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Truter P, Flanagan P, Waller R, Richards K, Makate M, Johnstone A, Bongiascia L, Spilsbury K, Cavalheri V, Lin I. Short waits, happy patients and expert care, moving basic musculoskeletal care from the emergency department to a physiotherapist-led diversion pathway. Emerg Med Australas 2024. [PMID: 38622755 DOI: 10.1111/1742-6723.14416] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE Patients with musculoskeletal conditions (MSKCs) are highly prevalent in ED. This project explores the impact of the pilot phase of a 'diversion pathway', which directed patients with MSKCs from the ED waiting room to an outpatient clinic led by advanced-scope physiotherapists. METHODS A prospective intervention study comparing care outcomes between patients in the 'diversion pathway' with usual ED care. The characteristics of patients considered eligible and non-eligible are described. RESULTS Between May and December 2022, 1099 patients were diverted. For diverted patients, mean length of stay (LOS) in ED was reduced by 110 (95% confidence interval [CI]: 99-120) min and 4 h rule compliance improved by 19.3% compared to usual ED care. There were fewer patients who 'did not wait' (DNW) with the diversion pathway. The diverted group was young (median age 22 years and 41% paediatric), mostly low urgency, self-referred and arrived by private transport with minor limb trauma. The diversion pathway triage process appropriately identified 182 patients ineligible for diversion. 96.7% of patients reported satisfaction with care received from the diversion pathway. There was no change in ED representation rates for diverted patients. CONCLUSIONS A new pathway resulted in reduced LOS, reduced DNW, high patient satisfaction and more people being discharged within 4 h for diverted patients compared to usual ED care. The pathway increased ED capacity, improved key ED performance metrics and safely expedited care delivery for patients.
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Affiliation(s)
- Piers Truter
- Physiotherapy Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Physiotherapy Department, Rockingham Peel Group, Perth, Western Australia, Australia
- School of Health Sciences and Physiotherapy, University of Notre Dame, Fremantle, Western Australia, Australia
- South Metropolitan Health Service, Perth, Western Australia, Australia
| | - Pippa Flanagan
- Physiotherapy Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Physiotherapy Department, Rockingham Peel Group, Perth, Western Australia, Australia
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Robert Waller
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Karen Richards
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- St John of God Midland Public and Private Hospital, Perth, Western Australia, Australia
| | - Marshall Makate
- Curtin University School of Public Health, Perth, Western Australia, Australia
| | - Anthony Johnstone
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Luke Bongiascia
- Physiotherapy Department, Rockingham Peel Group, Perth, Western Australia, Australia
| | - Katrina Spilsbury
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Vinicius Cavalheri
- South Metropolitan Health Service, Perth, Western Australia, Australia
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Ivan Lin
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
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Truter P, Attwooll L, Flanagan P, McGinty C, Taylor R, Hince D, Wand BM. Comparing multi-disciplinary low back pain care in the ED to the Australian clinical care standard: The possible influence of profession, experience and back pain beliefs. Int Emerg Nurs 2023; 71:101351. [PMID: 37757581 DOI: 10.1016/j.ienj.2023.101351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/12/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Piers Truter
- Fiona Stanley Hospital, Emergency Department, Perth, Murdoch, WA 6150, Australia; School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA 6160, Australia.
| | - Lydia Attwooll
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA 6160, Australia
| | - Pippa Flanagan
- Fiona Stanley Hospital, Emergency Department, Perth, Murdoch, WA 6150, Australia; School of Allied Health, Curtin University, Perth, WA 6845, Australia
| | - Casey McGinty
- Fiona Stanley Hospital, Emergency Department, Perth, Murdoch, WA 6150, Australia
| | - Rosalind Taylor
- Fiona Stanley Hospital, Emergency Department, Perth, Murdoch, WA 6150, Australia
| | - Dana Hince
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, WA 6160, Australia
| | - Benedict M Wand
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA 6160, Australia
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Flanagan P, Costello L, Alsaleh E, Byrne L, Maguire P, Adams A, Flannery S. Best practice in male urinary catheterization – A systematic review. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00243-3] [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: 12/01/2022] Open
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4
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Flanagan P, McAlpine L, Ramskill S, Smith A, Eglin R, Parry J, Mortimer P. Evaluation of a Combined
HIV-1/2 and HTLV-I/II Assay for Screening Blood Donors. Vox Sang 2017. [DOI: 10.1159/000462936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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5
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Murphy N, O'Mahony B, Flanagan P, Noone D, White B, Bergin C, Norris S, Thornton L. Progression of hepatitis C in the haemophiliac population in Ireland, after 30 years of infection in the pre-DAA treatment era. Haemophilia 2017; 23:712-720. [PMID: 28752601 DOI: 10.1111/hae.13244] [Citation(s) in RCA: 7] [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] [Accepted: 03/10/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Prior to the introduction of viral inactivation of factor concentrates and screening of blood, 225 people with haemophilia became infected with hepatitis C (HCV) in Ireland. AIM Our aim was to assess liver disease progression and mortality in this population after 30 years of infection. METHODS Demographic and clinical data were collected from medical records in five hepatology units and one infectious disease unit retrospectively in 2005, and on four subsequent occasions. RESULTS The participation rate was 73% (165/225). Eighty three percent of patients, who had been tested for RNA (n = 106/128), developed chronic HCV infection. Thirty four percent were co-infected with HIV. All-cause mortality, after approximately 30 years of infection with chronic HCV, was 44% in HIV positive patients and 29% in HIV negative patients. Liver-related mortality was 12.5% and did not vary significantly by HIV status. Thirty seven percent of patients had developed advanced liver disease, including 20% with cirrhosis and 9% with hepatocellular carcinoma. In the pre-interferon-free direct acting antivirals era, 57% (n = 60/106) of patients were treated for HCV, 65% of whom achieved a sustained virological response. Successfully treated patients had few adverse liver outcomes. CONCLUSION After 30 years of infection, 40% of the patients who had evidence of chronic HCV had developed advanced liver disease, such as cirrhosis and HCC, or had died from liver-related causes. This proportion is high relative to similar international cohorts despite good anti-HCV treatment uptake and responses.
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Affiliation(s)
- N Murphy
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | - B O'Mahony
- Irish Haemophilia Society, Dublin, Ireland
| | - P Flanagan
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | - D Noone
- Irish Haemophilia Society, Dublin, Ireland
| | - B White
- St James's Hospital, Dublin, Ireland
| | - C Bergin
- St James's Hospital, Dublin, Ireland
| | - S Norris
- St James's Hospital, Dublin, Ireland
| | - L Thornton
- HSE Health Protection Surveillance Centre, Dublin, Ireland
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Iqbal M, McCormick PA, Cannon M, Murphy N, Flanagan P, Kennelly JE, Thornton L. Long-term follow-up of patients with spontaneous clearance of hepatitis C: does viral clearance mean cure? Ir Med J 2017; 110:582. [PMID: 28952672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Up to 40% of patients with hepatitis C virus (HCV) antibodies are negative for HCV RNA at initial evaluation. If there is a risk of viral re-activation, long term follow-up is required with attendant financial, psychological and medical implications. We investigated the risk of re-activation in the Irish anti-D cohort. Information was obtained from the national hepatitis C database which includes data on patients infected by anti-D immunoglobulin in two large outbreaks, 1977-9 and 1991-94. As part of a screening programme, starting in 1994, 64,907 females exposed to anti-D immunoglobulin were evaluated. Three hundred and forty-seven were found to be antibody positive but HCV RNA negative at initial assessment. 93% had subsequent RNA tests. There was no evidence of HCV recurrence in patients whose infection resolved spontaneously. It appears that two initial sequential negative results for HCV RNA are sufficient to confirm spontaneous viral clearance and probable cure of hepatitis C virus infection.
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Affiliation(s)
- M Iqbal
- National Liver Transplant Unit, St Vincent's University Hospital and University College Dublin
| | - P A McCormick
- National Liver Transplant Unit, St Vincent's University Hospital and University College Dublin
| | - M Cannon
- National Liver Transplant Unit, St Vincent's University Hospital and University College Dublin
| | - N Murphy
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
| | - P Flanagan
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
| | - J E Kennelly
- National Liver Transplant Unit, St Vincent's University Hospital and University College Dublin
| | - L Thornton
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
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Qi Y, Peng J, Lo HC, Holt JR, Willemann M, Gaire C, Evans S, Flanagan P, Yu H, Hu O, Kennett M. In-Situ Boron Doped SiGe Epitaxy Optimization for FinFET Source/Drain. ACTA ACUST UNITED AC 2016. [DOI: 10.1149/07508.0265ecst] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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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Flanagan P, O'Lorcain P, Cotter S, Connell J, Lynch B, Cunney R, O'Flanagan D. Reporting of Acute Flaccid Paralysis in Children under 15 years of age: Improving Surveillance, January 2009 - December 2014. Ir Med J 2016; 109:357. [PMID: 27685691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Acute Flaccid Paralysis (AFP) surveillance, including case investigation and specimen collection is a gold standard method for poliomyelitis surveillance. The expected annual non-polio AFP rate <15 years of age in Ireland is = 1/100 000 population. This study reviewed all cases of AFP reported to the Irish Paediatric Surveillance Unit and the Health Protection Surveillance Centre between January 2009 and December 2014 and compared reporting rates with the expected incidence rate annually. We assessed quality of surveillance data in terms of completeness of investigation for each case reported. Forty-three AFP cases in children <15 years were notified; 35 of which were confirmed. Guillain-Barre Syndrome (GBS) accounted for 48.6% (n=17) of AFP notifications. In 2014, the expected annual AFP target rate was reached. This study identified possible under-reporting of AFP paediatric cases in Ireland between 2009-2013. Completeness of investigations has improved over time, but requires further work.
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Affiliation(s)
- P Flanagan
- Health Protection Surveillance Centre, 25-27 Middle Gardiner St, Dublin 1
| | - P O'Lorcain
- Health Protection Surveillance Centre, 25-27 Middle Gardiner St, Dublin 1
| | - S Cotter
- Health Protection Surveillance Centre, 25-27 Middle Gardiner St, Dublin 1
| | - J Connell
- National Virus Reference Laboratory, UCD, Belfield, Dublin 4
| | - B Lynch
- Department of Paediatric Neurology, Childrens University Hospital, Temple St, Dublin 1
| | - R Cunney
- Health Protection Surveillance Centre, 25-27 Middle Gardiner St, Dublin 1
| | - D O'Flanagan
- Health Protection Surveillance Centre, 25-27 Middle Gardiner St, Dublin 1
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Wang L, Flanagan P, Gleason R, Murphy C, Churilla T, Galloway T. One Size Does Not Fit All: Evaluating the Need for Separate Unilateral and Bilateral Radiation Therapy Normal Tissue Treatment Planning Goals for Oropharynx Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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O'Connor L, Ward M, Bennett D, Mulhall R, O'Lorcain P, Cunney R, McDermott R, Neville E, Heslin J, FitzGerald R, Meyler K, Conlon M, Clarke A, Corcoran B, Fitzpatrick G, O'Connor B, Flanagan P, O'Flanagan D, Cotter S. A prolonged outbreak of invasive meningococcal disease in an extended Irish Traveller family across three Health Service Executive (HSE) areas in Ireland, 2010 to 2013. ACTA ACUST UNITED AC 2015; 20. [PMID: 26062560 DOI: 10.2807/1560-7917.es2015.20.21.21139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Between March 2010 and November 2013 eight laboratory-confirmed cases of serogroup B, invasive meningococcal disease (IMD) were identified in an extended Irish Traveller family across three Health Service Executive (HSE) areas of Ireland. Cases were aged between 5 and 46 months, and were either a cousin or sibling of another case. All eight cases survived. Chemoprophylaxis was given to relevant nuclear family members and close contacts on each occasion, but failed to prevent further cases. Neisseria meningitidis isolates from six cases were highly related, belonging to the ST-41/44 clonal complex, and shared the porA designation 7–2,4. In November 2013, the outbreak control team recommended that directly observed ciprofloxacin chemoprophylaxis be administered simultaneously to the extended family, and that the four component meningococcal B (4CMenB) vaccine be administered to family members aged 2 months to 23 years inclusive and relevant close contacts of the eighth case. Subsequently these recommendations were implemented at three regional clinics. Additionally pharyngeal swabs (n=112) were collected to assess carriage rates of N. meningitidis in this extended family. Pharyngeal carriage of N. meningitidis was detected in 15 (13%) family members. From the epidemiological investigation and carriage study overcrowding was the most likely risk factor identified in this outbreak. To date, the combination of directly observed ciprofloxacin chemoprophylaxis and use of 4CMenB vaccine have controlled the outbreak with no further cases diagnosed.
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Affiliation(s)
- L O'Connor
- Department of Public Health, HSE East, Dr Steevens Hospital, Dublin, Ireland
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Lieberman L, Devine DV, Reesink HW, Panzer S, Wong J, Raison T, Benson S, Pink J, Leitner GC, Horvath M, Compernolle V, Scuracchio PSP, Wendel S, Delage G, Nahirniak S, Dongfu X, Krusius T, Juvonen E, Sainio S, Cazenave JP, Guntz P, Kientz D, Andreu G, Morel P, Seifried E, Hourfar K, Lin CK, O'Riordan J, Raspollini E, Villa S, Rebulla P, Flanagan P, Teo D, Lam S, Ang AL, Lozano M, Sauleda S, Cid J, Pereira A, Ekermo B, Niederhauser C, Waldvogel S, Fontana S, Desborough MJ, Pawson R, Li M, Kamel H, Busch M, Qu L, Triulzi D. Prevention of transfusion-transmitted cytomegalovirus (CMV) infection: Standards of care. Vox Sang 2014; 107:276-311. [DOI: 10.1111/vox.12103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Turner M, Robinson N, Wilkie G, Rivera N, Russell J, Fraser N, Clark D, Barry J, Robertson V, Turner D, Newlands H, Vickers M, van Tilburg C, Flanagan P. Establishment of a bank of blood donor derived epstein barr virus specific T cell lines for treatment of post-transplant lymphoproliferative disease. Cytotherapy 2013. [DOI: 10.1016/j.jcyt.2013.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
BACKGROUND The low, fluctuating levels of DNA characteristic of occult hepatitis B infection make its detection by nucleic acid testing (NAT) a challenge. METHODS Four year's routine use of the Ultrio and Ultrio Plus assays in blood donations in New Zealand was analysed. RESULTS 0·09% of donations tested with Ultrio and Ultrio Plus assays showed reactivity in the multiplex assay, but non-reactivity in all three discriminatory assays and relevant mandatory serological assays (anti-HIV, anti-HCV, HBsAg). These donations were more likely to be anti-HBc reactive (Ultrio, 13%; Ultrio Plus, 57%; random donors, 6·8%). Thirty-four per cent of these anti-HBc-reactive donations were also reactive in either an alternate NAT assay or on repeat multiplex testing. Thirteen per cent of the donors of the discriminatory-negative, anti-HBc-reactive donations who had given other Ultrio- or Ultrio Plus-tested donations had at least one other multiplex reactive donation. CONCLUSION These findings suggest that their HBV DNA levels are around the assay's limit of detection, that false reactivity cannot be presumed when a donor fails to discriminate and that caution should be applied when deciding whether to continue accepting donations from such donors.
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Affiliation(s)
- R Charlewood
- New Zealand Blood Service, Auckland, New Zealand.
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Price R, Koren S, Hossain M, Veltchev I, Galloway T, Flanagan P, Ma C. SU-E-T-554: PTV to Skin Proximity for Head and Neck IMRT Treatment Planning. Med Phys 2012; 39:3833. [DOI: 10.1118/1.4735643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Benjamin RJ, Bianco C, Goldman M, Seed CR, Yang H, Lee J, Keller AJ, Wendel S, Biagini S, Murray J, Devine DV, Zhu Y, Turek P, Moftah FM, Kullaste R, Pillonel J, Danic B, Bigey F, Folléa G, Seifried E, Mueller MM, Lin CK, Makroo RN, Grazzini G, Pupella S, Velati C, Tadokoro K, Bravo Lindoro A, D’Artote González A, Giner VT, Flanagan P, Olaussen RW, Letowska M, Rosiek A, Poglod R, Zhiburt E, Mali P, Rozman P, Gulube S, Castro Izaguirre E, Ekermo B, Barnes SM, McLaughlin L, Eder AF, Panzer S, Reesink HW. Deferral of males who had sex with other males. Vox Sang 2011; 101:339-67. [DOI: 10.1111/j.1423-0410.2011.01489.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Roth WK, Busch MP, Schuller A, Ismay S, Cheng A, Seed CR, Jungbauer C, Minsk PM, Sondag-Thull D, Wendel S, Levi JE, Fearon M, Delage G, Xie Y, Jukic I, Turek P, Ullum H, Tefanova V, Tilk M, Reimal R, Castren J, Naukkarinen M, Assal A, Jork C, Hourfar MK, Michel P, Offergeld R, Pichl L, Schmidt M, Schottstedt V, Seifried E, Wagner F, Weber-Schehl M, Politis C, Lin CK, Tsoi WC, O'Riordan J, Gottreich A, Shinar E, Yahalom V, Velati C, Satake M, Sanad N, Sisene I, Bon AH, Koppelmann M, Flanagan P, Flesland O, Brojer E, Lętowska M, Nascimento F, Zhiburt E, Chua SS, Teo D, Stezinar SL, Vermeulen M, Reddy R, Park Q, Castro E, Eiras A, Gonzales Fraile I, Torres P, Ekermo B, Niederhauser C, Chen H, Oota S, Brant LJ, Eglin R, Jarvis L, Mohabir L, Brodsky J, Foster G, Jennings C, Notari E, Stramer S, Kessler D, Hillyer C, Kamel H, Katz L, Taylor C, Panzer S, Reesink HW. International survey on NAT testing of blood donations: expanding implementation and yield from 1999 to 2009. Vox Sang 2011; 102:82-90. [PMID: 21933190 DOI: 10.1111/j.1423-0410.2011.01506.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Newton C, Fisher S, Flanagan P. Development of national audit tools for hospice community services. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000105.26] [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: 11/04/2022]
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Rodgers C, Flanagan P, Thompson A. Pooling resources to drive quality; the evolution of the National Audit Tools Group (NATG). BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000105.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Askar M, Flanagan P, Rybicki L, Kalaycio M, Pohlman B, Andresen S, Dean R, Duong H, Copelan E, Bolwell B, Sobecks R. The T-Cell Epitope (TCE) Algorithm for Classifying HLA-DPB1 Mismatches Does Not Predict Clinical Outcomes in HSCT. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.220] [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: 10/18/2022]
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Devine DV, Sher GD, Reesink HW, Panzer S, Hetzel PAS, Wong JK, Horvath M, Leitner GC, Schennach H, Nussbaumer W, Genoe K, Cioffi JM, Givisiez FN, Rogerson M, Howe D, Delage G, Sarappa C, Fu Y, Sarlija D, Vuk T, Strauss Patko M, Balija M, Jukić I, Ali A, Auvinen MK, Jaakonsalo E, Cazenave JP, Waller C, Kientz D, David B, Walther-Wenke G, Heiden M, Lin CK, Tsoi WC, Lee CK, Barotine-Toth K, Sawant RB, Murphy W, Quirke B, Bowler P, Shinar E, Yahalom V, Aprili G, Piccoli P, Gandini G, Tadokaro K, Nadarajan VS, de Kort W, Jansen N, Flanagan P, Forsberg PO, Hervig T, Letowska M, Lachert E, Dudziak K, Antoniewicz-Papis J, de Olim G, Nascimento F, Hindawi S, Teo D, Reddy R, Scholtz J, Swanevelder R, Rovira LP, Sauleda S, Carasa MAV, Vaquero MP, Ania MA, Gulliksson H, Holdsworth S, Cotton S, Howell C, Baldwin C, Cusick RM, Geele GA, Paden C, McEvoy P, Gottschall JL, McLaughlin LS, Benjamin RJ, Eder A, Draper NL, AuBuchon JP, León de González G. Inventory management. Vox Sang 2010; 98:e295-363. [PMID: 20432515 DOI: 10.1111/j.1423-0410.2009.01252.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A critical aspect of blood transfusion is the timely provision of high quality blood products. This task remains a significant challenge for many blood services and blood systems reflecting the difficulty of balancing the recruitment of sufficient donors, the optimal utilization of the donor's gift, the increasing safety related restrictions on blood donation, a growing menu of specialized blood products and an ever-growing imperative to increase the efficiency of blood product provision from a cost perspective. As our industry now faces questions about our standard practices including whether or not the age of blood has a negative impact on recipients, it is timely to take a look at our collective inventory management practices. This International Forum represents an effort to get a snap shot of inventory management practices around the world, and to understand the range of different products provided for patients. In addition to sharing current inventory management practices, this Forum is intended to foster an exchange of ideas around where we see our field moving with respect to various issues including specialty products, new technologies, and reducing recipient risk from blood transfusion products.
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Reesink HW, Panzer S, Gonzalez CA, Lena N, Muntaabski P, Gimbatti S, Wood E, Lambermont M, Deneys V, Sondag D, Alport T, Towns D, Devine D, Turek P, Auvinen MK, Koski T, Lin CK, Lee CK, Tsoi WC, Lawlor E, Grazzini G, Piccinini V, Catalano L, Pupella S, Kato H, Takamoto S, Okazaki H, Hamaguchi I, Wiersum-Osselton JC, Van Tilborgh AJW, Zijlker-Jansen PY, Mangundap KM, Schipperus MR, Dinesh D, Flanagan P, Flesland Ø, Steinsvåg CT, Espinosa A, Letowska M, Rosiek A, Antoniewicz-Papis J, Lachert E, Koh MBC, Alcantara R, Corral Alonso M, Muñiz-Diaz E. Haemovigilance for the optimal use of blood products in the hospital. Vox Sang 2010; 99:278-93. [DOI: 10.1111/j.1423-0410.2010.01323.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bettelheim D, Panzer S, Reesink HW, Csapo B, Pessoa C, Guerra F, Wendel S, Calda P, Sprogøe U, Dziegiel M, Aitokallio-Tallberg A, Koskinen S, Kuosmanen M, Legler TJ, Stein W, Villa S, Villa MA, Trespidi L, Acaia B, Vandenbussche FPHA, Brand A, De Haas M, Kanhai HHH, Gounder D, Flanagan P, Donegan R, Parry E, Sefonte C, Skulstad SM, Hervig T, Flesland Ø, Żupańska B, Uhrynowska M, Lapaire O, Zhong XY, Holzgreve W. Monitoring and treatment of anti-D in pregnancy. Vox Sang 2010; 99:177-92. [DOI: 10.1111/j.1423-0410.2010.01322.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Flanagan P. Emerging infections in Asia and its possible global effects. ISBT Science Series 2009; 4:188-191. [PMID: 32328163 PMCID: PMC7169329 DOI: 10.1111/j.1751-2824.2009.01236.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- P Flanagan
- National Medical Director, New Zealand Blood Service, Auckland, New Zealand
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English S, Katzourakis A, Flanagan P, Duda A, Francis J, Matthews P, Prendergast A, Goulder P, Fidler S, Weber J, McClure M, Phillips R, Frater J. P07-09. Contemporaneous transmission of genetically distinct HIV variants from a single donor to two recipients. Retrovirology 2009. [PMCID: PMC2767590 DOI: 10.1186/1742-4690-6-s3-p107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Reesink HW, Engelfriet CP, Schennach H, Gassner C, Wendel S, Fontão-Wendel R, de Brito MA, Sistonen P, Matilainen J, Peyrard T, Pham BN, Rouger P, Le Pennec PY, Flegel WA, von Zabern I, Lin CK, Tsoi WC, Hoffer I, Barotine-Toth K, Joshi SR, Vasantha K, Yahalom V, Asher O, Levene C, Villa MA, Revelli N, Greppi N, Marconi M, Tani Y, Folman CC, de Haas M, Koopman MMW, Beckers E, Gounder DS, Flanagan P, Wall L, Aranburu Urtasun E, Hustinx H, Niederhauser C, Flickinger C, Nance SJ, Meny GM. Donors with a rare pheno (geno) type. Vox Sang 2008; 95:236-53. [PMID: 19121189 DOI: 10.1111/j.1423-0410.2008.01084.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Reesink HW, Engelfriet CP, Hyland CA, Coghlan P, Tait B, Wsolak M, Keller AJ, Henn G, Mayr WR, Thomas I, Osselaer JC, Lambermont M, Beaten M, Wendel S, Qiu Y, Georgsen J, Krusius T, Mäki T, Andreu G, Morel P, Lefrère JJ, Rebulla P, Giovanelli S, Butti B, Lecchi L, Mozzi F, Van Hilten JA, Zwaginga JJ, Flanagan P, Flesland Ø, Brojer E, Łętowska M, Åkerblom O, Norda R, Prowse C, Dow B, Jarvis L, Davidson F, Kleinman S, Bianco C, Stramer SL, Dodd RY, Busch MP. Biobanks of blood from donors and recipients of blood products. Vox Sang 2008; 94:242-260. [PMID: 18225990 DOI: 10.1111/j.1423-0410.2007.01020.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Flanagan P. Product traceability and lookback: assuring the integrity of the transfusion process. Dev Biol (Basel) 2007; 127:225-33. [PMID: 17486896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- P Flanagan
- New Zealand Blood Service, Auckland, New Zealand.
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Freeman SRM, Mitra S, Malik TH, Flanagan P, Selby P. Expression of somatostatin receptors in arginine vasopressin hormone-secreting olfactory neuroblastoma--report of two cases. Rhinology 2005; 43:61-5. [PMID: 15844504] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE Arginine vasopressin hormone-secreting olfactory neuroblastomas are extremely rare, with fewer than twenty cases reported in the literature. Two of these cases, both initially presenting with the syndrome of inappropriate antidiuretic hormone, are presented. The second tumour was successfully identified using somatostatin receptor (octreotide) radiographic scintography. METHOD The pathological specimens from both cases were examined immunohistochemically for somatostatin receptors. RESULTS Samples from both cases demonstrated positivity for somatostatin receptors. CONCLUSIONS This report demonstrates the potential use of somatastatin analogues in the investigation, follow-up and treatment of patients with olfactory neuroblastoma.
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Affiliation(s)
- S R M Freeman
- Department of Otolaryngology, Manchester Royal Infirmary, Manchester, UK
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Hill S, Flanagan P. Is 10iu/L anti-HBs protective after hepatitis B vaccination? Commun Dis Public Health 2004; 7:227-8. [PMID: 15481218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Boone D, Eisenbraun E, Flanagan P, Grigsby R. Correction. The Acid-Catalyzed Alkylation and Cyclialkylation of the Cymenes with Isobutylene and Related olefins. J Org Chem 2003. [DOI: 10.1021/jo00822a622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Reesink HW, Engelfriet CP, Muylle L, Wendel S, Dickmeiss E, Krusius T, Mäki T, Lin CK, O'Riordan J, Prati D, Rebulla P, Shirato T, Nakajima K, Dupuis HM, Flanagan P, Carasa MAV, Gallastegui RA, Turek P, Hewitt P, Bernat JL, Bianco C, Dodd RY, Klein HG. Future counselling of donors and recipients of blood products concerning prion-related diseases. Vox Sang 2003; 85:126-48. [PMID: 12925171 DOI: 10.1046/j.1423-0410.2003.00343.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- H W Reesink
- Sanquin Blood Bank Region North-West, Amsterdam, The Netherlands.
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Engelfriet CP, Reesink HW, Klein HG, AuBuchon JP, Strauss RG, Krusius T, Mäki T, Rebulla P, Högman CF, Knutson F, Letowska M, Dickmeiss E, Winter M, Henn G, Menichetti E, Mayr WR, Flanagan P, Martin-Vega C, Massuet L, Wendel S, Turek P, Lin CK, Shirato T. The future use of pathogen-inactivated platelet concentrates. Vox Sang 2003; 85:54-66. [PMID: 12823735 DOI: 10.1046/j.1423-0410.2003.00315.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Drobniewski F, Strutt M, Smith G, Magee J, Flanagan P. Audit of scope and culture techniques applied to samples for the diagnosis of Mycobacterium bovis by hospital laboratories in England and Wales. Epidemiol Infect 2003; 130:235-7. [PMID: 12733491 PMCID: PMC2869970 DOI: 10.1017/s0950268802008105] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This audit examines the ability of English and Welsh laboratories to diagnose Mycobacterium bovis infection. All 164 clinical laboratories submitting samples to the PHLS Mycobacterium Reference Unit and Regional Centres for Mycobacteriology were surveyed. Twenty per cent of responding centres did not use a pyruvate-containing medium or incubate for the minimum recommended period of 8 weeks. This study demonstrates the potential for the underdiagnosis of M. bovis infection in England and Wales. Possible reasons for underdiagnosis are discussed together with strategies to optimize recovery of M. bovis.
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Affiliation(s)
- F Drobniewski
- PHLS Mycobacterium Reference Unit, South London Public Health Laboratory, Department of Infection Guy's, King's & St. Thomas' School of Medicine, Kings College Hospital (Dulwich), East Dulwich Grove, London SE22 8QF, UK
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Reesink HW, Engelfriet CP, Tegtmeier GE, O'Riordan J, Eglin R, Barbara JAJ, Flanagan P, Lin CK, Rawlinson W, Muylle L, Wendel S, Biagini S, Lazar AE, Krusius T, Alitupa E, Grillner L, Preiser W, Doerr HW, Brand A, Zupanska B, Brojer E, Degré M. Prevention of post-transfusion cytomegalovirus: leucoreduction or screening? Vox Sang 2002; 83:72-87. [PMID: 12100393 DOI: 10.1046/j.1423-0410.2002.t01-1-01851.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- H W Reesink
- Blood Bank North Holland (Sanquin) Plesmanlaan 125 NL - 1066 CX Amsterdam, The Netherlands
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Djuretic T, Herbert J, Drobniewski F, Yates M, Smith EG, Magee JG, Williams R, Flanagan P, Watt B, Rayner A, Crowe M, Chadwick MV, Middleton AM, Watson JM. Antibiotic resistant tuberculosis in the United Kingdom: 1993-1999. Thorax 2002; 57:477-82. [PMID: 12037221 PMCID: PMC1746361 DOI: 10.1136/thorax.57.6.477] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The re-emergence of tuberculosis as a global health problem over the past two decades, accompanied by an increase in tuberculosis drug resistance, prompted the development of a comprehensive national surveillance system for tuberculosis drug resistance in 1993. METHODS The UK Mycobacterial Resistance Network (Mycobnet), which includes all mycobacterial reference and regional laboratories in the UK, collects a minimum dataset on all individuals from whom an initial isolate of Mycobacterium tuberculosis complex has been isolated and submitted by source hospital laboratories. Data sought include susceptibility to first line antibiotics, demographic, geographical, and risk factor information. RESULTS There were 25 217 reports of initial isolates of M tuberculosis complex in the UK between 1993 and 1999. All were tested for sensitivity to isoniazid, rifampicin, and ethambutol and 12 692 of the isolates were also tested for sensitivity to pyrazinamide and streptomycin. A total of 1523 (6.1%) isolates were resistant to one or more drugs, 1397 isolates (5.6%) were resistant to isoniazid with or without resistance to other drugs, and 299 (1.2%) were multidrug resistant. Although the numbers of drug resistant isolates increased over the period, the proportions remained little changed. Certain groups of people were at a higher risk of acquiring drug resistant tuberculosis including younger men, residents of London, foreign born subjects, patients with a previous history of tuberculosis and those infected with HIV. CONCLUSION Although the proportion of drug resistant tuberculosis cases appears to be stable in the UK at present, more than one in 20 patients has drug resistant disease at diagnosis and more than one in 100 has multidrug resistant disease. Tuberculosis control measures should be strengthened to minimise the emergence of drug resistance through rapid diagnosis, rapid identification of drug resistance, supervised treatment, and maintenance of comprehensive surveillance.
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Affiliation(s)
- T Djuretic
- Public Health Laboratory Service Communicable Disease Surveillance Centre, London NW9 5EQ, UK
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Engelfriet CP, Reesink HW, Pietersz RN, Schwartz DW, Mayr WR, Blajchman MA, Goldman M, Décary F, Sher G, Georgsen J, Sprogøe-Jakobsen U, Kekomäki R, Kühnl P, Seitz R, Maniatis A, Pintér J, Baróti K, Shinar E, Rebulla P, Greppi N, Sirchia G, Faber JC, Flanagan P, Brand A, Lêtowska M, Nel T, Argelagues E, Martin-Vega C, AuBuchon JP, Williamson L, Wallington T. Universal leucocyte-depletion of blood components: cell concentrates and plasma. Vox Sang 2001; 81:56-77. [PMID: 11520421 DOI: 10.1046/j.1423-0410.2001.00043.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- C P Engelfriet
- Central Laboratory, Netherlands Red Cross, Blood Transfusion Service, Amsterdam, The Netherland
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43
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Engelfriet CP, Reesink HW, de Lange GG, Flanagan P, Solheim BG, Akerblom O, Messeter L, James V, Bruce M, O'Riordan J, Murphy W, Schönitzer D, Mayr WR, Henn G, L'Herminez PC, Kühnl P, Kluge A, Mozzi F, Rebulla F, Sirchia P, Carbonell-Uberos F, Medgyesi G, Pisacka M, Letowska M, Gustafson M, Ganz P, Rees JW, Décary F, Wendel S, Rodrigues Almeida PT, Lin CK, Tadokoro K. Quality assurance, quality control and accreditation. Vox Sang 2001; 79:253-64. [PMID: 11206090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Engelfreit CP, Reesink HW, Krusius T, Wendel S, Fontäo-Wendel R, Hoffer I, Medgyesi G, Tadokoro K, Pisacka M, Kühnl P, Schwartz DW, Mayr WR, Schönitzer D, Lin CK, James V, Castel A, Hazenberg CA, Letowska M, Solheim BG, Guerts M, Ghosh S, Flanagan P, Epstein J, Säfwenberg J, Riccardi D, Sirchia G. The use of the computer cross-match. Vox Sang 2001; 80:184-92. [PMID: 11449959 DOI: 10.1046/j.1423-0410.2001.00032.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- C P Engelfreit
- Central Laboratory of the Blood Transfusion Service (Sanquin) Plesmanlaan 125, NL-1066 CX Amsterdam, The Netherlands
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Abstract
OBJECTIVE To review the current practice of adolescent health care providers when an adolescent reports a negative or uncertain history of chickenpox in order to provide information for future practice. METHODS Retrospective chart review of a sample of patients seen in a hospital-based adolescent primary care clinic between 1996 and 1999. RESULTS Among adolescents who reported a positive history of chickenpox (190 patients, aged 15 +/- 1 years), varicella occurred before age 5 years in 30%, between 5 and 10 years in 56%, and at older than age 10 years in 14% of the patients. When adolescents reported a negative or uncertain history of varicella (55 patients, aged 15 +/- 1 years), serotesting was ordered for the majority (73%) of cases, while only 16% were presumptively vaccinated with varicella vaccine. In six patients no intervention was noted in the charts, and these patients were contacted. In 80% of the patients who were serotested, varicella IgG titers of > or = 1:32 indicated a previous unnoticed infection and lifelong immunity to varicella. In only 20% of the patients sera were negative for varicella IgG titer, requiring varicella vaccination. There was no statistical difference between the number of siblings of patients with a positive serologic test (3 +/- 1) and the number of siblings of seronegative patients (2 +/- 1, p = 0.41). Seven of the eight seronegative patients consented to varicella vaccination and were vaccinated within 10 months of serotesting. CONCLUSIONS These data support the practice of serotesting for a previously unnoticed varicella infection rather than presumptive vaccination in the adolescent age group. A follow-up vaccination of seronegative adolescents should be scheduled as close to serotesting as possible.
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Affiliation(s)
- Z Harel
- Division of Adolescent Medicine, Hasbro Children's Hospital, Providence, Rhode Island 02903, USA
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Reesink HW, Engelfriet CP, Vrielink H, Krusius T, Lankinen M, Flanagan P, Barbara J, Gill P, Dodd RY, Busch MP, Prati D, Mozzi F, Sirchia G, Diekamp U, Epstein JS, Tabor E, Martin-Vega C, Hernândez JM. Consequences of nucleic acid amplification testing for blood transfusion centres. Vox Sang 2000; 74:263-70. [PMID: 9691411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Flanagan P. Genomic screening of blood donations - the new dawn arrives. Vox Sang 2000; 76:135-7. [PMID: 10341326 DOI: 10.1159/000031037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Eberle G, McAnally KI, Martin RL, Flanagan P. Localization of amplitude-modulated high-frequency noise. J Acoust Soc Am 2000; 107:3568-71. [PMID: 10875404 DOI: 10.1121/1.429428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Abstract
A nonpreemptive queuing system based upon operations management theory is used to evaluate expected steady state wait periods for traditional and distributed CT scheduling models. Both models are constructed using two classes of patient service--emergent and nonemergent. The former model uses only one point of service per scanner while the latter employs multiple points of service in order to accomplish all of the functions necessary to complete a CT scan. Sample data are drawn from a tertiary care hospital-based system using a traditional service model. Comparison of a traditional and distributed service system, each with emergent and nonemergent service classes, shows that breaking as many activities as possible out of the scanner should provide substantial improvements in cost efficiency and service for patients having CT scans. Nonemergent patients may experience as much as an 89% reduction in steady-state wait times while emergent patients may experience as much as a 59% reduction in wait times. The cost efficiencies recognized either through increased scanner utilization or reduced scanner needs, even with only modest improvements, should more than offset any additional personnel needed to implement a distributed model. Proper implementation of a distributed scheduling model for CT scanning can provide substantial cost efficiencies and improvements in service for both nonemergent and emergent CT scans.
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Affiliation(s)
- W R Reinus
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Abstract
Mycobacterium chelonae was isolated from the blood of four immunosuppressed patients over a period of 10 weeks. Three patients had intravascular catheters in situ and the other had a biliary stent. All presented with recurrent fever despite treatment with broad-spectrum antibiotics. Blood cultures using standard bacteriological medium yielded a gram-positive bacillus from each patient. Ziehl-Neelsen staining of these cultures demonstrated a branching acid-fast bacillus that was subsequently identified as Mycobacterium chelonae in each case. The isolates were sensitive to clarithromycin and, although success of treatment with clarithromycin monotherapy has been variable, this antibiotic combined with removal of the intravascular catheters was used to treat those three patients. The treatment was successful with no recurrence of symptoms after 12 months of follow-up. The patient with the biliary stent died soon after Mycobacterium chelonae was isolated. Pyrolysis mass spectrometry analysis indicated the isolates were of two distinct strains. Radiological insertion of the Hickman lines and biliary stent was implicated epidemiologically as the source of infection.
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Affiliation(s)
- D McCracken
- Regional Centre for Mycobacteriology, Department of Microbiology and Public Health Laboratory, University Hospital of Wales, Cardiff, UK.
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