with a concentrated off the shelf product is an attractive treatment option. However, there is currently insufficient high-level evidence to support the use of fibrinogen concentrate over cryoprecipitate in the paediatric trauma population. Pilot studies currently under way will go some way to addressing this important knowledge gap, and facilitate the design of larger definitive multi-centre randomised trials.
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Affiliation(s)
- Sharon Maconachie
- Department of Anaesthesia, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Melanie Jansen
- Department of Anaesthesia, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Paediatric Intensive Care Unit, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Emma Cottle
- Mental Health Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - John Roy
- Department of Anaesthesia, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Department of Haematology, Pathology Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Bryony Ross
- Department of Haematology, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - James Winearls
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Intensive Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Shane George
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Intensive Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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Huijbregts KML, Grobbink LH, Jansen M, Verhoeven EJ, van Dijk FE. [Monitoring with four recovery phases. First experiences in FACT]. Tijdschr Psychiatr 2020; 62:385-392. [PMID: 32484567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Following an audit, the flexible assertive community treatment-teams (FACT-teams), in Winterswijk, the Netherlands, set out to discover a more recovery-oriented approach to treatment and monitoring. Their findings support researching four recovery phases described previously.<br/> AIM: A pilot-study to investigate the possibilities to create a more recovery-oriented working method by applying the four recovery phases - ranging from being overwhelmed by the condition to living past the condition - in FACT-teams.<br/> METHOD: The FACT-teams started to monitor patients during the recovery phases and developed a semi-structured interview that can be used to determine the current recovery phase. After the phase has been determined, a plan is written on how to progress to the next phase.<br/> RESULTS: Monitoring during the recovery phases proved to be useful in showing both succesfull and stagnating treatments. The recovery phases also became part of the standard treatment plans in the electronic patient dossier. An important result of this project was the recovery-oriented interview we developed.<br/> CONCLUSION: Monitoring and interviewing based on the four recovery phases subjectively leads to more in-depth and more recovery-oriented evaluations of treatment. More empirical research into this method is necessary.
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Abstract
Abstract
Background
As coordination issues arise in an increasingly complex health domain with a growing number of stakeholders involved in health initiatives, WHO proposed a transformation towards a Whole of Society approach. However, this abstract approach lacks practical guidelines to tackle these issues. In domains such as the environmental policy sector, similar transformations were established by applying governance strategies. This study aims to answer, which conditions and arrangements are found in the governance literature for the coordination and evaluation of the transformation of health towards a Whole of Society approach?
Methods
A systematic search was conducted by combining ’governance’, with adjectives as ’collaborative’, ’adaptive’, ’experimentalist’ and ’reflexive’ in order to target relevant governance theories in JStor, Web of Science, EBSCO and Google Scholar. Based on inclusion criteria two reviewers independently selected articles following PRISMA.
Results
Analysis of 56 articles showed that transformation should be coordinated by stimulating favourable conditions such as learning and experimenting in networks that cut across traditional boundaries. These conditions and methods can be divided into three categories. First, establish collaborations with government as equal partner by making the inclusion and decision-making process open and transparent. Second, stimulating innovation by engaging local initiatives, and supporting learning, experimentation, reflection and adaptation. Third, ensuring the sustainability of innovation by enabling institutional change.
Conclusions
To coordinate and evaluate the transformation of health towards a Whole of Society approach, conditions may consist of a combination of collaboration, innovation and institutional change.
Key messages
To bring together the fragmented resources for public health, we present emerging conditions for the coordination of a Whole of Society approach as transformative governance strategy. The transformative capacity of governance can be found in the combination of the theories as adjectives: collaborative, adaptive, experimentalist and reflexive.
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Affiliation(s)
- F Schreurs
- Health Services Research, Maastricht University, Maastricht, Netherlands
| | - M P M Bekker
- Maatschappijwetenschappen, Wageningen University, Wageningen, Netherlands
| | - J K Helderman
- Public Administration & Political Science, Radboud University, Nijmegen, Netherlands
| | - M Jansen
- Health Services Research, Maastricht University, Maastricht, Netherlands
| | - D Ruwaard
- Health Services Research, Maastricht University, Maastricht, Netherlands
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Wealleans AL, Jansen M, di Benedetto M. The addition of lysolecithin to broiler diets improves growth performance across fat levels and sources: a meta-analysis of 33 trials. Br Poult Sci 2019; 61:51-56. [DOI: 10.1080/00071668.2019.1671955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - M. Jansen
- Kemin Animal Health and Nutrition, Herentals, Belgium
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Schoenaker R, Kamsteeg E, Rodenburg R, Van Engelen B, Jansen M, Saris C. P.63Chronic progressive external ophthalmoplegia (CPEO) and CPEO-plus cohort of 54 patients from the Netherlands. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rauwerdink A, Jansen M, de Borgie CAJM, Bemelman WA, Daams F, Schijven MP, Buskens CJ. Improving enhanced recovery after surgery (ERAS): ERAS APPtimize study protocol, a randomized controlled trial investigating the effect of a patient-centred mobile application on patient participation in colorectal surgery. BMC Surg 2019; 19:125. [PMID: 31477107 PMCID: PMC6719362 DOI: 10.1186/s12893-019-0588-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/19/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Perioperative care in colorectal surgery is systematically defined in the Enhanced Recovery After Surgery (ERAS) protocol. The ERAS protocol improves perioperative care in a multimodal way to enhance early and safe release from the hospital. Adequate compliance to the elements of the ERAS protocol is multifactorial. There are still opportunities to improve compliance of the protocol by actively involving the patient. The main objective of this study is to investigate whether compliance of selected items in the ERAS protocol can be improved through actively involving patients in the ERAS care pathway through the use of a patient-centred mobile application. METHODS A multicentre randomized controlled trial will be conducted. Patients undergoing elective colorectal surgery, who are 18 years or older and in possession of an eligible smartphone, will be included. Patients assigned to the intervention group will install a patient-centred mobile application to be guided through the ERAS care pathway. Patients in the control group will receive care as usual. Both groups will wear an activity tracker. The primary outcome is overall compliance to selected active elements of the ERAS protocol, as registered by the patient. Secondary outcomes include Patient Reported Outcome Measures (PROMs) such as health-related quality of life, physical activity, and patient satisfaction of received care. Care-related outcomes, such as length of hospital stay, number of complications, re-intervention, and readmission rates, will also be assessed. RESULTS The enrolment of patients will start in the second quarter of 2019. Data collection had not begun by the time this protocol was submitted. CONCLUSION We hypothesize that by providing patients with a patient-centred mobile application, compliance to the active elements of ERAS protocol can be improved, resulting in an increased health-related quality of life, physical activity, and patient satisfaction. TRIAL REGISTRATION Netherlands Trial Register, NTR7314 , prospectively registered on the 9th of November 2017 ( http://www.trialregister.nl ).
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Affiliation(s)
- A. Rauwerdink
- Department of surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - M. Jansen
- Department of surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - C. A. J. M. de Borgie
- Clinical Research Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - W. A. Bemelman
- Department of surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - F. Daams
- Department of surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - M. P. Schijven
- Department of surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - C. J. Buskens
- Department of surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
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Santamaría-Pérez D, Daisenberger D, Ruiz-Fuertes J, Marqueño T, Chulia-Jordan R, Muehle C, Jansen M, Rodriguez-Hernandez P, Muñoz A, Johnson ER, Otero-de-la-Roza A. Gold(i) sulfide: unusual bonding and an unexpected computational challenge in a simple solid. Chem Sci 2019; 10:6467-6475. [PMID: 31341598 PMCID: PMC6610519 DOI: 10.1039/c9sc00371a] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/22/2019] [Accepted: 05/19/2019] [Indexed: 11/23/2022] Open
Abstract
We report the experimental high-pressure crystal structure and equation of state of gold(i) sulfide (Au2S) determined using diamond-anvil cell synchrotron X-ray diffraction. Our data shows that Au2S has a simple cubic structure with six atoms in the unit cell (four Au in linear, and two S in tetrahedral, coordination), no internal degrees of freedom, and relatively low bulk modulus. Despite its structural simplicity, Au2S displays very unusual chemical bonding. The very similar and relatively high electronegativities of Au and S rule out any significant metallic or ionic character. Using a simple valence bond (Lewis) model, we argue that the Au2S crystal possesses two different types of covalent bonds: dative and shared. These bonds are distributed in such a way that each Au atom engages in one bond of each kind. The multiple arrangements in space of dative and shared bonds are degenerate, and the multiplicity of configurations imparts the system with multireference character, which is highly unusual for an extended solid. The other striking feature of this system is that common computational (DFT) methods fail quite spectacularly to describe it, with 20% and 400% errors in the equilibrium volume and bulk modulus, respectively. We explain this by the poor treatment of static correlation in common density-functional approximations. The fact that the solid is structurally very simple, yet presents unique chemical bonding and is unmodelable using current DFT methods, makes it an interesting case study and a computational challenge.
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Affiliation(s)
- D Santamaría-Pérez
- Departamento de Física Aplicada-ICMUV , Universidad de Valencia , MALTA Consolider Team , Edificio de Investigación, C/Dr Moliner 50, E-46100 Burjassot , Valencia , Spain .
| | | | - J Ruiz-Fuertes
- DCITIMAC , Universidad de Cantabria , Avenida de Los Castros 48 , 39005 Santander , Spain
| | - T Marqueño
- Departamento de Física Aplicada-ICMUV , Universidad de Valencia , MALTA Consolider Team , Edificio de Investigación, C/Dr Moliner 50, E-46100 Burjassot , Valencia , Spain .
| | - R Chulia-Jordan
- Departamento de Física Aplicada-ICMUV , Universidad de Valencia , MALTA Consolider Team , Edificio de Investigación, C/Dr Moliner 50, E-46100 Burjassot , Valencia , Spain .
| | - C Muehle
- Max Planck Institute for Solid State Research , Heisenbergstrasse 1 , 70569 Stuttgart , Germany
| | - M Jansen
- Max Planck Institute for Solid State Research , Heisenbergstrasse 1 , 70569 Stuttgart , Germany
| | - P Rodriguez-Hernandez
- Departamento de Física , Instituto de Materiales y Nanotecnología , Universidad de La Laguna , MALTA Consolider Team , E-38206 La Laguna , Tenerife , Spain
| | - A Muñoz
- Departamento de Física , Instituto de Materiales y Nanotecnología , Universidad de La Laguna , MALTA Consolider Team , E-38206 La Laguna , Tenerife , Spain
| | - Erin R Johnson
- Department of Chemistry , Dalhousie University , 6274 Coburg Road , Halifax , Nova Scotia , Canada B3H 4R2
| | - A Otero-de-la-Roza
- Departamento de Química Física y Analítica , Facultad de Química , Universidad de Oviedo , 33006 Oviedo , Spain .
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Erkelens GJ, Bourfiss M, Jansen M, Baas AF, Asselbergs FW, Velthuis BK. 337Value of feature tracking cardiovascular magnetic resonance imaging in detecting genotype-positive hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez122.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G J Erkelens
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - M Bourfiss
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - M Jansen
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - A F Baas
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - F W Asselbergs
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - B K Velthuis
- University Medical Center Utrecht, Utrecht, Netherlands (The)
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45
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Sammani A, Jansen M, Linschoten M, Bagheri A, de Jonge N, Kirkels H, van Laake LW, Vink A, van Tintelen JP, Dooijes D, Te Riele ASJM, Harakalova M, Baas AF, Asselbergs FW. UNRAVEL: big data analytics research data platform to improve care of patients with cardiomyopathies using routine electronic health records and standardised biobanking. Neth Heart J 2019; 27:426-434. [PMID: 31134468 PMCID: PMC6712144 DOI: 10.1007/s12471-019-1288-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Despite major advances in our understanding of genetic cardiomyopathies, they remain the leading cause of premature sudden cardiac death and end-stage heart failure in persons under the age of 60 years. Integrated research databases based on a large number of patients may provide a scaffold for future research. Using routine electronic health records and standardised biobanking, big data analysis on a larger number of patients and investigations are possible. In this article, we describe the UNRAVEL research data platform embedded in routine practice to facilitate research in genetic cardiomyopathies. Design Eligible participants with proven or suspected cardiac disease and their relatives are asked for permission to use their data and to draw blood for biobanking. Routinely collected clinical data are included in a research database by weekly extraction. A text-mining tool has been developed to enrich UNRAVEL with unstructured data in clinical notes. Preliminary results Thus far, 828 individuals with a median age of 57 years have been included, 58% of whom are male. All data are captured in a temporal sequence amounting to a total of 18,565 electrocardiograms, 3619 echocardiograms, data from over 20,000 radiological examinations and 650,000 individual laboratory measurements. Conclusion Integration of routine electronic health care in a research data platform allows efficient data collection, including all investigations in chronological sequence. Trials embedded in the electronic health record are now possible, providing cost-effective ways to answer clinical questions. We explicitly welcome national and international collaboration and have provided our protocols and other materials on www.unravelrdp.nl.
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Affiliation(s)
- A Sammani
- Department of Cardiology, Division Heart & Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands.
| | - M Jansen
- Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - M Linschoten
- Department of Cardiology, Division Heart & Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - A Bagheri
- Department of Cardiology, Division Heart & Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands.,Department of Methodology and Statistics, Faculty of Social Sciences, University of Utrecht, Utrecht, The Netherlands
| | - N de Jonge
- Department of Cardiology, Division Heart & Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - H Kirkels
- Department of Cardiology, Division Heart & Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - L W van Laake
- Department of Cardiology, Division Heart & Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - A Vink
- Department of Pathology, Division of Pathology, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - J P van Tintelen
- Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - D Dooijes
- Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - A S J M Te Riele
- Department of Cardiology, Division Heart & Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - M Harakalova
- Department of Cardiology, Division Heart & Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands.,Department of Pathology, Division of Pathology, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - A F Baas
- Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - F W Asselbergs
- Department of Cardiology, Division Heart & Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK.,Health Data Research UK London and Institute of Health Informatics, University College London, London, UK
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46
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Ricotti V, Selby V, Ridout D, Domingos J, Decostre V, Mayhew A, Eagle M, Butler J, Guglieri M, Van der Holst M, Jansen M, Verschuuren JJGM, de Groot IJM, Niks EH, Servais L, Straub V, Voit T, Hogrel JY, Muntoni F. Respiratory and upper limb function as outcome measures in ambulant and non-ambulant subjects with Duchenne muscular dystrophy: A prospective multicentre study. Neuromuscul Disord 2019; 29:261-268. [PMID: 30852071 DOI: 10.1016/j.nmd.2019.02.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 12/17/2018] [Revised: 02/05/2019] [Accepted: 02/08/2019] [Indexed: 11/19/2022]
Abstract
The field of translational research in Duchenne muscular dystrophy (DMD) has been transformed in the last decade by a number of therapeutic targets, mostly studied in ambulant patients. A paucity of studies focus on measures that capture the non-ambulant stage of the disease, and the transition between the ambulant and non-ambulant phase. In this prospective natural history study, we report the results of a comprehensive assessment of respiratory, upper limb function and upper limb muscle strength in a group of 89 DMD boys followed in 3 European countries, 81 receiving corticosteroids, spanning a wide age range (5-18 years) and functional abilities, from ambulant (n = 60) to non-ambulant (n = 29). Respiratory decline could be detected in the early ambulatory phase using Peak Expiratory Flow percentage predicted (PEF%), despite glucocorticoid use (mean annual decline: 4.08, 95% CI [-7.44,-0.72], p = 0.02 in ambulant; 4.81, 95% CI [-6.79,-2.82], p < 0.001 in non-ambulant). FVC% captured disease progression in non-ambulant DMD subjects, with an annual loss of 5.47% (95% CI [-6.48,-4.45], p < 0.001). Upper limb function measured with the Performance of Upper Limb (PUL 1.2) showed an annual loss of 4.13 points (95% CI [-4.79,3.47], p < 0.001) in the non-ambulant cohort. Measures of upper limb strength (MyoGrip and MyoPinch) showed a continuous decline independent of the ambulatory status, when reported as percentage predicted (grip force -5.51%, 95% CI [-6.54,-4.48], p < 0.001 in ambulant and a slower decline -2.86%; 95% CI -3.29,-2.43, p < 0.001, in non-ambulant; pinch force: -2.66%, 95% CI [-3.82,-1.51], p < 0.001 in ambulant and -2.23%, 95% CI [-2.92,-1.53], p < 0.001 in non-ambulant). Furthermore, we also explored the novel concept of a composite endpoint by combining respiratory, upper limb function and force domains: we were able to identify clear clinical progression in patients in whom an isolated measurement of only one of these domains failed to appreciate the yearly change. Our study contributes to the field of natural history of DMD, linking the ambulant and non-ambulant phases of the disease, and suggests that composite scores should be explored further.
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Affiliation(s)
- V Ricotti
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, University College London, London, UK; Solid Biosciences, London, UK.
| | - V Selby
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, University College London, London, UK; Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, London, UK
| | - D Ridout
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, University College London, London, UK; Population, Policy and Practice Program, UCL Great Ormond Street Institute of Child Health, London, UK
| | - J Domingos
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, London, UK
| | - V Decostre
- Groupe Hospitalier Pitié Salpêtrière, Institut de Myologie, Paris, France
| | - A Mayhew
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle, UK
| | - M Eagle
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle, UK
| | - J Butler
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, London, UK
| | - M Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle, UK
| | | | - M Jansen
- Department of Rehabilitation, Donders Centre of Neuroscience, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | - I J M de Groot
- Department of Rehabilitation, Donders Centre of Neuroscience, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - E H Niks
- Leiden University Medical Centre, Leiden, The Netherlands
| | - L Servais
- Groupe Hospitalier Pitié Salpêtrière, Institut de Myologie, Paris, France
| | - V Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle, UK
| | - T Voit
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, University College London, London, UK; Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, London, UK
| | - J Y Hogrel
- Groupe Hospitalier Pitié Salpêtrière, Institut de Myologie, Paris, France
| | - F Muntoni
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, University College London, London, UK; Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, London, UK.
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Shannon G, Jansen M, Williams K, Cáceres C, Motta A, Odhiambo A, Eleveld A, Mannell J. Gender equality in science, medicine, and global health: where are we at and why does it matter? Lancet 2019; 393:560-569. [PMID: 30739691 DOI: 10.1016/s0140-6736(18)33135-0] [Citation(s) in RCA: 217] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/26/2018] [Accepted: 12/03/2018] [Indexed: 11/25/2022]
Abstract
The purpose of this Review is to provide evidence for why gender equality in science, medicine, and global health matters for health and health-related outcomes. We present a high-level synthesis of global gender data, summarise progress towards gender equality in science, medicine, and global health, review the evidence for why gender equality in these fields matters in terms of health and social outcomes, and reflect on strategies to promote change. Notwithstanding the evolving landscape of global gender data, the overall pattern of gender equality for women in science, medicine, and global health is one of mixed gains and persistent challenges. Gender equality in science, medicine, and global health has the potential to lead to substantial health, social, and economic gains. Positioned within an evolving landscape of gender activism and evidence, our Review highlights missed and future opportunities, as well as the need to draw upon contemporary social movements to advance the field.
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Affiliation(s)
- Geordan Shannon
- Centre for Gender and Global Health, Institute for Global Health, University College London, London, UK.
| | - Melanie Jansen
- Paediatric Intensive Care Unit and Centre for Children's Health Ethics and Law, Children's Health Queensland, Brisbane, QLD, Australia
| | | | - Carlos Cáceres
- Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angelica Motta
- Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Jenevieve Mannell
- Centre for Gender and Global Health, Institute for Global Health, University College London, London, UK
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48
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Jansen M, van der Meulen C. [Working with courage and trust]. Ned Tijdschr Geneeskd 2018; 162:D3579. [PMID: 30570943] [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: 06/09/2023]
Abstract
Diminished trust in professionals has resulted in professional pain among many of them. Professionals feel obstructed by external stakeholders such as policymakers and insurance companies who do not understand the reality in which professionals work. Protests by professionals against this type of disciplining have been diminishing for a long time, and some professionals have even collaborated with these stakeholders. In many professions, this has resulted in so-called 'voluntary servitude'. For instance, it has been stated that the majority of professionals in health care deviate from their standards of professional behaviour to a greater or lesser degree. This attitude of distrust towards professionals unjustly injures their professional pride. In this paper the concept of professional pride is explained and the authors argue why this is crucial for good healthcare.
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Affiliation(s)
- M Jansen
- Stichting Beroepseer, Culemborg
- Contact: M. Jansen
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Abstract
In recent decades, evidence-based medicine has become one of the foundations of clinical practice, making it necessary that healthcare practitioners develop keen critical appraisal skills for scientific papers. Worksheets to guide clinicians through this critical appraisal are often used in journal clubs, a key part of continuing medical education. A similar need is arising for health professionals to develop skills in the critical appraisal of medical ethics papers. Medicine is increasingly ethically complex, and there is a growing medical ethics literature that modern practitioners need to be able to use in their practice. In addition, clinical ethics services are commonplace in healthcare institutions, and the lion's share of the work done by these services is done by clinicians in addition to their usual roles. Education to support this work is important. In this paper, we present a worksheet designed to help busy healthcare practitioners critically appraise ethics papers relevant to clinical practice. In the first section, we explain what is different about ethics papers. We then describe how to work through the steps in our critical appraisal worksheet: identifying the point at issue; scrutinising definitions; dissecting the arguments presented; considering counterarguments; and finally deciding on relevance. Working through this reflective worksheet will help healthcare practitioners to use the ethics literature effectively in clinical practice. We also intend it to be a shared evaluative tool that can form the basis of professional discussion such as at ethics journal clubs. Practising these critical reasoning skills will also increase practitioners' capacity to think through difficult ethical decisions in daily clinical practice.
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Affiliation(s)
- Melanie Jansen
- Paediatric Intensive Care Unit & Centre for Children’s Health Ethics and Law, Children’s Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Peter Ellerton
- Faculty of Humanities and Social Sciences, University of Queensland, Brisbane, Queensland, Australia
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50
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Stuij W, Jansen M, de Groot I. DUCHENNE MUSCULAR DYSTROPHY – IMAGING AND BIOMARKERS. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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