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Cardwell K, Clyne B, Broderick N, Tyner B, Masukume G, Larkin L, McManus L, Carrigan M, Sharp M, Smith SM, Harrington P, Connolly M, Ryan M, O'Neill M. Lessons learnt from the COVID-19 pandemic in selected countries to inform strengthening of public health systems: a qualitative study. Public Health 2023; 225:343-352. [PMID: 37979311 DOI: 10.1016/j.puhe.2023.10.024] [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: 05/18/2023] [Revised: 09/11/2023] [Accepted: 10/10/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has prompted governments internationally to consider strengthening their public health systems. To support the work of Ireland's Public Health Reform Expert Advisory Group, the Health Information and Quality Authority, an independent governmental agency, was asked to describe the lessons learnt regarding the public health response to COVID-19 internationally and the applicability of this response for future pandemic preparedness. METHODS Semi-structured interviews with key public health representatives from nine countries were conducted. Interviews were conducted in March and April 2022 remotely via Zoom and were recorded. Notes were taken by two researchers, and a thematic analysis undertaken. RESULTS Lessons learnt from the COVID-19 pandemic related to three main themes: 1) setting policy; 2) delivering public health interventions; and 3) providing effective communication. Real-time surveillance, evidence synthesis, and cross-sectoral collaboration were reported as essential for policy setting; it was noted that having these functions established prior to the pandemic would lead to a more efficient implementation in a health emergency. Delivering public health interventions such as testing, contact tracing, and vaccination were key to limiting and or mitigating the spread of the SARS-CoV-2 virus. However, a number of challenges were highlighted such as staff capacity and burnout, delays in vaccination procurement, and reduced delivery of regular healthcare services. Clear, consistent, and regular communication of the scientific evidence was key to engaging citizens with mitigation strategies. However, these communication strategies had to compete with an infodemic of information being circulated, particularly through social media. CONCLUSIONS Overall, functions relating to policy setting, public health interventions, and communication are key to pandemic response. Ideally, these should be established in the preparedness phase so that they can be rapidly scaled-up during a pandemic.
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Affiliation(s)
- K Cardwell
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - B Clyne
- Department of Public Health & Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - N Broderick
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - B Tyner
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - G Masukume
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - L Larkin
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - L McManus
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Carrigan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Sharp
- Department of Public Health & Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - S M Smith
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | - P Harrington
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Connolly
- School of Medicine, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
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Benson R, Rigby J, Brunsdon C, Corcoran P, Dodd P, Ryan M, Cassidy E, Colchester D, Hawton K, Lascelles K, de Leo D, Crompton D, Kõlves K, Leske S, Dwyer J, Pirkis J, Shave R, Fortune S, Arensman E. Real-Time Suicide Surveillance: Comparison of International Surveillance Systems and Recommended Best Practice. Arch Suicide Res 2023; 27:1312-1338. [PMID: 36237124 DOI: 10.1080/13811118.2022.2131489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Some countries have implemented systems to monitor suicides in real-time. These systems differ because of the various ways in which suicides are identified and recorded. The main objective of this study was to conduct an international comparison of major real-time suicide mortality surveillance systems to identify joint strengths, challenges, and differences, and thereby inform best-practice criteria at local, national, and international levels. METHODS Five major real-time suicide mortality surveillance systems of various coverage levels were identified and selected for review via an internet-based scoping exercise and prior knowledge of existing systems. Key information including the system components and practices was collated from those organizations that developed and operate each system using a structured template. The information was narratively and critically synthesized to determine similarities and differences between the systems. RESULTS The comparative review of the five established real-time suicide surveillance systems revealed more commonalities than differences overall. Commonalities included rapid, routine surveillance based on minimal, provisional data to facilitate timely intervention and postvention efforts. Identified differences include the timeliness of case submission and system infrastructure. CONCLUSION The recommended criteria could promote replicable components and practices in real-time suicide surveillance while offering flexibility in adapting to regional/local circumstances and resource availability.HIGHLIGHTSEvidence-informed recommendations for current best practice in real-time suicide surveillance.Proposed comprehensive framework can be adapted based on available resources and capacity.Real-time suicide mortality data facilitates rapid data-driven decision-making in suicide prevention.
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Miller MA, Ballard J, Feld H, Ryan M. Learning with, about, and from COVID-19: An interprofessional global comparison of pandemic responses. Curr Pharm Teach Learn 2023; 15:829-835. [PMID: 37482496 DOI: 10.1016/j.cptl.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/13/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND AND PURPOSE University of Kentucky developed a fully virtual course to educate global health learners about the COVID-19 pandemic and compare country responses to it. EDUCATIONAL ACTIVITY AND SETTING Forty-three students participated in 13 weeks of synchronous interprofessional group meetings via Zoom (Zoom Video Communications, Inc) and asynchronous modules. Interprofessionality was intentional yet implicit, and a flipped classroom was utilized. Assessment was accomplished with one instrument measuring learning outcomes associated with select Consortium of Universities of Global Health Interprofessional Global Health Competencies, Association of American Colleges and Universities Global Learning Value Rubric competencies, and course satisfaction and effectiveness utilizing a retrospective pre-/post-methodology. FINDINGS Positive pre-/post-change was observed in 10 survey items. Evaluation results concerning course structure and experience were uniformly high, with the key informant interview rated most helpful. Items with significant improvement included a better understanding of the student's place in the world; improved interprofessional communication skills; population health data skills; and understanding of health systems and entities that influence global health and development. Learners appreciated the value of interprofessional teamwork and gained a deeper understanding of the roles and training of colleagues from other programs, leading to a deeper understanding of the actions those professions may take within health systems. SUMMARY The pivot to all online global health education was a viable solution to addressing the pause in global travel and study abroad experiences at University of Kentucky.
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Affiliation(s)
- Madeline Aulisio Miller
- Health and Exercise Science Program, Transylvania University, 300 North Broadway, Lexington, KY 40508, United States.
| | - James Ballard
- Center for Interprofessional and Community Health Education, University of Kentucky College of Medicine, 138 Leader Avenue, Lexington, KY 40508, United States.
| | - Hartley Feld
- University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536, United States.
| | - Melody Ryan
- University of Kentucky College of Pharmacy, 789 South Limestone Street, Lexington, KY 40508, United States.
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Ankeny RA, Whittaker AL, Ryan M, Boer J, Plebanski M, Tuke J, Spencer SJ. The power of effective study design in animal Experimentation: Exploring the statistical and ethical implications of asking multiple questions of a data set. Brain Behav Immun 2023:S0889-1591(23)00156-3. [PMID: 37315700 DOI: 10.1016/j.bbi.2023.06.012] [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] [Received: 02/27/2023] [Revised: 05/31/2023] [Accepted: 06/10/2023] [Indexed: 06/16/2023] Open
Abstract
One of the chief advantages of using highly standardised biological models including model organisms is that multiple variables can be precisely controlled so that the variable of interest is more easily studied. However, such an approach often obscures effects in sub-populations resulting from natural population heterogeneity. Efforts to expand our fundamental understanding of multiple sub-populations are in progress. However, such stratified or personalised approaches require fundamental modifications of our usual study designs that should be implemented in Brain, Behavior and Immunity (BBI) research going forward. Here we explore the statistical feasibility of asking multiple questions (including incorporating sex) within the same experimental cohort using statistical simulations of real data. We illustrate and discuss the large explosion in sample numbers necessary to detect effects with appropriate power for every additional question posed using the same data set. This exploration highlights the strong likelihood of type II errors (false negatives) for standard data and type I errors when dealing with complex genomic data, where studies are too under-powered to appropriately test these interactions. We show this power may differ for males and females in high throughput data sets such as RNA sequencing. We offer a rationale for the use of alternative experimental and statistical strategies based on interdisciplinary insights and discuss the real-world implications of increasing the complexities of our experimental designs, and the implications of not attempting to alter our experimental designs going forward.
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Affiliation(s)
- R A Ankeny
- School of Humanities, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - A L Whittaker
- School of Animal and Veterinary Sciences, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - M Ryan
- School of Computer and Mathematical Sciences, University of Adelaide, Adelaide, South Australia 5005, Australia; Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Australia
| | - J Boer
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria 3083, Australia
| | - M Plebanski
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria 3083, Australia
| | - J Tuke
- School of Computer and Mathematical Sciences, University of Adelaide, Adelaide, South Australia 5005, Australia; Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Australia
| | - S J Spencer
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria 3083, Australia.
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Harmer V, Harbeck N, Boyle F, Werutsky G, Ammendolea C, El Mouzain D, Marshall D, Thomas C, Heidenreich S, Lu H, Dionne PA, Gao M, Aubel D, Pathak P, Ryan M. P263 Patients’ perspectives on treatments for HR+/HER2– early breast cancer: developing a quantitative patient preference survey. Breast 2023. [DOI: 10.1016/s0960-9776(23)00381-8] [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: 03/15/2023] Open
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Ryan M, Tuke J, Hutchinson MR, Spencer SJ. Gender-specific effects of COVID-19 lockdowns on scientific publishing productivity: Impact and resilience. Soc Sci Med 2023; 320:115761. [PMID: 36780736 PMCID: PMC9896855 DOI: 10.1016/j.socscimed.2023.115761] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023]
Abstract
RATIONALE The SARS-CoV2 pandemic led to drastic social restrictions globally. Early data suggest that women in science have been more adversely affected by these lockdowns than men, with relatively fewer scientific articles authored by women. However, these observations test broad populations with many potential causes of disparity. Australia presents a natural experimental condition where several states of similar demographics and disease impact had differing approaches in their social isolation strategies. The state of Victoria experienced 280 days of lockdowns from 2020 to 2021, whereas the comparable state of New South Wales experienced 107 days, most of these in 2021, and other states even fewer restrictions. OBJECTIVE AND METHODS To assess how the gender balance changed in Australian biomedical publishing with the lockdowns, we created a custom workflow to analyse PubMed data from more than 120,000 published articles submitted in 2019-2021 from Australian authors. RESULTS Broadly, Australian women have been incredibly resilient to the challenges faced by the lockdowns. There was an increase in the number of published articles submitted in 2020 that was equally due to women as men, including from Victoria. On the other hand, articles specifically addressing COVID-19 were significantly less likely to be authored by women than those on other topics, a finding not likely due to particular gender imbalance in virology or viral epidemiology, since publications on HIV followed similar patterns to previous years. By 2021, this imbalance had reversed, with more COVID-19-related papers authored by women than men. CONCLUSIONS These data suggest women from Victoria were less able to rapidly transition to new research early in the pandemic but had accommodated to the new conditions by 2021. This work indicates we need strategies to support women in science as the pandemic continues and to continue to monitor the situation for its impact on vulnerable groups.
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Affiliation(s)
- M Ryan
- School of Mathematical Sciences, University of Adelaide, Adelaide, South Australia, 5005, Australia; Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Australia
| | - J Tuke
- School of Mathematical Sciences, University of Adelaide, Adelaide, South Australia, 5005, Australia; Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Australia
| | - M R Hutchinson
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, 5005, Australia; Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, Australia; Davies Livestock Research Centre, University of Adelaide, South Australia, 5005, Australia; Institute for Photonics & Advanced Sensing, University of Adelaide, South Australia, 5005, Australia; Robinson Research Institute, University of Adelaide, South Australia, 5005, Australia
| | - S J Spencer
- Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, Australia; School of Health and Biomedical Sciences, RMIT University, Melbourne, Vic, 3083, Australia.
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Ryan M, Morella K, Boan A, Key J, Head K. Evaluating equity in participation within a comprehensive school based wellness initiative amongst schools from different resource settings. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00744-9] [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: 01/28/2023]
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8
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Ryan M, Boan A, Morella K, Key J, Head K. The impact of the COVID-19 pandemic on implementation and maintenance of an evidence-$$$based school wellness initiative. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00738-3] [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: 01/28/2023]
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9
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Ryan M, Hoffmann T, Hofmann R, van Sluijs E. Incomplete reporting of activity behaviour interventions in school-based research: a systematic review of randomised controlled trials published 2015-2020. J Sci Med Sport 2022. [DOI: 10.1016/j.jsams.2022.09.099] [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: 11/17/2022]
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10
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Boyle O, Kelly L, Whelan C, Murtagh E, O'Dwyer A, Ryan M, Hill F, McCabe A, Hayden D. 251 PREVALENCE AND CHARACTERISTICS OF SWALLOWING/COMMUNICATION IMPAIRMENTS IN FRAIL OLDER ADULTS ATTENDING THE EMERGENCY DEPARTMENT: A RETROSPECTIVE COHORT STUDY. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.220] [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: 11/15/2022] Open
Abstract
Abstract
Background
The presentation of frail older adults to the Emergency Department (ED) may be complicated by swallowing and/or communication impairment. Adults with communication impairment may experience difficulty accessing healthcare. Dysphagia is associated with frailty irrespective of age and/or number of chronic diseases [1]. This study aims to determine the prevalence and characteristics of swallowing and/or communication impairments among frail older adults attending the ED.
Methods
A retrospective cohort study of consecutive ED attendees aged ≥ 75 years assessed by an interdisciplinary Gerontological ED team between October 2021 – February 2022 was conducted. A swallow/communication screening tool determined requirement for Speech and Language Therapy (SLT) referral. Data related to demographics and SLT interventions was extracted. Data analysis was completed using STATA Version 12. Ethical approval was obtained.
Results
Among 518 patients, 118 (23%) (mean age 82.4 (+/-6.4) years, 54% male) required SLT assessment. These patients had high rates of frailty (Median CFS= 6 (IQR 5-7), suspected delirium (4AT ≥ 4 in 45%), suspected malnutrition (MNA score 0-11 in 75%), and probable sarcopenia (SARC-F= ≥ 4 in 75%). Therapy Outcome Measurement Scales and the Functional Oral Intake Scale were used in this first episode of SLT care. Oropharyngeal dysphagia was identified for 43% (27% mild, 10% moderate, 3% moderate-severe, 3% severe), with 6% presenting with signs/symptoms of oesophageal dysphagia. Changes in baseline communication was identified for 57%; cognitive communication difficulties (38%), dysarthria (11%), dysphonia (8%). SLT intervention and management approaches were initiated in the ED.
Conclusion
Findings indicate a high prevalence of swallowing/communication impairment in frail older adults attending the ED. Future research should explore SLT outcomes at point of discharge to refine these swallowing/communication presentations.
Reference
1. Bahat G et al. Association between dysphagia and frailty in community-dwelling older adults. The Journal of Nutrition, Health & Ageing. 2019:23, 571–577.
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Affiliation(s)
- O Boyle
- Tallaght University Hospital Department of Speech and Language Therapy, , Tallaght, Dublin 24, Ireland
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
| | - L Kelly
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
| | - C Whelan
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
| | - E Murtagh
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
| | - A O'Dwyer
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
| | - M Ryan
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
| | - F Hill
- Tallaght University Hospital Department of Speech and Language Therapy, , Tallaght, Dublin 24, Ireland
| | - A McCabe
- Tallaght University Hospital Department of Emergency Medicine, , Tallaght, Dublin 24, Ireland
| | - D Hayden
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
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Mahon CM, Ryan M, Kennelly SM, Martin R. 204 DEDICATED NURSING HOME SERVICE IN A TERTIARY HOSPITAL: EFFECT ON ADMISSION NUMBERS AND LENGTH OF STAY. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.176] [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
In 2019 a dedicated Nursing Home (NH) in-patient service was established in a tertiary hospital, comprising a Consultant Geriatrician, clinical nurse specialist, NCHD and administrative support. All NH residents over 65 with medical diagnoses were admitted by the NH team who also provide a consult service for NH residents under other specialties.
Methods
Data were sourced from the Hospital Inpatient Enquiry system on length of stay of patients identified as admitted from a nursing home compared to those admitted under the NH team and their average lengths of stay over 2019-2021.
Results
In 2019, 749 NH residents were admitted to hospital with an average length of stay (ALOS) of 7.93 days, the NH inpatient service was established in July 2019 and showed a reduction of ALOS from 9.25 to 6.6 days in the 6 months following its establishment (29% difference.) In 2020, 707 NH residents were admitted with 352 admitted under the NH team. The ALOS of NH residents admitted under the NH team was 5.66 days in 2020 compared to 8.65 overall (35% difference.) In 2021, 765 NH residents were admitted with 402 under the NH team. ALOS of NH residents admitted under the NH team was 5.33 days in 2021 compared to 8.28 overall (36% difference.)
Conclusion
Within six months of its commencement the dedicated NH service had decreased length of stay by 29%. The average length of stay across all services has decreased year on year from 6.6 to 5.3 days from 2019 to 2021. The ALOS in the total cohort (including residents admitted surgically and those under 65) was 29-36% higher. Though difficult to accurately compare these cohorts due to different presenting diagnoses and medical backgrounds in those admitted surgically or those under 65, the overall reduction in length of stay over the three years does highlight the benefit from this dedicated service.
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Affiliation(s)
- CM Mahon
- Connolly Hospital, Blanchardstown , Dublin, Ireland
| | - M Ryan
- Connolly Hospital, Blanchardstown , Dublin, Ireland
| | - SM Kennelly
- Royal College of Surgeons Ireland , Dublin, Ireland
| | - R Martin
- Connolly Hospital, Blanchardstown , Dublin, Ireland
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Cardwell K, Broderick N, Tyner B, Masukume G, Harrington P, Connolly M, Larkin L, Clyne B, Ryan M, O'Neill M. High level review of configuration and reform of Public Health systems in selected countries. Eur J Public Health 2022. [PMCID: PMC9594392 DOI: 10.1093/eurpub/ckac129.206] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The impact of the COVID-19 pandemic has prompted governments internationally to consider reform and strengthening of their Public Health systems. To support this work in Ireland, we undertook a review Public Health systems internationally (research question [RQ] 1), and identified lessons learned from the COVID-19 pandemic (RQ2). Methods Data relating to Public Health systems (RQ1), and lessons learned (RQ2) for a select group of 12 countries were identified from organisations’ websites, an electronic database and grey literature search and representatives from key national-level organisations. Data for RQ1 were extracted, mapped to the 12 Essential Public Health functions (EPHFs) at national, regional and local levels, and verified by participating representatives. For RQ2, thematic analysis of semi-structured interviews with participating representatives was undertaken and. Results Typically, across all included countries, there is national strategic oversight of all EPHFs and, for certain functions, there is regional and local level implementation. Lessons learned from the COVID-19 pandemic broadly related to the themes of legislation and decision making; data collection, surveillance, evidence synthesis and collaboration; public health interventions; public participation, public messaging and communication; continuation of healthcare services; and workforce capacity and resilience. Conclusions When structuring Public Health systems, there is a need to identify which functions, and or which elements of a function, should be delivered at a national, regional or local level to ensure a sustainable and comprehensive Public Health system. Appropriate IT infrastructure, strong communication and an established evidence synthesis function are key to timely and informed decision making. Ideally, these functions should be established during periods of relative stability to permit a faster response during a pandemic or emergency situation.
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Affiliation(s)
- K Cardwell
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - N Broderick
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - B Tyner
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - G Masukume
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - P Harrington
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - M Connolly
- School of Medicine, National University of Ireland Galway , Galway, Ireland
| | - L Larkin
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - B Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences , Dublin, Ireland
| | - M Ryan
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
- Department of Pharmacology and Therapeutics, Trinity College Dublin , Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
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Norris M, Carty P, McDowell C, O’Loughlin M, Comaskey F, Jingjing J, Harrington P, Ryan M, O'Neill M. Organisational perspectives on Public Health delivery in Ireland: Lessons learned from COVID-19. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The COVID-19 pandemic has placed healthcare systems worldwide under unprecedented pressure, with the Irish Public Health system no different. To strengthen delivery of Essential Public Health Functions (EPHFs) and increase future pandemic preparedness, Public Health leaders are now focused on identifying learnings from the pandemic. Within Ireland, given their experience, organisations situated within the Public Health system may be in a unique position to provide valuable information around the delivery of EPHFs, both prior to and in light of the COVID-19 pandemic, and how this can be improved in the future.
Methods
An online survey was distributed by the Department of Health, from 2 March 2022 to 25 March 2022, amongst organisations situated within the Public Health domain in Ireland. The survey consisted of six open-ended questions around the delivery of EPHFs prior to and in light of the pandemic, success stories that could provide scalable solutions to EPHF delivery and current health system barriers, key areas in the public health system that require strengthening, and barriers to achieving these actions. Thematic analysis to identify key themes was conducted on survey responses.
Results
Twenty-eight organisational responses were received. Themes around the workforce were apparent throughout, with staff training, staff diversity and staff morale, identified as areas for strengthening EPHF delivery. Themes around ICT, data collection and research were frequently identified with a lack of adequate ICT identified as a key lesson from the pandemic, while the Public Health ICT strategy was identified as key to strengthening future EPHF delivery.
Conclusions
In general, themes around the workforce; leadership, management and governance and ICT, data collection and research were reoccurring across organisational responses and therefore may be key areas for consideration when strengthening delivery of the EPHFs in Ireland.
Speakers/Panelist
Louise Hendricks
Department of Health, Ireland
Sohel Saikat
WHO, Geneva, Switzerland
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Affiliation(s)
- M Norris
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - P Carty
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - C McDowell
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - M O’Loughlin
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
- Department of Public Health, Health Service Executive Midwest , Limerick, Ireland
| | - F Comaskey
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - J Jingjing
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - P Harrington
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - M Ryan
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
- Department of Pharmacology and Therapeutics, Trinity College Dublin , Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
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Ryan M, Morgan H, O'Gallagher K, Demir O, Rahman H, Ellis H, Dancy L, Sado D, Strange J, Melikian N, Marber M, Shah A, De Silva K, Chiribiri A, Perera D. Coronary wave energy to predict functional recovery in patients with ischemic left ventricular dysfunction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2013] [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: 11/15/2022] Open
Abstract
Abstract
Background
Invasive coronary angiography and non-invasive viability testing are the cornerstones of diagnosing and managing ischemic left ventricular dysfunction. At present there is no single test which serves both needs but, if developed, could revolutionise investigation of this condition. Coronary wave intensity analysis (cWIA) interrogates both contractility and microvascular physiology of the subtended myocardium [1,2] and therefore has the potential to fulfil this goal.
Objectives
We hypothesized that cWIA measured during coronary angiography would predict functional recovery with a similar accuracy to late gadolinium enhanced cardiac magnetic resonance imaging (LGE-CMR).
Methods
Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. cWIA, fractional flow reserve and microvascular resistance were assessed with a simultaneous coronary Doppler and pressure-sensing guidewire during cardiac catheterization at rest, during hyperaemia and during low-dose dobutamine stress. Viability was assessed using LGE-CMR. Regional left ventricular function was assessed at baseline and 6-month follow up after optimization of medical therapy +/− revascularization, using transthoracic echocardiography. The primary outcome was regional functional recovery.
Results
Forty participants underwent baseline physiology, LGE-CMR and thirty had echocardiography at baseline and 6 months; 21/42 territories demonstrated functional recovery. Resting backward compression wave energy was significantly greater in recovering than non-recovering territories (−5240±3772 vs. −1873±1605 W m–2 s–1, p=0.099, Figure 1), and had comparable diagnostic accuracy to CMR (area under the curve 0.812 vs. 0.757, p=0.649, Figure 2); a threshold of −2500 W mm–2 s–1 had 86% sensitivity and 76% specificity at predicting recovery. Backward expansion wave energy did not predict recovery. FFR was numerically higher in recovering territories (0.81±0.17 vs. 0.71±0.16, p=0.058), whilst hyperaemic microvascular resistance did not differentiate recovering from non-recovering territories (1.97±0.73 vs. 2.29±1.00, p=0.287). The likelihood of functional recovery was similar in revascularised and non-revascularised territories (15/29 vs. 6/13 respectively, p=0.739). Low-dose dobutamine stress increased the energy of all waves, but did not improve the accuracy of cWIA in predicting recovery. In a regression model, resting backward compression wave energy and optimization of medical therapy predicted functional recovery; fractional flow reserve and hyperemic microvascular resistance did not.
Conclusions
Backward compression wave energy has similar accuracy to LGE-CMR in the prediction of functional recovery. cWIA has the potential to revolutionise the management of ischaemic left ventricular dysfunction, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The British Heart Foundation Clinical Research Training Fellowship
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Affiliation(s)
- M Ryan
- King's College London , London , United Kingdom
| | - H Morgan
- King's College London , London , United Kingdom
| | | | - O Demir
- King's College London , London , United Kingdom
| | - H Rahman
- King's College London , London , United Kingdom
| | - H Ellis
- King's College London , London , United Kingdom
| | - L Dancy
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - D Sado
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - J Strange
- Bristol Heart Institute , Bristol , United Kingdom
| | - N Melikian
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - M Marber
- King's College London , London , United Kingdom
| | - A Shah
- King's College London , London , United Kingdom
| | - K De Silva
- King's College London , London , United Kingdom
| | - A Chiribiri
- King's College London , London , United Kingdom
| | - D Perera
- King's College London , London , United Kingdom
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Kirschner J, Crawford T, Ryan M, Finkel R, Swoboda K, De Vivo D, Bertini E, Hwu H, Sansone V, Pechmann A, Montes J, Krasinski D, Chin R, Berger Z, Zhu C, Raynaud S, Paradis A, Johnson N. VP.51 Impact of nusinersen on caregiver experience and health-related quality of life (HRQoL) when initiated in the presymptomatic stage of SMA in NURTURE. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.205] [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: 11/05/2022]
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16
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Day J, Finkel R, Pascual S, Ryan M, Mercuri E, De Vivo D, Montes J, Gurgel-Giannetti J, Gambino G, Makepeace C, Foster R, Irzhevsky V, Berger Z. FP.22 Results from the end of Part A of the ongoing 3-part DEVOTE study to explore higher doses of nusinersen in SMA. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.181] [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: 11/05/2022]
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17
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Benson R, Brunsdon C, Rigby J, Corcoran P, Ryan M, Cassidy E, Dodd P, Hennebry D, Arensman E. The development and validation of a dashboard prototype for real-time suicide mortality data. Front Digit Health 2022; 4:909294. [PMID: 36065333 PMCID: PMC9440192 DOI: 10.3389/fdgth.2022.909294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/28/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction/Aim Data visualisation is key to informing data-driven decision-making, yet this is an underexplored area of suicide surveillance. By way of enhancing a real-time suicide surveillance system model, an interactive dashboard prototype has been developed to facilitate emerging cluster detection, risk profiling and trend observation, as well as to establish a formal data sharing connection with key stakeholders via an intuitive interface. Materials and Methods Individual-level demographic and circumstantial data on cases of confirmed suicide and open verdicts meeting the criteria for suicide in County Cork 2008–2017 were analysed to validate the model. The retrospective and prospective space-time scan statistics based on a discrete Poisson model were employed via the R software environment using the “rsatscan” and “shiny” packages to conduct the space-time cluster analysis and deliver the mapping and graphic components encompassing the dashboard interface. Results Using the best-fit parameters, the retrospective scan statistic returned several emerging non-significant clusters detected during the 10-year period, while the prospective approach demonstrated the predictive ability of the model. The outputs of the investigations are visually displayed using a geographical map of the identified clusters and a timeline of cluster occurrence. Discussion The challenges of designing and implementing visualizations for suspected suicide data are presented through a discussion of the development of the dashboard prototype and the potential it holds for supporting real-time decision-making. Conclusions The results demonstrate that integration of a cluster detection approach involving geo-visualisation techniques, space-time scan statistics and predictive modelling would facilitate prospective early detection of emerging clusters, at-risk populations, and locations of concern. The prototype demonstrates real-world applicability as a proactive monitoring tool for timely action in suicide prevention by facilitating informed planning and preparedness to respond to emerging suicide clusters and other concerning trends.
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Affiliation(s)
- R. Benson
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, WHO Collaborating Centre for Surveillance and Research in Suicide Prevention, Cork, Ireland
- Correspondence: Ruth Benson
| | - C. Brunsdon
- National Centre for Geocomputation, National University of Ireland Maynooth, Maynooth, Ireland
| | - J. Rigby
- National Centre for Geocomputation, National University of Ireland Maynooth, Maynooth, Ireland
| | - P. Corcoran
- National Suicide Research Foundation, WHO Collaborating Centre for Surveillance and Research in Suicide Prevention, Cork, Ireland
| | - M. Ryan
- Cork Kerry Community Health Services, Health Service Executive, Cork, Ireland
| | - E. Cassidy
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | - P. Dodd
- National Office for Suicide Prevention, Health Service Executive, Dublin, Ireland
| | - D. Hennebry
- Cork Kerry Community Health Services, Health Service Executive, Cork, Ireland
| | - E. Arensman
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, WHO Collaborating Centre for Surveillance and Research in Suicide Prevention, Cork, Ireland
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18
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Coghill S, Chaffee VD, Ryan M. Qualitative Thematic Analysis of Pharmacy Student Blogs for International Advanced Pharmacy Practice Experiences. Am J Pharm Educ 2022; 86:8673. [PMID: 34785494 PMCID: PMC10159427 DOI: 10.5688/ajpe8673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 10/08/2021] [Indexed: 05/06/2023]
Abstract
Objective. The primary objective of this study was to gain an understanding of student pharmacist learning that occurs during international advanced pharmacy practice experiences (APPEs). The secondary objective was to direct the development of suitable predeparture orientation activities for pharmacy students.Methods. University of Kentucky College of Pharmacy students authored blogs between 2012 and 2019 describing patient care and non-patient care international APPEs. This study utilized inductive thematic analysis to analyze the blogs and define codes, categories, and themes from the data set. The entire data set was used to generate changes to an orientation program delivered to students before they study abroad (predeparture orientation).Results. The analysis included 47 blogs from which seven pictorial codes and 24 text codes were isolated to ultimately form four categories: Learning About Health Care; My Surroundings; Logistics; and Me, Myself, and I. Two overall themes emerged from the codes and categories: Everything Is Different and Here's What I Think and Feel. Through examining the data and reviewing other studies focusing on study abroad experiences, the results indicate that the themes isolated in this study parallel previously described benefits of studying abroad. Additionally, analysis of the blogs suggested that expanding the predeparture orientation for students and including follow-up discussions may facilitate student understanding prior to travel.Conclusion. This study gives unique insight into thoughts and the relative importance of pharmacy students' experiences while studying abroad. The resulting data, considered along with previously published studies, can guide educators in refining predeparture materials. Further studies are needed to evaluate the effectiveness of revised predeparture orientation.
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Affiliation(s)
- Stephanie Coghill
- Advocate Lutheran General Hospital
- University of Kentucky, College of Pharmacy
| | - Valerie D Chaffee
- Cancer and Hematology Centers of Western Michigan
- University of Kentucky Healthcare
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Mercer KJ, Moga D, Fleming S, Carrión C, Ryan M. Evaluation of anemia in communities served by Shoulder to Shoulder Global: a cross-sectional study in Santo Domingo, Ecuador. Journal of Global Health Reports 2022. [DOI: 10.29392/001c.34230] [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: 11/08/2022] Open
Abstract
Background Shoulder to Shoulder Global (STSG) recognizes anemia as a cause of morbidity among patients in Santo Domingo, Ecuador. Little research has been done to assess targetable anemia risk factors to serve as a foundation for future pharmacotherapeutic interventions. This study sought to characterize anemia in this population to lay the foundation for future preventive intervention. Methods Cross-sectional data obtained from existing clinic records from 2010 to 2016 included hemoglobin/hematocrit, age, sex, pregnancy status, and respective community. Chi-square compared means to examine risk factors associated with anemia. Logistic regression and odds ratios (OR) were used to estimate risk factors associated with anemia. Results Of the 1145 (86.2%) subjects with complete data for analysis, 67.2% were female, 33% were children under five, 1.6% were pregnant, and 42.8% were anemic. Subjects were distributed throughout the seven communities with 11.2% presenting from an indigenous community. Risk factors for anemia were age <5 years and presenting from the communities of Plan de Vivienda, Los Naranjos, or El Bua. Neither sex nor pregnancy were significantly associated risk factors with anemia. Conclusions Risk factors for anemia in this population have not previously been determined. In this study, risk factors were age group <5 years and presentation from three different communities. This study pioneered the use of an electronic medical record database in this setting. A limitation of the study is its observational cross-sectional design with a study population that allows for selection bias. Additional research should evaluate the effectiveness of STSG health interventions on anemia.
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Affiliation(s)
- Kevin J Mercer
- University of Kentucky College of Public Health, Lexington, Kentucky, USA
| | - Daniela Moga
- University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
| | - Steven Fleming
- University of Kentucky College of Public Health, Lexington, Kentucky, USA
| | | | - Melody Ryan
- University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
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20
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O'Donovan T, McNulty J, Ryan M. PO-1856 Artificial intelligence: the opinions of radiation therapists in Ireland. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03819-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Berman M, Ali A, Macklam D, Garcia Saez D, Jothidasan A, Husain M, Stock U, Mehta V, Venkateswaran R, Curry P, Messer S, Mukadam M, Mascaro J, Clarke S, Baxter J, Tsui S, Large S, Osman M, Kaul P, Boda G, Jenkins D, Simmonds J, Quigley R, Whitney J, Gardiner D, Watson C, Rubino A, Currie I, Foley J, Macleod A, Slater C, Marley F, Downward L, Rushton S, Armstrong L, Ayton L, Ryan M, Parker M, Gibson S, Spence S, Quinn K, Watson S, Forsythe J. UK National DCD Heart Transplant Program - First Year Experience. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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22
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Moser F, Todoran T, Ryan M, Baker E, Gunnarsson C, Kellum J. Hemorrhagic Transformation Rates following Contrast Media Administration in Patients Hospitalized with Ischemic Stroke. AJNR Am J Neuroradiol 2022; 43:381-387. [PMID: 35144934 PMCID: PMC8910803 DOI: 10.3174/ajnr.a7412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/21/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Hemorrhagic transformation is a critical complication associated with ischemic stroke and has been associated with contrast media administration. The objective of our study was to use real-world in-hospital data to evaluate the correlation between contrast media type and transformation from ischemic to hemorrhagic stroke. MATERIALS AND METHODS We obtained data on inpatient admissions with a diagnosis of ischemic stroke and a record of either iso-osmolar or low-osmolar iodinated contrast media for a stroke-related diagnostic test and a treatment procedure (thrombectomy, thrombolysis, or angioplasty). We performed multivariable regression analysis to assess the relationship between contrast media type and the development of hemorrhagic transformation during hospitalization, adjusting for patient characteristics, comorbid conditions, procedure type, a threshold for contrast media volume, and differences across hospitals. RESULTS Inpatient visits with exclusive use of either low-osmolar (n = 38,130) or iso-osmolar contrast media (n = 4042) were included. We observed an overall risk reduction in hemorrhagic transformation among patients who received iso-osmolar compared with low-osmolar contrast media, with an absolute risk reduction of 1.4% (P = .032), relative risk reduction of 12.5%, and number needed to prevent harm of 70. This outcome was driven primarily by patients undergoing endovascular thrombectomy (n = 9211), in which iso-osmolar contrast media was associated with an absolute risk reduction of 4.6% (P = .028), a relative risk reduction of 20.8%, and number needed to prevent harm of 22, compared with low-osmolar contrast media. CONCLUSIONS Iso-osmolar contrast media was associated with a lower rate of hemorrhagic transformation compared with low-osmolar contrast media in patients with ischemic stroke.
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Affiliation(s)
- F.G. Moser
- From the Department of Imaging (F.G.M.), Cedars-Sinai Medical Center, Los Angeles, California
| | - T.M. Todoran
- Divisions of Cardiology and Vascular Surgery, Medical University of South Carolina (T.M.T.), Charleston, South Carolina
| | - M. Ryan
- MPR Consulting (M.R.), Cincinnati, Ohio
| | - E. Baker
- CTI Clinical Trial & Consulting Services (E.B., C.G.), Covington, Kentucky
| | - C. Gunnarsson
- CTI Clinical Trial & Consulting Services (E.B., C.G.), Covington, Kentucky
| | - J.A. Kellum
- Center for Critical Care Nephrology (J.A.K.), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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23
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Niyongere J, Welty TE, Bell MW, Consalvo D, Hammond C, Leung H, Patsalos PN, Ryan M, Suansanae T, Zhou D, Zuellig H. Barriers to Generic Antiseizure Medication Use: Results of a Global Survey by the International League Against Epilepsy Generic Substitution Task Force. Epilepsia Open 2022; 7:260-270. [PMID: 35124903 PMCID: PMC9159248 DOI: 10.1002/epi4.12583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/20/2022] Open
Abstract
The objective of this study was to identify and quantify barriers to generic substitution of antiseizure medications (ASM). A questionnaire on generic ASM substitution was developed by the International League Against Epilepsy (ILAE) Task Force on Generic Substitution. Questions addressed understanding of bioequivalence, standards for generic products, experiences with substitution, and demographic data. The survey was web‐based and distributed to ILAE chapters, their membership, and professional colleagues of task force members. Comparisons in responses were between ILAE regions and country income classification. A total of 800 individuals responded, with 44.2% being from the Asia‐Oceania ILAE Region and 38.6% from European Region. The majority of respondents had little or no education in generic substitution or bioequivalence. Many respondents indicated lack of understanding aspects of generic substitution. Common barriers to generic substitution included limited access, poor or inconsistent quality, too expensive, or lack of regulatory control. Increase in seizures was the most common reported adverse outcome of substitution. Of medications on the World Health Organization Essential Medication list, problems with generic products were most frequent with carbamazepine, lamotrigine, and valproic acid. Several barriers with generic substitution of ASM revolved around mistrust of regulatory control and quality of generic ASM. Lack of education on generic substitution is also a concern. Generic ASM products may be the only option in some parts of the world and efforts should address these issues. Efforts to address these barriers should improve access to medications in all parts of the world.
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Affiliation(s)
- Jenna Niyongere
- MercyOne Des Moines, Doctor of Pharmacy student, College of Pharmacy and Health Sciences at Drake University, Iowa, USA
| | - Timothy E Welty
- College of Pharmacy and Health Sciences, Drake University Des Moines, Iowa, USA
| | - Michelle W Bell
- Columbia University Irving Medical Center, Columbia University, New York City, New York, USA
| | - Damian Consalvo
- Epilepsy Section, Ramos Mejía Hospital, University of Buenos Aires, Institute of Neurology and Neurosurgery, Sanatorio de Los Arcos, Buenos Aires, Argentina
| | - Charles Hammond
- Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Howan Leung
- The Chinese University of Hong Kong, Hong Kong, China
| | - Philip N Patsalos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, England
| | - Melody Ryan
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Thanarat Suansanae
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Dong Zhou
- Sichuan University, Chengdu, Sichuan, China, Department of Neurosciences, College of Medicine, San Beda University, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Hazel Zuellig
- Sichuan University, Chengdu, Sichuan, China, Department of Neurosciences, College of Medicine, San Beda University, College of Public Health, University of the Philippines Manila, Manila, Philippines
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24
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Ikpeme M, Omotoyinbo F, Toluwade T, Ryan M. Work-Life Balance Inequalities among Veterinary and Allied Professionals: A Qualitative Review. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.328] [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
This study aimed to review qualitative psychological and non-psychologically based literature for work-life balance (WLB) inequalities within the veterinary and other allied professions.
Methods
The PECO framework includes qualitative studies published in any language but with an English translation involving adult workers in the veterinary or allied profession and outcomes around work-life balance. Seven relevant electronic databases EMBASE, PsycARTICLES, PsycINFO, MEDLINE, Social Policy and Practice, HMIC Health Management Information Consortium, and Global Health, were used. The retrieved hits were exported to Endnote Desktop (Version 7.7.1) for sorting and management.
Results
Of the 3610 hits, 31 studies were eligible for narrative synthesis. The studies were published from 1980-2017 and came from 15 countries. 9(29%) of the 31 studies were from the USA. 22 of the 31 studies (71%) focused on a mix of professions. Data were collected in six different ways, with the most common being interviews (17 (54.8%) of 31 studies). Twenty-three questions were used to assess WLB. The most common ones focused on women becoming mothers, maternity leave, and return to work (five (16.1%) of 31 articles). Secondly were attitudes of ethnic minorities concerning education, employment, role-family conflict, etc., and family commitments (three (9.7%) of the 31 papers). Findings came under 74 different topics. Nineteen (25.7%) of the 74 topics occurred more than four times and were allocated under the appropriate sub-theme. The nine sub-themes include pregnancy, breastfeeding, motherhood, job/life satisfaction, age/gender/ethnic inequalities, return to work (RTW), health and lifestyle, dual-earning couples/family, workplace support, and work-family/family-work conflicts.
Conclusions
The review suggests that women, ethnic minorities, older staff, and those with health concerns are negatively impacted by inequalities around WLB in veterinary and allied professions.
Key messages
The findings from the review were used to support the development of psychological measures of work-life balance and gender differences. The results were used in online questionnaires/surveys for future participants within the veterinary profession in addressing inequalities.
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Affiliation(s)
- M Ikpeme
- Faculty of Medicine, Imperial College, London, UK
- FACE, University of Hull, Hull, UK
| | | | - T Toluwade
- SES, Ogun State Institute of Technology, Igbesa, Nigeria
| | - M Ryan
- CLES, University of Exeter, Exeter, UK
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Sharp M, Forde Z, McGeown C, O'Murchu E, Smith SM, O'Neill M, Ryan M, Clyne B. Media coverage of evidence outputs during the COVID-19 pandemic: findings from one national agency. Eur J Public Health 2021. [PMCID: PMC8574242 DOI: 10.1093/eurpub/ckab164.740] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The COVID-19 Evidence Synthesis Team within the Health Information and Quality Authority (HIQA) in Ireland produced a range of evidence-based reports on a broad range of public health topics related to COVID-19. These evidence outputs (EO) arose directly from questions posed by policy makers and clinicians supporting Ireland's National Public Health Emergency Team (NPHET). Findings from these EOs informed the national response to the COVID-19 pandemic in Ireland and influenced international public health guidance. How research findings are presented through domestic news can influence behaviour and risk perceptions.
Methods
We investigated traditional media coverage of nine COVID-19 EOs and associated press releases, published (April to July 2020) by HIQA. NVivo was used for conceptual content analysis of manifest content. ‘Core messages' from each evidence output were proposed and 488 sources from national and regional broadcast, print, and online media were coded at the phrase level. The presence of political and public health actors in coverage were also coded.
Results
Coverage largely did not distort or misrepresent the results of the EOs, however, there was variability in terms of what content was reported on and to what extent different stakeholders were involved in the contextualization of the findings of the EOs. Coverage appeared to focus more on ‘human-interest' stories as opposed to more technical reports (e.g. focusing on viral load, antibodies, testing, etc.). Selective reporting and the variability in the use of quotes from governmental and public health stakeholders changed and contextualized results in different manners than perhaps originally intended in the press release.
Conclusions
Our findings provide a case-study of European media coverage of evidence reports produced by a national agency. Results highlighted several strengths and weaknesses of current communication efforts.
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Affiliation(s)
- M Sharp
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Z Forde
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - C McGeown
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - E O'Murchu
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - SM Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - B Clyne
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
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Clyne B, Byrne P, Smith SM, O'Neill M, Ryan M. Evaluating rapid review provision to inform policy during the COVID-19 pandemic. Eur J Public Health 2021. [PMCID: PMC8574241 DOI: 10.1093/eurpub/ckab164.741] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Evidence based decision making is central to population health, particularly during a pandemic. Few studies examine the production and use of evidence in decision-making during crisis management. This study describes and evaluates the provision of rapid evidence products by a single agency to support national decision making.
Methods
Semi-structured interviews were conducted with a convenience sample of evidence providers (who gathered and disseminated the required evidence) and service users (policy makers). Interviews were transcribed verbatim and analysed using thematic analysis. Quantitative data of work activity were summarised descriptively.
Results
Three themes were generated from the data: the work, the use and the future, with a fourth theme cross-cutting across these: the team. The work followed clear protocols and was centrally managed. The scope and changing nature of the evidence were highlighted as issues. The service providers reported a strong sense of team work and ‘being in this together', however, the majority of the participants felt that the workload was huge and exhausting and not sustainable long-term. Overall the service users thought the rapid evidence synthesis was indispensable to the decision-making process and had trust and confidence in the work, largely based on existing working relationships with the team. While they recognised that the evidence synthesis support would be an essential component of the continued pandemic response, they did query the sustainability of the process and reflected on the amount of work the team performed.
Conclusions
This evaluation, drawing on qualitative data, has highlighted that, across the services users and evidence providers, the support provided by HIQA was generally perceived as positive. From the service users' perspective, having access to the team was indispensable to the decision making process. However, the sustainability of the work load was identified as a major challenge.
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Affiliation(s)
- B Clyne
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - P Byrne
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - SM Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
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27
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Ryan M. Evidence Synthesis to support the public health response during the COVID-19 pandemic. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.737] [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: 11/13/2022] Open
Abstract
Abstract
Background
In January 2020, the Irish National Public Health Emergency Team (NPHET) for COVID-19 was established. NPHET oversees and provides national direction, guidance, support and expert advice on the development and implementation of strategies to contain COVID-19 in Ireland. Since March 2020, HIQA's COVID-19 Evidence Synthesis Team has provided research evidence to support the work of NPHET and associated groups and inform the development of national public health guidance. From September 2020, as part of the move towards a sustainable response to the public health emergency, HIQA also provides evidence based advice in response to requests from NPHET. The advice provided to NPHET is informed by research evidence developed by HIQA's COVID-19 Evidence Synthesis Team and with expert input from HIQA's COVID-19 Expert Advisory Group.
Methods
This presentation describes the establishment and organisation of the COVID-19 Evidence Synthesis Team, with an overview of the processes and methodological approaches involved. The role of HIQA's COVID-19 Evidence Synthesis Team in informing the public health response during the COVID-19 pandemic is discussed, along with the challenges and opportunities this presents. The relevance now and for future pandemic preparedness is outlined.
Results
As of 19 April 2021, HIQA has produced, and in some instances has regularly updated, 25 evidence summaries, 11 advice documents, 9 reviews of international guidance, 3 scoping reports, 5 reviews of care pathways, 2 analyses/models and 2 databases.
Conclusions
In the context of the COVID-19 pandemic, HIQA has developed and implemented a process to ensure rapid access to the best available evidence relevant to the COVID-19 outbreak to inform decision-making at each stage of the pandemic.
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Affiliation(s)
- M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
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Broderick N, Fawsitt CG, Tyner B, Larkin J, McCarthy M, Walsh KA, O'Neill M, Ryan M. COVID-19 Public Health Guidance Database. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.738] [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
Since March 2020, members of the Health Technology Assessment (HTA) team in HIQA have been identifying, reviewing and presenting COVID-19 public health guidance produced by international organisations. The aim of this work has been to inform the development of public health guidance and policy by the Health Protection Surveillance Centre (HPSC), Department of Health and Health Service Executive (HSE), using international evidence and best practice.
Methods
International resources are searched on a weekly basis to identify new or updated public health guidance on COVID-19. The three distinct steps in the process include, searching relevant international resources, reviewing identified relevant public health guidance for COVID-19, and presenting new or updated guidance in a COVID-19 Public Health Guidance Database, which was created by the team using Microsoft Excel. The international organisations reviewed include the World Health Organisation, European Centre for Disease Prevention and Control and Centers for Disease Control and Prevention, as well as a range of ministries of health and public health agencies from 10 countries. These were chosen, based on guidance being available in English, widespread use of the organisation's advice, and/or the working constraints of the HTA team.
Results
The COVID-19 Public Health Guidance Database is updated weekly and provided to the relevant individuals within HPSC, Department of Health, and HSE, who are responsible for developing public health and infection, prevention and control guidance related to COVID-19 in Ireland. Following this the database is published online and may be utilised by the public or other international organisations.
Conclusions
The COVID-19 Public Health Guidance Database is used to inform the ongoing response to the COVID-19 pandemic, specifically, to inform the development of public health and infection, prevention and control guidance to prevent the spread of COVID-19.
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Affiliation(s)
- N Broderick
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - CG Fawsitt
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - B Tyner
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - J Larkin
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M McCarthy
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - KA Walsh
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
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Cardwell K, O'Murchu E, Byrne P, Broderick N, O'Neill S, Smith SM, Harrington P, O'Neill M, Ryan M. COVID-19 - Interventions and lifestyle factors that prevent infection or minimise progression to severe disease. Eur J Public Health 2021. [PMCID: PMC8574924 DOI: 10.1093/eurpub/ckab164.739] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
This evidence summary synthesised the evidence relating to pharmacological and non-pharmacological interventions in the community to prevent COVID-19/progression to severe disease. An additional aim was to identify potentially modifiable lifestyle factors associated with reduced risk of infection/progression to severe disease.
Methods
A systematic search of published peer-reviewed articles and non-peer-reviewed pre-prints was undertaken from 1 January 2020 to 19 April 2021; no language restrictions were applied. All potentially eligible papers were exported to Covidence. Titles/abstracts and full texts were single screened for relevance. Data extraction and quality appraisal of included studies was completed by a single reviewer and checked by a second.
Results
In total, 50 studies, three randomised controlled trials (RCTs), one non-RCT and 46 cohort studies were included. The four included controlled trials tested variations of the pharmacological intervention, ivermectin. While these controlled trials reported a protective effect for ivermectin use, these trials were of poor quality and had serious risk of bias. Across 46 cohort studies, the modifiable lifestyle risk factors identified were obesity, smoking, vitamin D status, physical activity, alcohol consumption and processed meat consumption. These studies reported mixed results in terms of the association between modifiable lifestyle risk factors and poor COVID-19 outcomes.
Conclusions
At the time of writing there is no high quality evidence of benefit to support pharmacological interventions to prevent COVID-19. Although there were mixed results for the risk factors identified, maintenance of healthy weight, smoking cessation, engaging in physical activity and moderation of alcohol and processed meat consumption are likely to be beneficial to health and should continue to be encouraged.
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Affiliation(s)
- K Cardwell
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E O'Murchu
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - P Byrne
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - N Broderick
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - S O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - SM Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P Harrington
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
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Bruen R, Stirling A, Ryan M, Sheehan M, MacMahon P. Shelling the myth: allergies to Iodine containing substances and risk of reaction to Iodinated contrast media. Emerg Radiol 2021; 29:67-73. [PMID: 34609674 DOI: 10.1007/s10140-021-01989-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE In excess of 100 million procedures using iodinated radio-contrast media are conducted each year. There is a common misunderstanding regarding the links between allergy to iodinated substances and the risk of allergic reaction to intravenous iodinated contrast agents. These perceived risks are managed via administration of corticosteroids or avoidance of iodinated contrast altogether. METHODS An extensive review of published literature on scientific databases and international guidelines was conducted in order to inform the research question. A questionnaire was formulated and distributed to hospital doctors in four tertiary centres. Within this questionnaire, hospital doctors were presented with six different scenarios of bona fide allergy to iodinated substances (e.g. shellfish) and asked to select the treatment response option which they deemed to be the most suitable from a choice of three (standard contrast scan/delay scan with pre-medication/change to non-contrast scan). RESULTS Eighty-seven questionnaire responses were received. Contrast (standard protocol) was the most appropriate regimen in the setting of all the listed allergies. This was identified correctly by 76%, 69%, 44%, 32%, 18% and 14% for kiwi, fish, poly-food, shellfish, betadine and tincture of iodine allergies, respectively. CONCLUSIONS There is a lack of understanding amongst local junior medical staff regarding administration of iodinated contrast media to patients with a history of allergy to iodinated substances. These misconceptions may potentiate the unnecessary usage of pre-medication and ordering of non-contrast scans in the setting of a gold-standard enhanced scan. Findings from this study suggest that there is a need for future education efforts targeted during the basic specialty training stage.
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Affiliation(s)
| | - Aaron Stirling
- Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - M Ryan
- Department of Radiology, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - M Sheehan
- Department of Radiology, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - Peter MacMahon
- Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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Mercuri E, Finkel R, Day J, Pascual SP, Ryan M, De Vivo D, Montes J, Gurgel-Giannetti J, Gambino G, Nuzzo R, Makepeace C, Garafalo S, Berger Z. SMA - TREATMENT. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hoffman E, Dang U, Clemens P, Gordish-Dressman H, Schwartz B, Mengle-Gaw L, Leinonen M, Smith E, Castro D, Kuntz N, Finkel R, Tulinius M, Nevo Y, Ryan M, Webster R, van den Anker J, Ward L, Damsker J, McDonald C, Guglieri M, Mah J. CLINICAL TRIAL HIGHLIGHTS. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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McMichael AJ, Zafeiridi E, Ryan M, Cunningham EL, Passmore AP, McGuinness B. Anticholinergic drug use and risk of mortality for people with dementia in Northern Ireland. Aging Ment Health 2021; 25:1475-1482. [PMID: 33073601 DOI: 10.1080/13607863.2020.1830028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Anticholinergic burden refers to the cumulative effect of medications which contain anticholinergic properties. We assessed how anticholinergic burden and different types of anticholinergic medications influence mortality rates among people with dementia in Northern Ireland. Our secondary aim was to determine what demographic characteristics predict the anticholinergic burden of people with dementia. METHODS Data were extracted from the Enhanced Prescribing database for 25,418 people who were prescribed at least one dementia management medication between 2010 and 2016. Information was also extracted on the number of times each available anticholinergic drug was prescribed between 2010 and 2016, allowing the calculation of an overall anticholinergic burden. Cox proportional hazard models were used to determine how anticholinergic burden influenced mortality whilst multilevel model regression determined what demographic characteristics influence overall anticholinergic burden. RESULTS Of the 25,418 people with dementia, only 15% (n = 3880) had no anticholinergic burden. Diazepam (42%) and risperidone (18%) were the two most commonly prescribed drugs. Unadjusted Cox proportional hazard models indicated that higher anticholinergic burden was associated with significantly higher mortality rates in comparison to people with dementia who had no anticholinergic burden (HR = 1.59: 95% CI = 1.07-2.36). In particular, urological (HR = 1.20: 95% CI = 1.05-1.38) and respiratory (HR = 1.17: 95% CI = 1.08-1.27) drugs significantly increased mortality rates. People with dementia living in areas with low levels of deprivation had significantly lower anticholinergic burden (HR=-.39: 95% CI=-.47:-30). CONCLUSIONS Reducing anticholinergic burden is essential for people with dementia. Further research should address the unfavourable prognosis of people living with dementia in highly deprived areas.
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Affiliation(s)
- A J McMichael
- Centre for Public Health, Institute for Clinical Sciences Block B, Queens University Belfast, Belfast, Northern Ireland
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Wyborn C, Montana J, Kalas N, Clement S, Davila F, Knowles N, Louder E, Balan M, Chambers J, Christel L, Forsyth T, Henderson G, Izquierdo Tort S, Lim M, Martinez‐Harms MJ, Merçon J, Nuesiri E, Pereira L, Pilbeam V, Turnhout E, Wood S, Ryan M. An agenda for research and action toward diverse and just futures for life on Earth. Conserv Biol 2021; 35:1086-1097. [PMID: 33244774 PMCID: PMC8359367 DOI: 10.1111/cobi.13671] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/14/2020] [Accepted: 11/20/2020] [Indexed: 06/11/2023]
Abstract
Decades of research and policy interventions on biodiversity have insufficiently addressed the dual issues of biodiversity degradation and social justice. New approaches are therefore needed. We devised a research and action agenda that calls for a collective task of revisiting biodiversity toward the goal of sustaining diverse and just futures for life on Earth. Revisiting biodiversity involves critically reflecting on past and present research, policy, and practice concerning biodiversity to inspire creative thinking about the future. The agenda was developed through a 2-year dialogue process that involved close to 300 experts from diverse disciplines and locations. This process was informed by social science insights that show biodiversity research and action is underpinned by choices about how problems are conceptualized. Recognizing knowledge, action, and ethics as inseparable, we synthesized a set of principles that help navigate the task of revisiting biodiversity. The agenda articulates 4 thematic areas for future research. First, researchers need to revisit biodiversity narratives by challenging conceptualizations that exclude diversity and entrench the separation of humans, cultures, economies, and societies from nature. Second, researchers should focus on the relationships between the Anthropocene, biodiversity, and culture by considering humanity and biodiversity as tied together in specific contexts. Third, researchers should focus on nature and economies by better accounting for the interacting structures of economic and financial systems as core drivers of biodiversity loss. Finally, researchers should enable transformative biodiversity research and action by reconfiguring relationships between human and nonhuman communities in and through science, policy, and practice. Revisiting biodiversity necessitates a renewed focus on dialogue among biodiversity communities and beyond that critically reflects on the past to channel research and action toward fostering just and diverse futures for human and nonhuman life on Earth.
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Affiliation(s)
- C. Wyborn
- Luc Hoffmann InstituteIUCN Conservation CentreRue Mauverney 28Gland1196Switzerland
- Institute for Water Futures, Fenner School of Environment and SocietyAustralian National UniversityCanberraACT0200Australia
| | - J. Montana
- School of Geography and the EnvironmentUniversity of OxfordSouth Parks RoadOxfordOX1 3QYU.K.
| | - N. Kalas
- Department of Environmental Systems ScienceETH ZürichUniversitätstrasse 8‐22Zürich8092Switzerland
| | - S. Clement
- Geography and PlanningUniversity of LiverpoolLiverpoolL69 3BXU.K.
| | - F. Davila
- Institute for Sustainable FuturesUniversity of Technology Sydney253 Jones StreetUltimoNSW2007Australia
| | - N. Knowles
- Department of Geography and Environmental ManagementUniversity of Waterloo200 University Ave WWaterlooONN2L 3G1Canada
| | - E. Louder
- School of Geography and DevelopmentUniversity of ArizonaENR2 Building, South 4th floor 1064 E. Lowell StreetTucsonAZ85721U.S.A.
| | - M. Balan
- The Forest WayNo 8, 2nd St, D P Nagar, KotturpuramChennaiTamil Nadu600085India
| | - J. Chambers
- Forest and Nature Conservation Policy GroupWageningen UniversityP.O. Box 47Wageningen6700 AAThe Netherlands
| | - L. Christel
- School of Politics and Government (EPyG)National University of San MartinAvenida 25 de Mayo 1021San MartínProvincia de Buenos Aires1650Argentina
| | - T. Forsyth
- Department of International DevelopmentLondon School of Economics and Political ScienceHoughton StreetLondonWC2A 2AEU.K
| | - G. Henderson
- Harry Ransom CenterThe University of Texas at AustinP.O. Drawer 7219, 300 W 21st StreetAustinTX78712U.S.A.
| | - S. Izquierdo Tort
- Institut des Sciences de la Forêt TempéréeUniversité du Québec en Outaouais58 rue PrincipaleRiponQCJ0V 1V0Canada
- Natura y Ecosistemas Mexicanos A.C.Plaza San Jacinto 23D, San Ángel, Álvaro ObregónMexico City01000Mexico
| | - M. Lim
- Centre for Environmental Law, Macquarie Law SchoolMacquarie University6 First WalkSydneyNSW2109Australia
| | - M. J. Martinez‐Harms
- Center for Applied Ecology and Sustainability (CAPES)Pontificia Universidad Católica de ChileSantiago, Avd. Libertador Bernardo O'Higgins 340SantiagoChile
| | - J. Merçon
- Instituto de Investigaciones en EducasiónUniversidad VeracruzanaPaseo 112, Nuevo JalapaXalapa‐Enríquez91193Mexico
| | - E. Nuesiri
- Social Science FacultyAfrican Leadership University (ALU)Powder Mill RoadPamplemousses21001Mauritius
| | - L. Pereira
- Stockholm Resilience CentreStockholm UniversityKräftriket 2BStockholmSE‐10691Sweden
- Copernicus Institute of Sustainable DevelopmentUtrecht UniversityPrincetonlaan 8aUtrecht3584 CBThe Netherlands
- Centre for Complex Systems in TransitionStellenbosch University19 Jonkershoek Rd, MostertsdriftStellenbosch7600South Africa
| | - V. Pilbeam
- Clear Horizon Consulting132B Gwynne StCremorneVIC3121Australia
| | - E. Turnhout
- Forest and Nature Conservation Policy GroupWageningen UniversityP.O. Box 47Wageningen6700 AAThe Netherlands
| | - S. Wood
- Future Earth1250 Guy St, MontrealQuebecONH3H 2L3Canada
| | - M. Ryan
- Luc Hoffmann InstituteIUCN Conservation CentreRue Mauverney 28Gland1196Switzerland
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Wyborn C, Montana J, Kalas N, Clement S, Davila F, Knowles N, Louder E, Balan M, Chambers J, Christel L, Forsyth T, Henderson G, Izquierdo Tort S, Lim M, Martinez-Harms MJ, Merçon J, Nuesiri E, Pereira L, Pilbeam V, Turnhout E, Wood S, Ryan M. An agenda for research and action toward diverse and just futures for life on Earth. Conserv Biol 2021; 35:1086-1097. [PMID: 33244774 DOI: 10.13140/rg.2.2.12086.52804/2] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/14/2020] [Accepted: 11/20/2020] [Indexed: 05/18/2023]
Abstract
Decades of research and policy interventions on biodiversity have insufficiently addressed the dual issues of biodiversity degradation and social justice. New approaches are therefore needed. We devised a research and action agenda that calls for a collective task of revisiting biodiversity toward the goal of sustaining diverse and just futures for life on Earth. Revisiting biodiversity involves critically reflecting on past and present research, policy, and practice concerning biodiversity to inspire creative thinking about the future. The agenda was developed through a 2-year dialogue process that involved close to 300 experts from diverse disciplines and locations. This process was informed by social science insights that show biodiversity research and action is underpinned by choices about how problems are conceptualized. Recognizing knowledge, action, and ethics as inseparable, we synthesized a set of principles that help navigate the task of revisiting biodiversity. The agenda articulates 4 thematic areas for future research. First, researchers need to revisit biodiversity narratives by challenging conceptualizations that exclude diversity and entrench the separation of humans, cultures, economies, and societies from nature. Second, researchers should focus on the relationships between the Anthropocene, biodiversity, and culture by considering humanity and biodiversity as tied together in specific contexts. Third, researchers should focus on nature and economies by better accounting for the interacting structures of economic and financial systems as core drivers of biodiversity loss. Finally, researchers should enable transformative biodiversity research and action by reconfiguring relationships between human and nonhuman communities in and through science, policy, and practice. Revisiting biodiversity necessitates a renewed focus on dialogue among biodiversity communities and beyond that critically reflects on the past to channel research and action toward fostering just and diverse futures for human and nonhuman life on Earth.
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Affiliation(s)
- C Wyborn
- Luc Hoffmann Institute, IUCN Conservation Centre, Rue Mauverney 28, Gland, 1196, Switzerland
- Institute for Water Futures, Fenner School of Environment and Society, Australian National University, Canberra, ACT, 0200, Australia
| | - J Montana
- School of Geography and the Environment, University of Oxford, South Parks Road, Oxford, OX1 3QY, U.K
| | - N Kalas
- Department of Environmental Systems Science, ETH Zürich, Universitätstrasse 8-22, Zürich, 8092, Switzerland
| | - S Clement
- Geography and Planning, University of Liverpool, Liverpool, L69 3BX, U.K
| | - F Davila
- Institute for Sustainable Futures, University of Technology Sydney, 253 Jones Street, Ultimo, NSW, 2007, Australia
| | - N Knowles
- Department of Geography and Environmental Management, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - E Louder
- School of Geography and Development, University of Arizona, ENR2 Building, South 4th floor 1064 E. Lowell Street, Tucson, AZ, 85721, U.S.A
| | - M Balan
- The Forest Way, No 8, 2nd St, D P Nagar, Kotturpuram, Chennai, Tamil Nadu, 600085, India
| | - J Chambers
- Forest and Nature Conservation Policy Group, Wageningen University, P.O. Box 47, Wageningen, 6700 AA, The Netherlands
| | - L Christel
- School of Politics and Government (EPyG), National University of San Martin, Avenida 25 de Mayo 1021, San Martín, Provincia de Buenos Aires, 1650, Argentina
| | - T Forsyth
- Department of International Development, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, U.K
| | - G Henderson
- Harry Ransom Center, The University of Texas at Austin, P.O. Drawer 7219, 300 W 21st Street, Austin, TX, 78712, U.S.A
| | - S Izquierdo Tort
- Institut des Sciences de la Forêt Tempérée, Université du Québec en Outaouais, 58 rue Principale, Ripon, QC, J0V 1V0, Canada
- Natura y Ecosistemas Mexicanos A.C., Plaza San Jacinto 23D, San Ángel, Álvaro Obregón, Mexico City, 01000, Mexico
| | - M Lim
- Centre for Environmental Law, Macquarie Law School, Macquarie University, 6 First Walk, Sydney, NSW, 2109, Australia
| | - M J Martinez-Harms
- Center for Applied Ecology and Sustainability (CAPES), Pontificia Universidad Católica de Chile, Santiago, Avd. Libertador Bernardo O'Higgins 340, Santiago, Chile
| | - J Merçon
- Instituto de Investigaciones en Educasión, Universidad Veracruzana, Paseo 112, Nuevo Jalapa, Xalapa-Enríquez, 91193, Mexico
| | - E Nuesiri
- Social Science Faculty, African Leadership University (ALU), Powder Mill Road, Pamplemousses, 21001, Mauritius
| | - L Pereira
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, Stockholm, SE-10691, Sweden
- Copernicus Institute of Sustainable Development, Utrecht University, Princetonlaan 8a, Utrecht, 3584 CB, The Netherlands
- Centre for Complex Systems in Transition, Stellenbosch University, 19 Jonkershoek Rd, Mostertsdrift, Stellenbosch, 7600, South Africa
| | - V Pilbeam
- Clear Horizon Consulting, 132B Gwynne St, Cremorne, VIC, 3121, Australia
| | - E Turnhout
- Forest and Nature Conservation Policy Group, Wageningen University, P.O. Box 47, Wageningen, 6700 AA, The Netherlands
| | - S Wood
- Future Earth, 1250 Guy St, Montreal, Quebec, ON, H3H 2L3, Canada
| | - M Ryan
- Luc Hoffmann Institute, IUCN Conservation Centre, Rue Mauverney 28, Gland, 1196, Switzerland
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Franks R, Milidonis X, Morgan H, Ryan M, Perera D, Plein S, Chiribiri A. Myocardial perfusion quantification by CMR for detection of obstructive coronary artery disease in patients with previous coronary artery bypass surgery. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): British Heart Foundation
Background
Coronary artery bypass grafting (CABG) is an established treatment for patients with advanced coronary artery disease (CAD). A subsequent recurrence of symptoms can cause the need for re-assessment of the coronary circulation. The accuracy of visually assessed stress perfusion cardiovascular magnetic resonance (CMR) for the detection of obstructive CAD is reduced in patients with prior CABG. In patients with complex multi-vessel CAD, myocardial perfusion quantification by CMR is superior to visual assessment (VA) for detection of obstructive disease however patients with CABG have been absent from previous studies.
Purpose
This study sought to assess the performance of myocardial perfusion quantification by CMR against invasive coronary angiography (ICA) for detecting obstructive CAD in patients with previous CABG.
Methods
Twenty-nine patients with a history of previous CABG and subsequent clinically indicated perfusion CMR study and invasive coronary angiography were recruited. Patients underwent a dual bolus stress perfusion CMR with late gadolinium enhancement (LGE) imaging at 3 Tesla. Stress myocardial blood flow (MBF) was estimated at the coronary territory level according to the AHA 16 segment model using Fermi function-constrained deconvolution. Segments with transmural LGE were excluded from MBF analysis. Stress perfusion images were analysed visually alongside LGE images and matched perfusion-LGE defects were considered negative. On ICA, coronary territories with lumen stenosis >70% without an unobstructed bypass graft (<70% stenosis) were considered positive.
Results
86/87 coronary territories were suitable for analysis. Sixty-five territories had at least one bypass graft including 32 territories with arterial grafts. 28/86 territories (33%) had obstructive disease on angiography. Territories with obstructive CAD had significantly lower stress MBF than unobstructed territories (1.21 [IQR: 0.96–1.45] vs 1.58 [1.40–1.84] ml/g/min, p < 0.001, Figure 1). Stress MBF had good accuracy to detect coronary territories with obstructive CAD (sensitivity 71%, specificity 84%, area under the curve (AUC) 0.83, p < 0.001, Figure 2A). For visual assessment, sensitivity was 79%, specificity 78% and diagnostic accuracy 78%. When analysis was confined to only territories with bypass grafts, stress MBF had 78% sensitivity, 81% specificity and AUC of 0.85, p < 0.001 (Figure 2B).. In this subgroup, VA had a sensitivity of 78%, specificity of 76% and a 77% diagnostic accuracy.
Conclusions
In patients with previous surgical revascularisation, quantification of stress myocardial blood flow by CMR offers good diagnostic accuracy for the detection and localisation of anatomically significant stenoses. Accuracy is reduced compared with published data in patients without coronary grafts but remains comparable to expert visual assessment.
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Affiliation(s)
- R Franks
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - X Milidonis
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - H Morgan
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Ryan
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - D Perera
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Chiribiri
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
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Tambakis G, Lee T, Shah R, Wright E, Connell W, Miller A, Demediuk B, Ryan M, Howell J, Tsoi E, Lust M, Basnayake C, Ding N, Croagh C, Hong T, Kamm M, Farrell A, Papaluca T, MacIsaac M, Iser D, Mahady S, Holt B, Thompson A, Holmes J. Low failure to attend rates and increased clinic capacity with Telehealth: A highly effective outpatient model that should continue beyond the COVID-19 pandemic. J Gastroenterol Hepatol 2021; 36:1136-1137. [PMID: 33338284 DOI: 10.1111/jgh.15379] [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] [Received: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 12/09/2022]
Affiliation(s)
- G Tambakis
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - T Lee
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - R Shah
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - E Wright
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - W Connell
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - A Miller
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - B Demediuk
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M Ryan
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - J Howell
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - E Tsoi
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M Lust
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - C Basnayake
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - N Ding
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - C Croagh
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - T Hong
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M Kamm
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - A Farrell
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - T Papaluca
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M MacIsaac
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - D Iser
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - S Mahady
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - B Holt
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - A Thompson
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - J Holmes
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
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O'Neill SM, Clyne B, Bell M, Casey A, Leen B, Smith SM, Ryan M, O'Neill M. Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation. BMC Emerg Med 2021; 21:15. [PMID: 33509099 PMCID: PMC7842002 DOI: 10.1186/s12873-021-00403-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/08/2021] [Indexed: 12/23/2022] Open
Abstract
Background Early warning systems (EWSs) are used to assist clinical judgment in the detection of acute deterioration to avoid or reduce adverse events including unanticipated cardiopulmonary arrest, admission to the intensive care unit and death. Sometimes healthcare professionals (HCPs) do not trigger the alarm and escalate for help according to the EWS protocol and it is unclear why this is the case. The aim of this qualitative evidence synthesis was to answer the question ‘why do HCPs fail to escalate care according to EWS protocols?’ The findings will inform the update of the National Clinical Effectiveness Committee (NCEC) National Clinical Guideline No. 1 Irish National Early Warning System (INEWS). Methods A systematic search of the published and grey literature was conducted (until February 2018). Data extraction and quality appraisal were conducted by two reviewers independently using standardised data extraction forms and quality appraisal tools. A thematic synthesis was conducted by two reviewers of the qualitative studies included and categorised into the barriers and facilitators of escalation. GRADE CERQual was used to assess the certainty of the evidence. Results Eighteen studies incorporating a variety of HCPs across seven countries were included. The barriers and facilitators to the escalation of care according to EWS protocols were developed into five overarching themes: Governance, Rapid Response Team (RRT) Response, Professional Boundaries, Clinical Experience, and EWS parameters. Barriers to escalation included: Lack of Standardisation, Resources, Lack of accountability, RRT behaviours, Fear, Hierarchy, Increased Conflict, Over confidence, Lack of confidence, and Patient variability. Facilitators included: Accountability, Standardisation, Resources, RRT behaviours, Expertise, Additional support, License to escalate, Bridge across boundaries, Clinical confidence, empowerment, Clinical judgment, and a tool for detecting deterioration. These are all individual yet inter-related barriers and facilitators to escalation. Conclusions The findings of this qualitative evidence synthesis provide insight into the real world experience of HCPs when using EWSs. This in turn has the potential to inform policy-makers and HCPs as well as hospital management about emergency response system-related issues in practice and the changes needed to address barriers and facilitators and improve patient safety and quality of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00403-9.
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Affiliation(s)
- S M O'Neill
- The Health Information and Quality Authority (HIQA), City Gate, Mahon, Cork, T12 Y2XT, Ireland.
| | - B Clyne
- The Health Information and Quality Authority (HIQA), City Gate, Mahon, Cork, T12 Y2XT, Ireland.,HRB Centre for Primary Care Research and Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M Bell
- The Deteriorating Patient Recognition and Response Improvement Programme (DPIP), Clinical Design and Innovation, Health Service Executive, Dr. Steeven's Hospital, Steevens' Lane, D08W2A8, Dublin, Ireland
| | - A Casey
- The Deteriorating Patient Recognition and Response Improvement Programme (DPIP), Clinical Design and Innovation, Health Service Executive, Dr. Steeven's Hospital, Steevens' Lane, D08W2A8, Dublin, Ireland
| | - B Leen
- Regional Librarian, Health Service Executive South, Kilkenny, Ireland
| | - S M Smith
- HRB Centre for Primary Care Research and Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M Ryan
- The Health Information and Quality Authority (HIQA), City Gate, Mahon, Cork, T12 Y2XT, Ireland
| | - M O'Neill
- The Health Information and Quality Authority (HIQA), City Gate, Mahon, Cork, T12 Y2XT, Ireland
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Abstract
Epilepsy, although common, remains difficult to treat with as much as 30% of patients having treatment-resistant conditions. Lennox-Gastaut syndrome and Dravet syndrome are childhood-onset epilepsies and among the most difficult to treat. Cannabidiol has been approved by the Food and Drug Administration to treat these conditions in individuals over 2 years of age; however, there is a great deal of interest in off-label use. This article examines 3 cases: 1 of a patient with Lennox-Gastaut syndrome, 1 of off-label use of cannabidiol to treat epilepsy, and 1 of nonprescription forms of cannabidiol to treat epilepsy.
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Finkel R, Day J, Ryan M, Mercuri E, De Vivo D, Pascual SP, Montes J, Gurgel-Giannetti J, Mitchell-Sweeney N, Foster R, Sun P, Ramirez-Schrempp D, Kandinov B, Farwell W. SMA – THERAPY. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.264] [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: 11/17/2022]
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Billich N, Bray P, Truby H, Evans M, Sowerby B, de Valle K, Carroll K, Villano D, Ryan M, Davidson Z. DMD & BMD – CLINICAL. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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42
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Nathisuwan S, Pattharachayakul S, Subongkot S, Doungngern T, Jones SM, Engle JP, Lau A, Katz MD, Moreton JE, Ryan M. U.S.‐Thai Consortium for the development of pharmacy education in Thailand: History, progress, and impact. J Am Coll Clin Pharm 2020. [DOI: 10.1002/jac5.1262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
| | | | - Suphat Subongkot
- Faculty of Pharmaceutical Sciences Khon Kaen University Khon Kaen Thailand
| | - Thitima Doungngern
- Faculty of Pharmaceutical Sciences Prince of Songkla University Songkla Thailand
| | - Sirada M. Jones
- School of Pharmacy University of Wisconsin Madison Wisconsin USA
| | - Janet P. Engle
- Office of the Executive Director Accreditation Council for Pharmacy Education (ACPE) Chicago Illinois USA
| | - Alan Lau
- College of Pharmacy University of Illinois at Chicago Chicago Illinois USA
| | - Michael D. Katz
- College of Pharmacy University of Arizona Tucson Arizona USA
| | | | - Melody Ryan
- College of Pharmacy University of Kentucky Lexington Kentucky USA
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Abstract
Migraine is the third-most prevalent disease in the world and affects approximately 39 million individuals in the United States alone. Migraine occurs in nearly 1 in 7 individuals between 15 and 49 years of age and is 3 times more frequent in women than in men. The Food and Drug Administration (FDA) recently approved 3 new humanized monoclonal antibodies that target calcitonin gene-related peptide (CGRP): erenumab, fremanezumab, and galcanezumab. The agents either bind to the CGRP receptor (erenumab) or bind to the CGRP ligand (fremanezumab and galcanezumab) and block its binding to the receptor. All 3 products are indicated for preventative treatment of episodic or chronic migraine in adults. The available studies to date document that these agents reduce migraine attacks. The CGRP monoclonal antibodies offer patients new options once they have exhausted other treatments.
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Affiliation(s)
| | - Melody Ryan
- University of Kentucky College of Pharmacy, Lexington.
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Crowe SJ, Karwa R, Schellhase EM, Miller ML, Abrons JP, Alsharif NZ, Andrade C, Cope RJ, Dornblaser EK, Hachey D, Holm MR, Jonkman L, Lukas S, Malhotra JV, Njuguna B, Pekny CR, Prescott GM, Ryan M, Steeb DR, Tran DN. American College of Clinical Pharmacy Global Health Practice and Research Network's opinion paper: Pillars for global health engagement and key engagement strategies for pharmacists. J Am Coll Clin Pharm 2020. [DOI: 10.1002/jac5.1232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Susie J. Crowe
- Bill Gatton College of Pharmacy; East Tennessee State University; Johnson City Tennessee USA
| | - Rakhi Karwa
- College of Pharmacy; Purdue University; West Lafayette Indiana USA
| | | | - Monica L. Miller
- College of Pharmacy; Purdue University; West Lafayette Indiana USA
| | | | - Naser Z. Alsharif
- School of Pharmacy and Health Professions; Creighton University; Omaha Nebraska USA
| | | | - Rebecca J. Cope
- The Arnold and Marie Schwartz College of Pharmacy and Health Sciences; Long Island University; Brooklyn New York USA
| | | | - David Hachey
- Department of Family Medicine; Idaho State University; Pocatello Idaho USA
| | | | - Lauren Jonkman
- School of Pharmacy; University of Pittsburgh; Pittsburgh Pennsylvania USA
| | | | - Jodie V. Malhotra
- School of Pharmacy and Pharmaceutical Sciences; University of Colorado; Aurora Colorado USA
| | - Benson Njuguna
- Department of Pharmacy; Moi Teaching and Referral Hospital; Eldoret Kenya
- Department of Cardiology; Moi Teaching and Referral Hospital; Eldoret Kenya
| | - Chelsea R. Pekny
- College of Pharmacy; The Ohio State University; Columbus Ohio USA
| | - Gina M. Prescott
- School of Pharmacy and Pharmaceutical Sciences; The University at Buffalo; Buffalo New York USA
| | - Melody Ryan
- University of Kentucky College of Pharmacy; Lexington Kentucky USA
| | - David R. Steeb
- Chapel Hill Eshelman School of Pharmacy; The University of North Carolina; Chapel Hill North Carolina USA
| | - Dan N. Tran
- College of Pharmacy; Purdue University; West Lafayette Indiana USA
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Jannati A, Ryan M, Block G, Kayarian F, Oberman L, Rotenberg A, Pascual-Leone A. P223 Utility of continuous theta-burst stimulation of motor cortex as a biomarker for adults with autism spectrum disorder: The role of BDNF and APOE polymorphisms. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.334] [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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46
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Ryan M, Feld H, Yarrison R. Using Photovoice to Encourage Reflection in Health Professions Students Completing a Short-term Experience in Global Health. Am J Pharm Educ 2020; 84:7630. [PMID: 32431312 PMCID: PMC7223937 DOI: 10.5688/ajpe7630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/07/2019] [Indexed: 06/11/2023]
Abstract
Objective. To engage health professions students in a photo and caption sharing methodology to stimulate reflection and inculcate principles related to global health at a formative time in training. Methods. Undergraduate and graduate students from multiple colleges enrolled in a course that would prepare them for an in-country global health experience. As part of the course, participants took photos to illustrate one of three topics: global health ethics, interprofessional practice, or social determinants of health. The iterative and participatory photovoice process was used for students to analyze, discuss, and reflect on their work in country and upon return. Final photos with captions were displayed online. Researchers analyzed photos and captions using content analysis to identify unifying themes. All students were required to complete the photovoice assignment, but only those who gave informed consent were included in the qualitative analysis. Results. Twenty-six students were included in the analysis. Two overarching themes emerged: revelation and adaptation. Revelation encompassed novel elements that surprised the students, including differences and similarities between the United States and Ecuador. Coded segments related to adaptation discussed participants' resourcefulness while challenging work environments, and how they would apply this new perspective to their future practice in the United States. Conclusion. This global health photovoice project provided a unique medium for reflection for health care trainees. This project enhanced our understanding of the learners' perspectives and this new means of expression offered the learners a greater opportunity for deeper reflection. The assignment also revealed gaps in learning related to social determinants of health and areas of concern related to solidarity and privilege.
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Affiliation(s)
- Melody Ryan
- University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Hartley Feld
- University of Kentucky College of Pharmacy, Lexington, Kentucky
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47
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Ryan M, Barnett L, Rochester J, Wilkinson JM, Dall'Ara E. A new approach to comprehensively evaluate the morphological properties of the human femoral head: example of application to osteoarthritic joint. Sci Rep 2020; 10:5538. [PMID: 32218496 PMCID: PMC7098981 DOI: 10.1038/s41598-020-62614-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 03/17/2020] [Indexed: 11/25/2022] Open
Abstract
Osteoarthritis affects the morphological properties of the femoral head. The goal of this study was to develop a method to elucidate whether these changes are localised to discrete regions, or if the reported trends in microstructural changes may be identified throughout the subchondral bone of the human femoral head. Whole femoral heads extracted from osteoarthritic (n = 5) and healthy controls (n = 5) underwent microCT imaging 39 μm voxel size. The subchondral bone plate was virtually isolated to evaluate the plate thickness and plate porosity. The trabecular bone region was divided into 37 volumes of interest spatially distributed in the femoral head, and bone morphometric properties were determined in each region. The study showed how the developed approach can be used to study the heterogeneous properties of the human femoral head affected by a disease such as osteoarthritis. As example, in the superior femoral head osteoarthritic specimens exhibited a more heterogeneous micro-architecture, with trends towards thicker cortical bone plate, higher trabecular connectivity density, higher trabecular bone density and thicker structures, something that could only be observed with the newly developed approach. Bone cysts were mostly confined to the postero-lateral quadrants extending from the subchondral region into the mid trabecular region. Nevertheless, in order to generalise these findings, a larger sample size should be analysed in the future. This novel method allowed a comprehensive evaluation of the heterogeneous micro-architectural properties of the human femoral head, highlighting effects of OA in the superior subchondral cortical and trabecular bone. Further investigations on different stages of OA would be needed to identify early changes in the bone.
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Affiliation(s)
- M Ryan
- Department of Oncology and Metabolism, Mellanby Centre for bone Research, University of Sheffield, Sheffield, UK.,INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - L Barnett
- INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - J Rochester
- Academic Unit of Medical Education, Medical School, University of Sheffield, Sheffield, UK
| | - J M Wilkinson
- Department of Oncology and Metabolism, Mellanby Centre for bone Research, University of Sheffield, Sheffield, UK
| | - E Dall'Ara
- Department of Oncology and Metabolism, Mellanby Centre for bone Research, University of Sheffield, Sheffield, UK. .,INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, UK.
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Costa M, Campello LB, Ryan M, Rochester J, Viceconti M, Dall'Ara E. Effect of size and location of simulated lytic lesions on the structural properties of human vertebral bodies, a micro-finite element study. Bone Rep 2020; 12:100257. [PMID: 32551335 PMCID: PMC7292861 DOI: 10.1016/j.bonr.2020.100257] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/07/2020] [Accepted: 03/06/2020] [Indexed: 11/25/2022] Open
Abstract
Currently, the Spinal Instability Neoplastic Score system is used in clinics to evaluate the risk of fracture in patients with spinal metastases. This method, however, does not always provide a clear guideline due to the complexity in accounting for the effect of metastatic lesions on vertebral stability. The aim of this study was to use a validated micro Finite Element (microFE) modelling approach to analyse the effect of the size and location of lytic metastases on the mechanical properties of human vertebral bodies. Micro Computed Tomography based microFE models were generated with and without lytic lesions simulated as holes within a human vertebral body. Single and multiple lytic lesions were simulated with four different sizes and in five different locations. Bone was assumed homogenous, isotropic and linear elastic, and each vertebra was loaded in axial compression. It was observed that the size of lytic lesions was linearly related with the reduction in structural properties of the vertebral body (reduction of stiffness between 3% and 30% for lesion volume between 4% and 35%). The location of lytic lesions did not show a clear effect on predicted structural properties. Single or multiple lesions with the same volume provided similar results. Locally, there was a homogeneous distribution of axial principal strains among the models with and without lytic lesions. This study highlights the potential of microFE models to study the effect of lesions on the mechanical properties of the human vertebral body. MicroFE models can show the effect of lytic lesions on vertebral properties. The size of the lesions was more critical than the location of the lesions. Lesions affecting the cortical shell had a larger effect on the local strains. Multiple lesions showed a similar effect to single lesions.
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Affiliation(s)
- M.C. Costa
- Department of Oncology and Metabolism, Mellanby Centre for bone Research, University of Sheffield, UK
- INSIGNEO Institute for in silico Medicine, University of Sheffield, UK
| | | | - M. Ryan
- Department of Oncology and Metabolism, Mellanby Centre for bone Research, University of Sheffield, UK
- INSIGNEO Institute for in silico Medicine, University of Sheffield, UK
| | - J. Rochester
- Academic Unit of Medical Education, Medical School, University of Sheffield, UK
| | - M. Viceconti
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - E. Dall'Ara
- Department of Oncology and Metabolism, Mellanby Centre for bone Research, University of Sheffield, UK
- INSIGNEO Institute for in silico Medicine, University of Sheffield, UK
- Corresponding author at: The Pam Liversidge Building, Sir Robert Hadfield Building, Mappin Street, Sheffield S1 3JD, UK.
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Ioannidou E, Letra A, Shaddox LM, Teles F, Ajiboye S, Ryan M, Fox CH, Tiwari T, D'Souza RN. Empowering Women Researchers in the New Century: IADR's Strategic Direction. Adv Dent Res 2020; 30:69-77. [PMID: 31746653 DOI: 10.1177/0022034519877385] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gender inequality in science, medicine, and dentistry remains a central concern for the biomedical research workforce today. Although progress in areas of inclusivity and gender diversity was reported, growth has been slow. Women still face multiple challenges in reaching higher ranks and leadership positions while maintaining holistic success in these fields. Within dental research and academia, we might observe trends toward a more balanced pipeline. However, women continue to face barriers in seeking leadership roles and achieving economic equity and scholarship recognition. In an effort to evaluate the status of women in dental research and academia, the authors examined the role of the International Association for Dental Research (IADR), a global research organization, which has improved awareness on gender inequality. The goal of this article is to review five crucial issues of gender inequality in oral health research and academics-workforce pipeline, economic inequality, workplace harassment, gender bias in scholarly productivity, and work-life balance-and to discuss proactive steps that the IADR has taken to promote gender equality. Providing networking and training opportunities through effective mentoring and coaching for women researchers, the IADR has developed a robust pipeline of women leaders while promoting gender equality for women in dental academia through a culture shift. As knowledge gaps remained on the levels of conscious and unconscious bias and sexist culture affecting women advancement in academics, as well as the intersectionality of gender with race, gender identity, ability status, sexual orientation, and cultural backgrounds, the IADR has recognized that further research is warranted.
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Affiliation(s)
- E Ioannidou
- IADR Women in Science Network and AADR Board of Directors; School of Dental Medicine, UCONN Health, Farmington, CT, USA
| | - A Letra
- IADR Women in Science Network; School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - L M Shaddox
- IADR Women in Science Network; College of Dentistry, University of Kentucky, Lexington, KY, USA
| | - F Teles
- IADR Women in Science Network; School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - S Ajiboye
- International Association for Dental Research and American Association for Dental Research, Alexandria, VA, USA
| | - M Ryan
- American Association for Dental Research; Colgate-Palmolive Company, Piscataway, NJ, USA
| | - C H Fox
- International Association for Dental Research and American Association for Dental Research, Alexandria, VA, USA
| | - T Tiwari
- IADR Women in Science Network; School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - R N D'Souza
- International Association for Dental Research; University of Utah Health Sciences, Salt Lake City, UT, USA
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Campisi C, Ryan M, di Summa P, Scarabosio A, Campisi C, Campisi C. INCLUSION OF TARGETED SKIN PRODUCTS IN THE PRE-SURGICAL TREATMENT REGIMEN OF PERIPHERAL LYMPHEDEMA & LIPEDEMA. Lymphology 2020. [DOI: 10.2458/lymph.4642] [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: 11/05/2022]
Abstract
Advanced lymphedema is associated with a number of adverse skin changes including color, thickening of the epidermis, dryness, and hyperkeratosis. These changes are related to prolonged lymph stasis and contribute to an increased risk of infection. Similarly, lipedema is associated with skin thickening and appearance of nodular adipose deposition. Skin care is essential in both conditions. We examined whether inclusion of targeted skin products for 2 weeks to an established pre-surgical conservative treatment program was associated with beneficial effects on the skin condition in 150 patients with lymphedema and lipedema. Patients were randomly assigned to control or one of two treatment groups. All three groups (and for both lymphedema and lipedema) demonstrated a significant reduction in softness. Dimpling/redness was significantly reduced in the targeted skin product groups for both patients with lymphedema or lipedema. Only patients with lipedema demonstrated a significant reduction in dryness/ hyperkeratosis following targeted skin product treatment. This study demonstrates that short-term use of targeted skin products in both patients with lymphedema and lipedema can be of benefit and further studies are needed to replicate these results and explore possible mechanisms.
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