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Al-Antary N, Hirko KA, Elsiss F, Zatirka T, Ryan M, Movsas B, Chang SS, Adjei Boakye E, Tam SH. Clinic-based perspectives on the integration of patient-reported outcomes (PROs) in a tertiary cancer center. Support Care Cancer 2024; 32:148. [PMID: 38326573 DOI: 10.1007/s00520-024-08353-1] [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: 08/28/2023] [Accepted: 02/01/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE This study examines providers' and clinic staff's perspectives on patient-reported outcomes (PROs) implementation at an academic medical center. METHODS An anonymous and voluntary survey was administered to Henry Ford Cancer providers and clinic staff 18 months after PROs program implementation in September 2020, to obtain their feedback on perceived barriers, impact on workflows, and PROs administration frequency in routine cancer care. RESULTS A total of 180 providers and 40 clinic staff were invited to complete the survey; 31% and 63% completed the survey, respectively. Approximately 68% of providers reported that electronically integrated PROs scores were either beneficial or somewhat beneficial to their patients, while only 28% of the clinic staff reported that PROs were beneficial or somewhat beneficial to patients. According to the clinic staff, the most common barriers to PROs completion included lack of patients' awareness of the utility of the program with respect to their care, patients' health status at check-in, and PROs being offered too frequently. CONCLUSION There is favorable acceptance of the PROs program by providers, but clinic staff found it less favorable. Interventions to address barriers and improve program engagement are needed to ensure broad adoption of PROs in oncology practice.
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Affiliation(s)
- Nada Al-Antary
- Department of Public Health Sciences, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA
| | - Kelly A Hirko
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Farah Elsiss
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, MI, USA
| | | | - Michael Ryan
- Henry Ford Cancer, Henry Ford Health, Detroit, MI, USA
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health, Detroit, MI, USA
| | - Steven S Chang
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health, Detroit, MI, USA
| | - Eric Adjei Boakye
- Department of Public Health Sciences, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA.
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health, Detroit, MI, USA.
| | - Samantha H Tam
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health, Detroit, MI, USA
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David G, Bergman A, Gunnarsson C, Ryan M, Chikermane S, Thompson C, Clancy S. Limited Access to Aortic Valve Procedures in Socioeconomically Disadvantaged Areas. J Am Heart Assoc 2024; 13:e030569. [PMID: 38216519 PMCID: PMC10926797 DOI: 10.1161/jaha.123.030569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/01/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND To explore how differences in local socioeconomic deprivation impact access to aortic valve procedures and the treatment of aortic valve disease, in comparison to other open and minimally invasive surgical procedures. METHODS AND RESULTS Procedure volume data were obtained from the Healthcare Cost and Utilization Project from 18 states from 2016 to 2019 and merged with area deprivation index data, an index of zip code-level socioeconomic distress. We estimate the relationship between local deprivation ranking and differences in volumes of aortic valve replacement, which include transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR), versus coronary artery bypass graft surgery and laparoscopic colectomy (LC). All regressions control for state and year fixed effects and an array of zip code-level characteristics. TAVR procedures have increased over time across all zip codes. The rate of increase is negatively correlated with deprivation ranking, regardless of the higher share of hospitalizations per population in high deprivation areas. Distributional analysis further supports these findings, showing that lower area deprivation index areas account for a disproportionately large share of SAVR, TAVR, and LC procedures in our sample relative to their share of all hospitalizations in our sample. By comparison, the cumulative distribution of coronary artery bypass graft procedures was nearly identical to that of total hospitalizations, suggesting that this procedure is equitably distributed. Regressions show high area deprivation index areas have lower prevalence of SAVR (β=-15.1%, [95% CI, -26.8 to -3.5]), TAVR (β=-9.1%, [95% CI, -18.0 to -0.2]), and LC (β=-19.9%, [95% CI, -35.4 to -4.4]), with no statistical difference in the prevalence of coronary artery bypass graft (β=-2.5%, [95% CI, -12.7 to 7.6]), a widespread and commonly performed procedure. In the population aged ≥80 years, results show high area deprivation index areas have a lower prevalence of TAVR (β=-11.9%, [95% CI, -18.7 to -5.2]) but not SAVR (β=-0.8%, [95% CI, 8.1 to 6.3]), LC (β=-3.5%, [95% CI, -13.4 to -6.4]), or coronary artery bypass graft (β=5.2%, [95% CI, -1.1 to 1.1]). CONCLUSIONS People living in high deprivation areas have less access to life-saving technologies, such as SAVR, and even moreso to device-intensive minimally invasive procedures such as TAVR and LC.
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Affiliation(s)
- Guy David
- Department of Health Care Management, The Wharton SchoolUniversity of PennsylvaniaPhiladelphiaPA
| | - Alon Bergman
- Department of Health Care Management, The Wharton SchoolUniversity of PennsylvaniaPhiladelphiaPA
- Department of Medical Ethics and Health Policy, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA
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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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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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Huebner KT, Lamb E, Weymon A, Seamon L, Thakur M, Giuliani E, Ryan M, Córdoba M. Sonographic Diagnosis and Management With Delayed Hysterectomy of Two Cesarean Scar Pregnancies That Developed Into Placenta Percreta: Two Case Reports. Cureus 2023; 15:e37130. [PMID: 37153302 PMCID: PMC10159630 DOI: 10.7759/cureus.37130] [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] [Accepted: 03/30/2023] [Indexed: 04/07/2023] Open
Abstract
Approximately two-thirds of the patients with a cesarean scar pregnancy (CSP) will develop placenta accreta spectrum (PAS). PAS occurs when the placenta attaches too deeply to the uterine wall, and sometimes, the placenta can extend beyond the uterus, invading surrounding organs. PAS is commonly managed with a cesarean hysterectomy, and these deliveries are often complicated by maternal and fetal morbidity and mortality. However, delaying hysterectomy and using chemotherapeutic agents may be a safe and beneficial alternative. We describe the case of a 32 -year-old G3P2002 with a history of two prior cesarean sections (CS) who was referred to our Maternal Fetal Medicine department due to the concern of a gestational sac embedded in the anterior uterine wall in the cesarean scar. Magnetic resonance imaging (MRI) findings at 33 weeks confirmed that the patient had developed placenta percreta extending into the sigmoid colon. We also describe the case of a 30-year-old G6P4104 with a history of four prior CS who was referred to our department for concern of a pregnancy complicated by CSP. This patient had an MRI performed at 23 weeks that showed placenta percreta invading the bladder. Patients one and two were managed with a staged procedure, with CS followed by a delayed laparoscopic and abdominal hysterectomy, respectively, to minimize bowel and bladder injury. After the CS, the patients subsequently received a five-day course of intravenous (IV) etoposide 100mg/m2, and at six weeks postpartum, the patients had a hysterectomy, both showing resolution of the placenta invasion into the surrounding organs on postpartum MRI and confirmed by tissue pathology reports. Our cases present the challenge in diagnosis and management of the most severe presentation of PAS that varies from the generally accepted management recommendations. Delayed hysterectomy with chemotherapy can be a reasonable, conservative surgical approach in the most severe types of PAS. As in our cases, this management could improve maternal and fetal morbidity and mortality.
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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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Capellan P, Gonzalez LA, Abdallah Mahrous M, Weiss SJ, Botsford B, Lenis TL, Ryan M, Orlin A, Papakostas T, Kiss S, D'Amico D, Kovacs K. Primary and secondary focal choroidal excavation morphologic phenotypes, associated ocular disorders and prognostic implications. Br J Ophthalmol 2023; 107:373-379. [PMID: 34656984 DOI: 10.1136/bjophthalmol-2021-319569] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/29/2021] [Indexed: 11/04/2022]
Abstract
AIMS To characterise and classify the morphological, clinical and tomographic characteristics of focal choroidal excavation (FCE) lesions to determine their prognostic implications. METHODS 36 eyes with FCE (32 patients) underwent multimodal imaging, including spectral domain optical coherence tomography and fundus autofluorescence. FCE lesions were classified into three subtypes: (1) type 1: myopic (central choroidal thickness: <100 µm), (2) type 2: suspected congenital (central choroidal thickness: 100-200 µm, without associated chorioretinal pathology) and (3) type 3: secondary or acquired (central choroidal thickness: >200 µm, with associated chorioretinal pathology). RESULTS 80.6% of eyes were followed longitudinally (26.8±18.8 months). There were 9 type 1 FCEs (myopic), 8 type 2 FCEs (U-shaped, congenital) and 19 type 3 FCEs (V-shaped, secondary). Type 2 FCEs trended towards larger maximum widths (p=0.0563). Type 3 FCEs were associated with central serous chorioretinopathy or pachyvessels (47.4%), but were also seen in pattern dystrophy, geographic atrophy, inactive choroiditis, torpedo maculopathy and adult-onset vitelliform dystrophy. Choroidal neovascular membranes (CNVMs) were more prevalent in type 3 FCE (41.2% compared with 11.1% for type 1 FCE, p=0.251, and 0% for type 2 FCE, p=0.043). CONCLUSIONS The FCE types, stratified by central choroidal thickness, demonstrated distinct morphological characteristics and associated findings. The classification scheme held prognostic implications as type 3 FCE with V shapes were associated with other chorioretinal conditions and were more likely to develop CNVM.
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Affiliation(s)
- Pamela Capellan
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Luis A Gonzalez
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - M Abdallah Mahrous
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Stephanie J Weiss
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Benjamin Botsford
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Tamara L Lenis
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Michael Ryan
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Anton Orlin
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Thanos Papakostas
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Szilard Kiss
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Donald D'Amico
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Kyle Kovacs
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
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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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Baron S, Ryan M, Chikermane S, Gunnarsson C. LONG-TERM RISK OF REINTERVENTION AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01276-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Morgans AK, Ebrahimi R, Bobbili PJ, Nwokeji E, Gandhi R, Desai R, Horvath K, Ryan M, Hanson S, Duh MS, Preston MA. Association of intermittent vs continuous androgen deprivation therapy with cardiovascular disease and endocrine/metabolic disorders in patients with metastatic prostate cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.82] [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: 03/16/2023] Open
Abstract
82 Background: There is mixed evidence on the risks of cardiovascular disease (CVD) and endocrine/metabolic disorders associated with long-term intermittent and continuous androgen deprivation therapy (iADT and cADT, respectively) for metastatic prostate cancer (mPC). This study examined these risks in patients (pts) with mPC receiving iADT vs cADT in the US. Methods: This was a retrospective cohort study of SEER-Medicare pts with mPC initiating ADT (2010–2017), with ≥36 months of continuous insurance coverage, unless death occurred, who did not receive chemotherapy or a second-generation anti-androgen during follow-up. iADT and cADT cohorts were defined by treatment patterns and gaps in therapy. Comorbidities and clinical events were identified using ICD-9/10-CM codes. Outcomes examined were major adverse cardiovascular events (MACE [myocardial infarction (MI), stroke, cardiomyopathy/heart failure (HF), pulmonary embolism (PE), ischemic heart disease (IHD), or all-cause mortality]) and endocrine/metabolic events (diabetes, hypercholesterolemia, bone fractures, or osteoporosis). Inverse probability of treatment weighting (IPTW) was used to adjust for differences between cohorts; weighted Cox models were used to estimate the hazard ratio (HR) of the outcomes. Subgroup analyses examined pts by CVD history; a sensitivity analysis was performed restricting the definition of MACE to include CVD-related mortality as a component, i.e., MACESA (MI, stroke, cardiomyopathy/HF, PE, IHD, or CVD-related mortality). Results: 2234 pts with mPC were included; 478 (21%) received iADT and 1756 (79%) cADT. Median follow-up time was 27 and 13 months, and time on ADT (excluding gaps for iADT pts) was 24 and 19 months for the iADT and cADT cohorts, respectively. Deaths occurred in 39% of iADT pts vs 55% of cADT pts; PC was the most common cause of death in both cohorts. In adjusted analyses, pts receiving cADT had a higher risk of MACE vs iADT. No differences in risk of endocrine/metabolic events were observed. Subgroup analysis showed that baseline history of CVD did not alter the results for MACE. Sensitivity analysis results showed no difference in risk of MACESA between pts receiving cADT vs iADT. Conclusions: Pts with mPC receiving cADT had a higher risk of MACE (including all-cause mortality), and no difference in risk of endocrine/metabolic events, compared with those receiving iADT. When MACE was restricted to include CVD-related mortality, there was no difference in risk between cohorts. [Table: see text]
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Morgans AK, Ebrahimi R, Bobbili PJ, Nwokeji E, Gandhi R, Desai R, Zhang A, Ryan M, Hanson S, Duh MS, Preston MA. Association of intermittent or continuous androgen deprivation therapy with cardiovascular disease and endocrine/metabolic disorders in patients with nonmetastatic prostate cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.83] [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: 03/15/2023] Open
Abstract
83 Background: Evidence on risks of cardiovascular disease (CVD) and endocrine/metabolic disorders associated with long-term intermittent and continuous androgen deprivation therapy (iADT and cADT, respectively) in patients (pts) with nonmetastatic prostate cancer (nmPC) is mixed. This real-world study examined these risks in pts with nmPC receiving iADT or cADT in the US. Methods: This was a retrospective cohort study of SEER-Medicare pts with nmPC initiating ADT (2010–2017), with ≥36 months of continuous insurance coverage, unless death occurred, and who did not receive chemotherapy or a second-generation anti-androgen during follow-up. iADT and cADT cohorts were defined by treatment patterns and gaps in therapy. Comorbidities and clinical events were identified using ICD-9/10-CM codes. Outcomes examined were major adverse cardiovascular events (MACE [myocardial infarction (MI), stroke, cardiomyopathy/heart failure (HF), pulmonary embolism (PE), ischemic heart disease (IHD), or all-cause mortality]) and endocrine/metabolic events (diabetes, hypercholesterolemia, bone fractures, or osteoporosis). Inverse probability of treatment-weighted Cox regression models estimated the adjusted hazard ratio (aHR) of the outcomes. Subgroup analyses examined pts by CVD history. A sensitivity analysis restricted the definition of MACE to include CVD-related mortality as a component, i.e., MACESA (MI, stroke, cardiomyopathy/HF, PE, IHD, or CVD-related mortality). Results: 10,655 pts were included; 2095 (20%) received iADT and 8560 (80%) cADT; 63% of iADT pts and 66% of cADT pts had baseline CVD history. Median follow-up was 44 and 48 months and time on ADT (excluding gaps for iADT pts) was 23 and 17 months for the iADT and cADT cohorts, respectively. In adjusted analyses, pts receiving cADT had a lower risk of MACE vs iADT. No difference in risk of endocrine/metabolic events was observed. Results for MACE were similar in pts with prior CVD history; however, there was no difference in risk of MACE in those without CVD history. Sensitivity analysis results for MACESA were similar to the main results. Conclusions: Pts with nmPC receiving cADT had a lower risk of MACE, and no difference in risk of endocrine/metabolic events, compared with iADT. There was no difference in risk of MACE in pts without a prior history of CVD. [Table: see text]
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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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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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15
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Alrashdi N, Ryan M, Ithurburn M. Functional Recovery Measured by Longitudinal Daily Steps in Individuals with Acetabular Dysplasia Undergoing Periacetabular Osteotomy. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.08.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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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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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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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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Alrashdi N, Motl R, Aguiar E, Lein D, Ryan M, Ithurburn M. Accelerometer-determined Step-count, Peak 1-minute Cadence, And Walking Intensity In Persons With And Without Acetabular Dysplasia. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000879040.87806.09] [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: 11/21/2022]
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Alrashdi NZ, Motl R, Ryan M, Ithurburn M. Muscle Strength And Loading Patterns During Sport-related Tasks In Persons With Acetabular Dysplasia. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000882192.68367.f1] [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: 11/21/2022]
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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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Favaloro EJ, Mohammed S, Vong R, Chapman K, Kershaw G, Just S, Connelly L, Ryan M, Zebeljan D, Brighton T, Pasalic L. Harmonizing platelet function analyzer testing and reporting in a large laboratory network. Int J Lab Hematol 2022; 44:934-944. [PMID: 35754202 PMCID: PMC9545980 DOI: 10.1111/ijlh.13907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The platelet function analyzer (PFA) is a popular platelet function screening instrument, highly sensitive to von Willebrand disease (VWD) and to aspirin therapy, with moderate sensitivity to defects in platelet function and/or deficiencies in platelet number. There are two models, the original PFA-100 and the contemporary PFA-200. Normal reference ranges (NRRs) provided by the manufacturer are the same for both models, instead being based on the type of test cartridge, for which there are two main ones: collagen/epinephrine (C/Epi) and collagen/adenosine diphosphate (C/ADP). METHODS Comparative evaluations of PFA testing and reporting in six different sites of a large pathology network, aiming to harmonize NRRs and test reporting across all network sites. A separate comparative study of testing a range of samples (n > 150) on a PFA-100 versus that on a PFA-200. Review of contemporary literature. RESULTS Each site was identified to have a different reporting NRR, which after consolidating data permitted establishment of an agreed harmonized NRR for use across the network (C/Epi: 90-160; C/ADP: 70-124; based on n > 180). Similarly, each site reported and interpreted results in different ways, and after discussion and consolidation, a harmonized approach to interpretation and reporting was achieved. The separate comparative study of PFA-100 versus PFA-200 testing confirmed instrument equivalence. CONCLUSION We achieved harmonized NRRs and reporting for PFA testing across a large pathology network. Our approach may be useful for other laboratory networks wishing to harmonize PFA testing.
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Affiliation(s)
- Emmanuel J Favaloro
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Centres for Thrombosis and Haemostasis, Westmead, New South Wales, Australia.,Faculty of Science and Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Soma Mohammed
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ronny Vong
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Kent Chapman
- Haematology, NSW Health Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Geoffrey Kershaw
- Haematology, NSW Health Pathology, Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Sarah Just
- Haematology, NSW Health Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Lynne Connelly
- Haematology, NSW Health Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Michael Ryan
- Haematology, NSW Health Pathology, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Diane Zebeljan
- Haematology, NSW Health Pathology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Timothy Brighton
- Haematology, NSW Health Pathology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Leonardo Pasalic
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Centres for Thrombosis and Haemostasis, Westmead, New South Wales, Australia.,Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
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Lu Y, Stec DE, Liu R, Ryan M, Drummond HA. βENaC and ASIC2 associate in VSMCs to mediate pressure-induced constriction in the renal afferent arteriole. Am J Physiol Renal Physiol 2022; 322:F498-F511. [PMID: 35285274 PMCID: PMC8977180 DOI: 10.1152/ajprenal.00003.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/17/2022] [Accepted: 03/03/2022] [Indexed: 11/22/2022] Open
Abstract
In independent studies, our laboratory has shown the importance of the degenerin proteins β-epithelial Na+ channel (βENaC) and acid-sensing ion channel 2 (ASIC2) in pressure-induced constriction (PIC) in renal interlobar arteries. Most, but not all, of the PIC response is abolished in mice lacking normal levels of βENaC or in ASIC2-null mice, indicating that the functions of βENaC and ASIC2 cannot fully compensate for the loss of the other. Degenerin proteins are known to associate and form heteromeric channels in expression systems, but whether they interact biochemically and functionally in vascular smooth muscle cells is unknown. We hypothesized that βENaC and ASIC2 interact to mediate PIC responses in renal vessels. To address this possibility, we 1) used biochemical approaches to show that βENaC associates into high-molecular-weight complexes and immunoprecipitants with ASIC2 in vascular smooth muscle cells and then 2) examined PIC in renal afferent arterioles in mice lacking normal levels of βENaC (βENaCm/m) or/and ASIC2 (ASIC2-/-) using the isolated afferent arteriole-attached glomerulus preparation. We found that the sensitivity of the PIC response (slope of the relationship between intraluminal pressure and percent myogenic tone) decreased to 26%, 27%, and -8% of wild-type controls in ASIC2-/-, βENaCm/m, and ASIC2-/-/βENaCm/m groups, respectively, suggesting that the PIC response was totally abolished in mice deficient in both ASIC2 and βENaC. Surprisingly, we found that resting internal diameters were 20-30% lower (60 mmHg, Ca2+ free) in ASIC2-/-/βENaCm/m (11.3 ± 0.5 µm) mice compared with control (14.4 ± 0.6 µm, P = 0.0007, independent two-tailed t test) or singly modified (15.7 ± 1.0 to 16.3 ± 1.1 µm) mice, suggesting compensatory vasoconstriction or remodeling. We then examined mean arterial blood pressure (MAP) using radiotelemetry and glomerular injury using histological examination of renal sections. We found that 24-h MAP was mildly elevated (+8 mmHg) in ASIC2-/-/βENaCm/m mice versus wild-type controls and the glomerular injury score was modestly increased by 38%. These findings demonstrate that myogenic constriction in afferent arterioles is dependent on normal expression of βENaC and ASIC2 and that mice lacking normal levels of ASIC2 and βENaC have mild renal injury and increased MAP.NEW & NOTEWORTHY Transmission of systemic blood pressure to delicate renal microvessels is a primary determinant of vascular injury in chronic kidney disease progression to end-stage renal disease. Here, we identified two degenerin family members, with an evolutionary link to mechanosensing, that interact biochemically and functionally to regulate systemic blood pressure and renal injury. Thus, degenerin proteins may serve as a target for the development of therapies to prevent or delay renal disease progression.
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Affiliation(s)
- Yan Lu
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - David E Stec
- Department of Physiology and Biophysics and the Center for Excellence in Cardiovascular Renal Research, University of Mississippi Medical Center, Jackson, Mississippi
| | - Ruisheng Liu
- Department of Molecular Pharmacology and Physiology, University of South Florida, College of Medicine, Tampa, Florida
| | - Michael Ryan
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine, Columbia, South Carolina
| | - Heather A Drummond
- Department of Physiology and Biophysics and the Center for Excellence in Cardiovascular Renal Research, University of Mississippi Medical Center, Jackson, Mississippi
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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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Ziegler P, yaghi S, Gunnarsson C, Ryan M, Rosemas S, Reynolds MR. CE-539-02 UTILIZATION OF ORAL ANTICOAGULATION AFTER BLEEDING EVENTS IN STROKE PATIENTS WITH ATRIAL FIBRILLATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wegermann ZK, Mack MJ, Arnold SV, Thompson CA, Ryan M, Gunnarsson C, Strong S, Cohen DJ, Alexander KP, Brennan JM. Anxiety and Depression Following Aortic Valve Replacement. J Am Heart Assoc 2022; 11:e024377. [PMID: 35470691 PMCID: PMC9238623 DOI: 10.1161/jaha.121.024377] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The aim of this study was to identify patients vulnerable for anxiety and/or depression following aortic valve replacement (AVR) and to evaluate factors that may mitigate this risk. Methods and Results This is a retrospective cohort study conducted using a claims database; 18 990 patients (1/2013-12/2018) ≥55 years of age with 6 months of pre-AVR data were identified. Anxiety and/or depression risk was compared at 3 months, 6 months, and 1 year following transcatheter aortic valve replacement or surgical AVR (SAVR) after risk adjustment using logistic regression and Cox proportional hazards models. Separate models were estimated for patients with and without surgical complications and discharge location. Patients with SAVR experienced a higher relative risk of anxiety and/or depression at 3 months (12.4% versus 8.8%; adjusted hazard ratio [HR] 1.39 [95% CI, 1.19-1.63]) and 6 months (15.6% versus 13.0%; adjusted HR, 1.24 [95% CI, 1.08-1.42]), with this difference narrowing by 12 months (20.1% versus 19.3%; adjusted HR, 1.14 [95% CI, 1.01-1.29]) after AVR. This association was most pronounced among patients discharged to home, with patients with SAVR having a higher relative risk of anxiety and/or depression. In patients who experienced operative complications, there was no difference between SAVR and transcatheter aortic valve replacement. However, among patients without operative complications, patients with SAVR had an increased risk of postoperative anxiety and/or depression at 3 months (adjusted HR, 1.47 [95% CI, 1.23-1.75]) and 6 months (adjusted HR 1.26 [95% CI, 1.08-1.46]), but not at 12 months. Conclusions There is an associated reduction in the risk of new-onset anxiety and/or depression among patients undergoing transcatheter aortic valve replacement (versus SAVR), particularly in the first 3 and 6 months following treatment.
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Affiliation(s)
- Zachary K Wegermann
- Division of Cardiology Department of Medicine Duke University Health System Durham NC.,Duke Clinical Research Institute Durham NC
| | | | - Suzanne V Arnold
- Saint Luke's Mid America Heart InstituteUniversity of Missouri-Kansas City Kansas City MO
| | | | | | | | | | - David J Cohen
- Cardiovascular Research Foundation New York NY.,St. Francis Hospital Roslyn NY
| | - Karen P Alexander
- Division of Cardiology Department of Medicine Duke University Health System Durham NC.,Duke Clinical Research Institute Durham NC
| | - J Matthew Brennan
- Division of Cardiology Department of Medicine Duke University Health System Durham NC.,Duke Clinical Research Institute Durham NC
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Vercio C, Peltier C, Ryan M, Khidir A, Jackson J, Dallaghan GB, Paul CR. Can We Ensure That Workshops Are Effective in Their Goal? Impact of a National Education Workshop on Participants' Subsequent Scholarship. Med Sci Educ 2022; 32:287-290. [PMID: 35194522 PMCID: PMC8829970 DOI: 10.1007/s40670-021-01500-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Medical education conferences offer practical workshops to facilitate physicians' lifelong learning. Little is known about integration of workshop material after conferences. We sought to evaluate the application of workshop content focused on scholarly publication preparation. We developed an email survey to examine participants' progress preparing a publication in 2019, administered 4, 9, and 15 months post-conference. The survey included scaled items and open-ended questions. Thirty-three participants attended the workshop. Participants continued to develop their projects, but noted time, adequate evaluations, and no writing partners as barriers. Following up with workshop participants offers insights into effective application of workshop content.
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Affiliation(s)
- Chad Vercio
- Loma Linda University School of Medicine, 11175 Campus Street, Coleman Pavilion A1121, Loma Linda, CA 92350 USA
- Riverside University Health System, Moreno Valley, CA USA
| | - Chris Peltier
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Michael Ryan
- Virginia Commonwealth University School of Medicine, Richmond, VA USA
| | | | | | | | - Caroline R. Paul
- Grossman School of Medicine, New York University Langone Health, New York City, NY USA
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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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Affiliation(s)
- Michael Ryan
- Office of Product Evaluation and Quality, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Ann M Myers
- Office of Product Evaluation and Quality, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Aron S Yustein
- Office of Product Evaluation and Quality, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
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Witte KK, Lanctin D, Gunnarsson C, Ryan M, Rosemas S, Sarkar S, Irish W. ASSOCIATION BETWEEN INSERTABLE CARDIAC MONITOR USE AND HEART FAILURE EXACERBATION IN PATIENTS WITH HEART FAILURE AND ATRIAL FIBRILLATION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01182-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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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David G, Gunnarsson C, Laine L, Ryan M, Clancy S, Gunnarsson G, Moore K, Irish W. The unintended consequences of Medicare's wage index adjustment on device-intensive hospital procedures. Am J Manag Care 2022; 28:e96-e102. [PMID: 35404553 DOI: 10.37765/ajmc.2022.88842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To study the association between Medicare's wage index adjustment and the differential use of labor-intensive surgical procedures and medical device-intensive minimally invasive clinical procedures across the United States. STUDY DESIGN We combine a conceptual model and an empirical investigation of its predictions, applied to aortic valve replacement, to study the relationship between variation in Medicare wage index payment adjustment across hospital referral regions (HRRs) and the utilization of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in these areas. METHODS Using detailed individual Medicare claims data for 2013-2018 and a novel geographical crosswalk to nest information on Medicare's wage index and utilization of TAVR and SAVR, we estimate a mixed effects Poisson regression model across HRRs to test our hypotheses. RESULTS We find regional variation in Medicare wage index adjustment levels to be correlated with differential TAVR and SAVR utilization and growth over time. In particular, in HRRs where the wage index is half the national mean there is a 35% decline in the rate of TAVR use and in HRRs where the wage index is 50% higher than the national mean there is a 52% increase in the rate of TAVR use. CONCLUSIONS Consistent with our framework and hypothesis, our results highlight the importance of adjusting Medicare hospital inpatient payments for device-intensive procedures. Absent such adjustment, access to appropriate interventions may be reduced in areas with low wage index, and lower reimbursement, when driven by wage index adjustment, may influence the treatment approach selected.
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Affiliation(s)
- Guy David
- University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104.
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Bui AD, Sun Z, Wang Y, Huang S, Ryan M, Yu Y, Ying GS, Ramanathan S, Singh K, Yang Y, Han Y. Factors impacting cumulative dissipated energy levels and postoperative visual acuity outcome in cataract surgery. BMC Ophthalmol 2021; 21:439. [PMID: 34930170 PMCID: PMC8690865 DOI: 10.1186/s12886-021-02205-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To determine factors impacting cumulative dissipated energy (CDE) and postoperative best-corrected visual acuity (BCVA) in phacoemulsification. Design Review of 1102 cases at University of California, San Francisco (UCSF) and at Zhongshan Ophthalmic Center (ZOC), China. Subjects Patients who underwent cataract surgery at UCSF 03/2014–03/2019 and at ZOC 10/2018–05/2019. Methods Patient demographics, medical history, routine ocular examination, and surgical information, including disassembly method, complications, and surgeon training level were recorded. Univariable and multivariable regression models were used to determine factors associated with CDE and good postoperative BCVA (20/40 or better) at 1 month. Outcome measures CDE, postoperative BCVA. Results In multivariable analysis, patient age at time of surgery, diabetes, degree of nuclear sclerosis (NS), white-to-white corneal diameter, disassembly method, preoperative BCVA, surgeon training level, and surgical center were significantly associated with CDE. Log10CDE increased by 0.20–0.31 for patient age ≥ 70 years, by 0.07 if the patient had diabetes, by 0.12–0.41 for NS grade ≥ 2, by 0.48 per 10 mm increase in white-to-white corneal diameter, by 0.34–0.47 for disassembly method other than non-stop chop, by 0.16 per unit increase in preoperative logMAR BCVA, and by > 0.09 when phacoemulsification was performed by residents early in their training. Log10CDE was 0.33 higher at UCSF than ZOC. In multivariable analysis, worse baseline visual acuity and age above 90 years at time of surgery decreased the odds of good BCVA (OR = 0.26 per unit increase in preoperative logMAR BCVA; OR = 0.12 for age > 90); comorbid retinal issues decreased the odds of good postoperative BCVA (OR = 0.13–0.39); greater anterior chamber depth (ACD) or shorter axial length (AL), increased the odds of good postoperative outcome (OR = 2.64 per 1 mm increase ACD, OR = 0.84 per 1 mm increase AL). Conclusions Cataract grade determined by slit lamp exam and, for the first time, older patient age, were noted to be important predictors of high CDE. CDE was not a risk factor for postoperative BCVA measured at postoperative 1 month. When surgery was performed by trainees under supervision, lower training level was associated with higher CDE, but not with worse postoperative BCVA. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-02205-w.
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Affiliation(s)
- Anh D Bui
- Department of Ophthalmology, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA
| | - Zhimin Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yunzhen Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shengsong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Michael Ryan
- Department of Ophthalmology, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA
| | - Yinxi Yu
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
| | - Gui-Shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
| | - Saras Ramanathan
- Department of Ophthalmology, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA
| | - Kuldev Singh
- Department of Ophthalmology, Stanford University, Stanford, CA, USA
| | - Yangfan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| | - Ying Han
- Department of Ophthalmology, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA.
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Santen SA, Ryan M, Helou MA, Richards A, Perera RA, Haley K, Bradner M, Rigby FB, Park YS. Building reliable and generalizable clerkship competency assessments: Impact of 'hawk-dove' correction. Med Teach 2021; 43:1374-1380. [PMID: 34534035 DOI: 10.1080/0142159x.2021.1948519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Systematic differences among raters' approaches to student assessment may result in leniency or stringency of assessment scores. This study examines the generalizability of medical student workplace-based competency assessments including the impact of rater-adjusted scores for leniency and stringency. METHODS Data were collected from summative clerkship assessments completed for 204 students during 2017-2018 the clerkship at a single institution. Generalizability theory was used to explore variance attributed to different facets (rater, learner, item, and competency domain) through three unbalanced random-effects models by clerkship including applying assessor stringency-leniency adjustments. RESULTS In the original assessments, only 4-8% of the variance was attributed to the student with the remainder being rater variance and error. Aggregating items to create a composite score increased variability attributable to the student (5-13% of variance). Applying a stringency-leniency ('hawk-dove') correction substantially increased the variance attributed to the student (14.8-17.8%) and reliability. Controlling for assessor leniency/stringency reduced measurement error, decreasing the number of assessments required for generalizability from 16-50 to 11-14. CONCLUSIONS Similar to prior research, most of the variance in competency assessment scores was attributable to raters, with only a small proportion attributed to the student. Making stringency-leniency corrections using rater-adjusted scores improved the psychometric characteristics of assessment scores.
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Affiliation(s)
- Sally A Santen
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Michael Ryan
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Marieka A Helou
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Alicia Richards
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Robert A Perera
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kellen Haley
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Melissa Bradner
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Fidelma B Rigby
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Yoon Soo Park
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
- The Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Gu H, Wei C, Li L, Ryan M, Setchi R, Han Q, Qian L. Numerical and experimental study of molten pool behaviour and defect formation in multi-material and functionally graded materials laser powder bed fusion. ADV POWDER TECHNOL 2021. [DOI: 10.1016/j.apt.2021.09.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Parrado RH, Ryan M, Nadig SN, Kasi N. Can We Safely Avoid Nasogastric Feeding in Children with Chronic Liver Disease? an Evaluation of Gastrostomy Tube Placement in a High-risk Population. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.378] [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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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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45
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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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Du W, Gu M, Hu M, Pinchi P, Chen W, Ryan M, Nold T, Bannaga A, Xu H. Lysosomal Zn 2+ release triggers rapid, mitochondria-mediated, non-apoptotic cell death in metastatic melanoma. Cell Rep 2021; 37:109848. [PMID: 34686351 PMCID: PMC8559338 DOI: 10.1016/j.celrep.2021.109848] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 08/16/2021] [Accepted: 09/27/2021] [Indexed: 01/18/2023] Open
Abstract
During tumor progression, lysosome function is often maladaptively upregulated to match the high energy demand required for cancer cell hyper-proliferation and invasion. Here, we report that mucolipin TRP channel 1 (TRPML1), a lysosomal Ca2+ and Zn2+ release channel that regulates multiple aspects of lysosome function, is dramatically upregulated in metastatic melanoma cells compared with normal cells. TRPML-specific synthetic agonists (ML-SAs) are sufficient to induce rapid (within hours) lysosomal Zn2+-dependent necrotic cell death in metastatic melanoma cells while completely sparing normal cells. ML-SA-caused mitochondria swelling and dysfunction lead to cellular ATP depletion. While pharmacological inhibition or genetic silencing of TRPML1 in metastatic melanoma cells prevents such cell death, overexpression of TRPML1 in normal cells confers ML-SA vulnerability. In the melanoma mouse models, ML-SAs exhibit potent in vivo efficacy of suppressing tumor progression. Hence, targeting maladaptively upregulated lysosome machinery can selectively eradicate metastatic tumor cells in vitro and in vivo.
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Affiliation(s)
- Wanlu Du
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, 4104 Biological Sciences Building, 1105 North University Ave., Ann Arbor, MI 48109, USA.
| | - Mingxue Gu
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, 4104 Biological Sciences Building, 1105 North University Ave., Ann Arbor, MI 48109, USA
| | - Meiqin Hu
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, 4104 Biological Sciences Building, 1105 North University Ave., Ann Arbor, MI 48109, USA
| | - Prateeksunder Pinchi
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, 4104 Biological Sciences Building, 1105 North University Ave., Ann Arbor, MI 48109, USA
| | - Wei Chen
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, 4104 Biological Sciences Building, 1105 North University Ave., Ann Arbor, MI 48109, USA
| | - Michael Ryan
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, 4104 Biological Sciences Building, 1105 North University Ave., Ann Arbor, MI 48109, USA
| | - Timothy Nold
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, 4104 Biological Sciences Building, 1105 North University Ave., Ann Arbor, MI 48109, USA
| | - Ahmed Bannaga
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, 4104 Biological Sciences Building, 1105 North University Ave., Ann Arbor, MI 48109, USA
| | - Haoxing Xu
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, 4104 Biological Sciences Building, 1105 North University Ave., Ann Arbor, MI 48109, USA
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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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50
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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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