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Massey BJ, Grandeo J, Favaro L, Bliss R, Gagnon K, Young JL. Physical therapy students' application of an imaging decision rule for acute knee pain. Physiother Theory Pract 2023:1-11. [PMID: 37128903 DOI: 10.1080/09593985.2023.2206482] [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] [Indexed: 05/03/2023]
Abstract
BACKGROUND Evidence supports direct referral for imaging by physical therapists. Accuracy and self-efficacy for imaging decisions have not been investigated in entry-level doctor of physical therapy (DPT) students. OBJECTIVE The purpose of this study was to understand the relationship between entry-level DPT instruction and accuracy and self-efficacy for imaging referral due to acute knee trauma. A second purpose was to identify relationships between accuracy and self-efficacy. METHODS An online survey was sent via e-mail to program directors in accredited DPT programs in the United States with an invitation to forward the survey to DPT students. The survey captured demographic information and included five questions that assessed the respondent's ability to apply the Ottawa Knee Rules (OKR). Self-efficacy was assessed using the Physiotherapist Student Self-Efficacy (PSE) questionnaire, a self-rated 5-point Likert scaled tool. RESULTS Of 240 surveys, DPT students who completed imaging coursework had greater accuracy and higher self-efficacy (68.0% correct (95% CI, 63.6-72.5), PSE = 3.67, P < .001) compared to students who had not (45.8% correct (95% CI, 40.8-50.7), PSE = 2.67, P < .001). Conclusion: Accuracy by DPT students who completed imaging coursework was significantly improved and comparable to values from autonomous providers.
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Affiliation(s)
- B James Massey
- Doctor of Science Program in Physical Therapy, Bellin College, Green Bay, WI, USA
- Department of Physical Therapy, Wingate University, Wingate, NC, USA
| | - Jason Grandeo
- Doctor of Science Program in Physical Therapy, Bellin College, Green Bay, WI, USA
- School of Physical Therapy, University of Lynchburg, Lynchburg, VA, USA
| | - Laura Favaro
- Doctor of Science Program in Physical Therapy, Bellin College, Green Bay, WI, USA
- Department of Physical Therapy, Daemen University, Amherst, NY, USA
| | - Rebecca Bliss
- Doctor of Science Program in Physical Therapy, Bellin College, Green Bay, WI, USA
- School of Physical Therapy, University of Lynchburg, Lynchburg, VA, USA
- Department of Physical Therapy, University of Missouri, Columbia, MO, USA
| | - Kendra Gagnon
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jodi L Young
- Doctor of Science Program in Physical Therapy, Bellin College, Green Bay, WI, USA
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2
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Reaves T, Bliss R, Chole D, Bridges J. Team Approach to Delayed Pediatric Vestibular Diagnosis: A Case Study. Pediatr Phys Ther 2023:00001577-990000000-00052. [PMID: 37071883 DOI: 10.1097/pep.0000000000001022] [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: 04/20/2023]
Abstract
BACKGROUND AND PURPOSE This report highlights the challenges of diagnosing pediatric vestibular neuritis following dental treatment and addressing fear avoidance behaviors. CASE DESCRIPTION An 11-year-old boy came to physical therapy with vestibular dysfunction following dental treatment that was unable to be diagnosed by emergency department staff. The participant received multispecialty treatment for 6 weeks. MEASUREMENTS Computerized Dynamic Posturography, Limits of Stability, Dizziness Handicap Inventory, Functional Gait Assessment, Dynamic Visual Acuity, and Modified Clinical Test of Sensory Interaction on Balance. OUTCOMES Most notable improvements were seen in Limits of Stability and Computerized Dynamic Posturography. The participant made a full return to school and sport. CONCLUSIONS The difficulty of pediatric vestibular neuritis diagnosis led to fear avoidance behaviors that were addressed by a collaborative specialty approach. WHAT THIS ADDS TO EVIDENCE This is the first documented case of pediatric vestibular neuritis as a complication of a dental procedure with intervention focused on fear avoidance behaviors.
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Affiliation(s)
- Tyler Reaves
- Department of Physical Therapy, University of Missouri School of Health Professions, Columbia, Missouri
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3
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Thomas J, Weiss S, Bliss R, Guess T. Serial Subtraction Alters Lateral Step-down Tibiofemoral Kinematics in Healthy Adults. Int J Sports Med 2023; 44:286-291. [PMID: 36669524 DOI: 10.1055/a-1982-9978] [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: 01/22/2023]
Abstract
This study evaluated the effects of two types of cognitive dual-tasking on three-dimensional knee kinematics during the lateral step-down. 19 healthy individuals (22.05±1.61 yrs., 173.92±9.21 cm, 67.99±12.65 kg) participated in this study. Participants completed 5 repetitions of a lateral step-down task for each leg and each testing condition (control, Stroop, and serial subtraction by seven). An electromagnetic motion sensor was attached to the femur via compression clamp placed about the medial and lateral epicondyles. Another sensor was attached 2 cm below the ipsilateral tibial tuberosity. A custom MATLAB algorithm located the knee joint axis of rotation from dynamic knee flexion and extension. Discrete kinematics at peak flexion were used in this study. Paired samples t-tests were used to compare average frontal, transverse, and sagittal plane knee position at maximum flexion between conditions for each leg. No significant differences were found for either limb between control and Stroop conditions. Comparisons revealed significant differences in frontal and transverse plane knee angles at peak flexion between the control and serial subtraction by seven conditions. These findings indicate serial subtraction by seven requires different cognitive processing abilities which may cause greater interference with some aspects of motor control.
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Affiliation(s)
- Jacob Thomas
- School of Health Professions, University of Missouri, Columbia, United States
| | - Samantha Weiss
- Department of Engineering, University of Missouri, Columbia, United States
| | - Rebecca Bliss
- Department of Physical Therapy, University of Missouri, Columbia, United States
| | - Trent Guess
- Department of Physical Therapy, University of Missouri, Columbia, United States.,Department of Orthopaedic Surgery, University of Missouri, Columbia, United States
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4
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Miller K, Weitzel KJ, Bliss R, Duren DL, Ball SD, Baker B. Older adults who resistance train improve physical function and adopt long-term exercise habits despite COVID-19 restrictions. J Sports Sci 2022; 40:2128-2135. [PMID: 36436017 DOI: 10.1080/02640414.2022.2140912] [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] [Indexed: 11/28/2022]
Abstract
Exercise interventions targeting older adults often focus on acute changes, but lasting improvements require the adoption of long-term, independent exercise habits. This study aimed to assess the influence of eight-weeks of resistance training (SSSH) on clinically relevant fall-risk indicators in older adults and to evaluate if SSSH participation altered independent exercise engagement 12 months later. Sixty adults aged 50 yrs+ were randomised into SSSH, Walk, or Control groups and completed questionnaires and muscle strength and flexibility tests pre/post 8 weeks. SSSH and Walk met 2x/wk for 60 min. Twelve months later 24 participants also completed a follow-up survey amid COVID-19 restrictions. Eight-week group changes were analysed using one-way ANOVA with Bonferroni post hoc analyses, and survey responses were compared using paired t-tests with a Bonferroni correction. SSSH demonstrated greater absolute changes over 8 weeks in sleep quality, activity engagement, 30-second-sit-to-stand and upper-body flexibility than Walk or Controls (p < 0.05). Twelve months later, SSSH participants reported significantly increasing independent resistance (+68), aerobic (+125) and flexibility (+26) training minutes per week (all p < 0.01). In conclusion, SSSH reduced fall risk in 8 weeks and sparked older adults to begin and sustain positive exercise habits 12 months later, despite COVID-19 restrictions.
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Affiliation(s)
- Kristin Miller
- Department of Physical Therapy, University of Missouri, Columbia, USA.,Office of Extension and Engagement, University of Missouri, Columbia, USA
| | - Kelsey J Weitzel
- Department of Physical Therapy, University of Missouri, Columbia, USA.,Office of Extension and Engagement, University of Missouri, Columbia, USA
| | - Rebecca Bliss
- Department of Physical Therapy, University of Missouri, Columbia, USA
| | - Dana L Duren
- Department of Orthopaedic Surgery and the Thompson Laboratory for Regenerative Orthopaedics at the Missouri Orthopaedic Institute, University of Missouri, Columbia, USA.,Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, USA
| | - Stephen D Ball
- Department of Physical Therapy, University of Missouri, Columbia, USA.,Office of Extension and Engagement, University of Missouri, Columbia, USA
| | - Breanne Baker
- Department of Orthopaedic Surgery and the Thompson Laboratory for Regenerative Orthopaedics at the Missouri Orthopaedic Institute, University of Missouri, Columbia, USA.,Musculoskeletal Adaptations to Aging and eXercise Lab at Oklahoma State University, USA
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5
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Guess TM, Bliss R, Hall JB, Kiselica AM. Comparison of Azure Kinect overground gait spatiotemporal parameters to marker based optical motion capture. Gait Posture 2022; 96:130-136. [PMID: 35635988 DOI: 10.1016/j.gaitpost.2022.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Instrumented measurement of spatiotemporal parameters during walking can provide valuable information on an individual's overall function and health. Efficient, inexpensive, and accurate measurement of overground walking spatiotemporal parameters would be a critical component of providing point-of-care assessments of gait function, concussion recovery, fall-risk, and cognitive decline. Depth cameras combined with skeleton pose tracking algorithms, such as the Microsoft Kinect with body tracking software, have been used to measure walking spatiotemporal parameters. However, the ability of the latest generation Microsoft Kinect sensor, the Azure Kinect, to accurately measure overground walking spatiotemporal parameters has not been evaluated in the literature. RESEARCH QUESTION The purpose of this work was to compare overground walking spatiotemporal parameters measurements from a 12 camera Vicon optical motion capture system to measurements of a single Azure Kinect with body tracking SDK (software development kit). METHODS Spatiotemporal parameters of overground walking were simultaneously collected on twenty young healthy participants. Stride length, stride time, step length and step width were derived from ankle joint center locations and measurements from the two instruments were compared using descriptive statistics, scatter plots, Pearson correlation analyses, and Bland-Altman analyses. RESULTS Pearson correlation coefficients were greater than 0.87 for all spatiotemporal parameters with most parameters demonstrating very strong (> 0.9) agreement. The mean of the differences for stride length between measurements was 35.6 mm for the left limb and 39.1 mm for the right limb, both of which are less than 3% of average stride length. Mean of the differences for step width and stride time were less than 2% and 1% of their averages respectively. SIGNIFICANCE A single Microsoft Azure Kinect with body tracking SDK can provide clinically relevant measurement of walking spatiotemporal parameters, providing accessible and objective measurements that can improve clinical decision making across a variety of patient populations.
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Affiliation(s)
- Trent M Guess
- Department of Physical Therapy, University of Missouri, Columbia, MO, USA; Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.
| | - Rebecca Bliss
- Department of Physical Therapy, University of Missouri, Columbia, MO, USA
| | - Jamie B Hall
- Department of Physical Therapy, University of Missouri, Columbia, MO, USA
| | - Andrew M Kiselica
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
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6
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Thomas J, Hall JB, Bliss R, Guess TM. Comparison of Azure Kinect and optical retroreflective motion capture for kinematic and spatiotemporal evaluation of the sit-to-stand test. Gait Posture 2022; 94:153-159. [PMID: 35334335 DOI: 10.1016/j.gaitpost.2022.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The sit-to-stand test (STS) is commonly used to evaluate functional capabilities within a variety of clinical populations. Traditionally STS is a timed test, limiting the depth of information which can be gained from its evaluation. The Azure Kinect has the potential to add in-depth analysis to STS. Despite these potential benefits, the recently released (2019) Azure Kinect has yet to be evaluated for its ability to accurately assess STS. RESEARCH QUESTIONS Purposes of this work were to compare data captured during STS using both a 12 camera Vicon motion capture system and the Azure Kinect; and to calculate kinematic and spatiotemporal variables related to the four phases of the STS cycle. METHODS Spatiotemporal and kinematic measures for STS were simultaneously collected by both devices for 15 participants. Cycle waveforms were compared for right and left hip and knee flexion/extension angular displacement, right and left hip and knee flexion/extension angular velocity, and knee-to-ankle separation ratio. Evaluated discrete outcome variables included: phase time points, maximum knee extension velocity from phases 3 to 4, medial-lateral pelvic sway range, and total time to completion. Waveform summary data were compared using R, R2, and RMSE. Discrete variables were analyzed using Spearman's Rank correlation coefficient. RESULTS R and R2 values between the two systems indicated high levels of correlation (all R values > 0.711, all R2 values > 0.660). Although there was an overall high level of agreement between waveform shapes, high RMSE values indicated some minor tracking errors for Kinect within the STS cycle. Spearman's Rank correlation coefficient indicated high levels of correlation between the systems for discrete variables (all R values > 0.89), with the exception of medial-lateral pelvic sway range. SIGNIFICANCE The Azure Kinect provides valuable insight into STS movement strategies allowing for improved precision in clinical decision making across multiple clinical populations.
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Affiliation(s)
- Jacob Thomas
- School of Health Professions, University of Missouri, Columbia, MO, USA.
| | - Jamie B Hall
- Department of Physical Therapy, University of Missouri, Columbia, MO, USA
| | - Rebecca Bliss
- Department of Physical Therapy, University of Missouri, Columbia, MO, USA
| | - Trent M Guess
- Department of Physical Therapy, University of Missouri, Columbia, MO, USA; Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
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7
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Greene K, Truran P, Bliss R, Ramsingh J. 439 Managing Parathyroid Carcinoma in the Age of COVID 19. Br J Surg 2021. [PMCID: PMC8524553 DOI: 10.1093/bjs/znab259.537] [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: 12/01/2022]
Abstract
Aim Parathyroid carcinoma is a rare malignancy accounting for 1% of cases of primary hyperparathyroidism. Pre-operative diagnosis is difficult because in the absence of metastatic disease, the presentation is similar to benign parathyroid disease. In patients with hyperparathyroidism and severe hypercalcaemia or a significantly raised parathyroid hormone (PTH) level clinicians should consider parathyroid carcinoma and expediting surgical management. During the current pandemic, a high index of suspicion should be maintained to ensure that care is not compromised. A review of the management of patients with suspected parathyroid carcinoma during the COVID-19 pandemic is presented. Method In our tertiary referral centre for Endocrine surgery, 4 presentations of parathyroid cancer were reviewed. Their investigations, surgical management and post-operative outcomes are described with a brief literature review of parathyroid cancer. Results Of the four cases of parathyroid carcinoma described, all presented with severe hypercalcaemia and significantly raised PTH levels. Pre-operative mean calcium was 3.36mmol/L and mean PTH was 80pmol/L (52-99.8). Patients were imaged with a combination of cross-sectional imaging and ultrasound. Two patients had evidence of distant disease at presentation. 1 patient was transferred as an inpatient to our centre and the other three patients were seen within 2 weeks of referral; the mean time from referral to surgery was 14days (1-23). Post-operatively, all patients achieved normocalcaemia, with PTH levels normal in all but one. Conclusions Despite limitations on face-to-face clinic consultations and reduced capacity for elective surgery during the COVID-19 pandemic, all patients were investigated and managed promptly to ensure superior outcomes.
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Affiliation(s)
- K Greene
- Royal Victoria Infirmary, Newcastle, United Kingdom
| | - P Truran
- Royal Victoria Infirmary, Newcastle, United Kingdom
| | - R Bliss
- Royal Victoria Infirmary, Newcastle, United Kingdom
| | - J Ramsingh
- Royal Victoria Infirmary, Newcastle, United Kingdom
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8
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Greene K, Truran P, Bliss R, Ramsingh J. 1424 Enhanced Consent in Endocrine Surgery in The Era Of COVID-19. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.504] [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]
Abstract
Abstract
Aim
Informed consent is the process by which surgeon and patient agree to undergo a procedure after the risk, benefits and alternative treatments have been discussed. The current COVID-19 pandemic provides unique challenges to the consent process such as the uncertain risk of acquiring the virus and the impact of a second peak on the health services. The aim of this audit was to use an enhanced consent tool to inform patients of specific risks associated with surgery during the pandemic.
Method
At the beginning of the pandemic, elective operating was postponed - these patients were added to a COVID-19 database. With the resumption of services, all patients had a telephone clinic appointment with a 2-fold aim: 1) to ensure they wanted to remain on the waiting list and 2) to discuss consent specifically with regard to COVID-19 using an enhanced consent tool.
Results
Over a 6-week period, 79 patients were contacted. All patients were awaiting thyroid, parathyroid and adrenal operations. Of the 79 patients contacted, 77 (97%) agreed to remain on the waiting list after discussing the risks using the enhanced consent tool. The remaining 2 patients asked for their operations to be delayed. To date, none of our patients have acquired COVID-19 upon the resumption of services.
Conclusions
Despite the uncertain risks of COVID-19, the majority of patients requiring endocrine surgery were happy to proceed. Ongoing review of available literature concerning preoperative risk and COVID-19 is essential for clinicians involved in the consent process. The use of an enhanced consent tool standardised the consent process and enabled patients to make an informed decision concerning their care.
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Affiliation(s)
- K Greene
- Royal Victoria Infirmary, Newcastle, United Kingdom
| | - P Truran
- Royal Victoria Infirmary, Newcastle, United Kingdom
| | - R Bliss
- Royal Victoria Infirmary, Newcastle, United Kingdom
| | - J Ramsingh
- Royal Victoria Infirmary, Newcastle, United Kingdom
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9
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Marchitelli G, Tingle S, Bliss R, Truran P, Ramsingh J. 637 Patients' Perceptions of Complications Following Thyroidectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.540] [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]
Abstract
Abstract
Aim
The aim of this study was to assess patients' understanding of the risks of thyroid surgery and to assess whether their understanding of risks improved following the implementation of a pre-operative risk-tool.
Method
Single centre prospective cohort study between June 2019-August 2019. All patients that underwent thyroid surgery were recruited. Patients had either the standard process of consent or were provided with a pre-operative risk-tool and information leaflet. Post-operatively all patients were provided with a questionnaire to determine their understanding of the risks involved in having thyroid surgery. Data was analysed using GraphPad Prism v6.
Results
51 thyroidectomy patients were recruited; 28 patients had a standard process of consent and 23 patients were provided with the risk-tool. Patients undergoing standard consent processes had a poor understanding of the magnitude of post-operative risk; their median score for risk magnitude was 4.5/10 (2-7) versus 8/10 (4-10) in the cohort receiving the risk-tool. The proportion of intervention to non-intervention participants giving the correct answer reached a statistically significant difference in 50% of questions asked (P < 0.001).
Conclusions
It is imperative thyroidectomy patients are made aware of both rare events but also the frequency of which events occur so that they are properly informed prior to consenting. We have demonstrated that standard processes of consent in thyroidectomy patients leads to poor perception of risks; providing a surgical risk-tool can counteract this. These results warrant development of clear guidelines on the use of pre-operative surgical risk-tools in thyroidectomy patients.
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Affiliation(s)
- G Marchitelli
- Newcastle Upon Tyne Foundation Trust, Newcastle, United Kingdom
| | - S Tingle
- Newcastle Upon Tyne Foundation Trust, Newcastle, United Kingdom
| | - R Bliss
- Newcastle Upon Tyne Foundation Trust, Newcastle, United Kingdom
| | - P Truran
- Newcastle Upon Tyne Foundation Trust, Newcastle, United Kingdom
| | - J Ramsingh
- Newcastle Upon Tyne Foundation Trust, Newcastle, United Kingdom
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Adamson K, Bliss R, Shahab R, Sengsavang S, Craig S, Rankin V, Sur D. The SCOPE Intervention: Impact of a Social Care Optimization Pilot Initiative in the Emergency Department. Health Soc Work 2021; 45:284-288. [PMID: 33313754 DOI: 10.1093/hsw/hlaa021] [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] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/21/2020] [Accepted: 07/02/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Keith Adamson
- assistant professor, Department of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1V4 Canada
| | - Rebecca Bliss
- social worker, McMaster Children's Hospital, Ontario, Canada
| | - Ramish Shahab
- research assistant, Ontario Association of Social Workers, Toronto
| | - Sonia Sengsavang
- research coordinator, Ontario Association of Social Workers, Toronto
| | - Shelly Craig
- professor, Faculty of Social Work, University of Toronto
| | - Vanessa Rankin
- research and policy manager, Ontario Association of Social Workers, Toronto
| | - Deepy Sur
- chief executive officer, Ontario Association of Social Workers, Toronto
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11
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Bliss R, Jacobson E. Doctor of Physical Therapy Student Grit as a Predictor of Academic Success: A Pilot Study. Health Professions Education 2020. [DOI: 10.1016/j.hpe.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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12
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Gillette C, Dinkins MM, Bliss R, Pfaff M, Maupin E, Badran A, Manolakis M, Smith L, Sweetman M. Health professions students' attitudes and perceptions of interprofessional biases. Int J Pharm Pract 2019; 27:396-398. [PMID: 30912600 DOI: 10.1111/ijpp.12536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/25/2018] [Accepted: 02/26/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to examine attitudes toward interprofessional, team-based care in first-year health professions students. METHODS A cross-sectional questionnaire was administered to all first-year health professions students in their first semester at one university using the Interprofessional Attitudes Scale (IPAS). Kruskal-Wallis tests were used to analyze the data. KEY FINDINGS Results indicated only two significant differences among students in IPAS subdomains: teamwork (χ2 = 13.11, df = 3, P = 0.004) and patient-centredness (χ2 = 40.75, df = 3, P < 0.0001). CONCLUSIONS Not all health professions students come into their formal education with the same level of attitudes toward team-based care. Educators should consider this when designing IPE activities.
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Affiliation(s)
- Chris Gillette
- Department of Physician Assistant Studies, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Rebecca Bliss
- Department of Physical Therapy, Wingate University Levine College of Health Sciences, Wingate, NC, USA
| | - Michele Pfaff
- Simulation Lab, Department of Nursing, Wingate University Levine College of Health Sciences, Wingate, NC, USA
| | - Elizabeth Maupin
- Department of Physician Assistant Studies, Wingate University Levine College of Health Sciences, Wingate, NC, USA
| | - Aseel Badran
- Wingate University School of Pharmacy, Wingate, NC, USA
| | | | - Lisa Smith
- Wingate University School of Pharmacy, Wingate, NC, USA
| | - Melissa Sweetman
- Doctor of Occupational Therapy Program, Wingate University Levine College of Health Sciences, Wingate, NC, USA
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Habets EJ, Taphoorn MJ, Nederend S, Klein M, Delgadillo D, Hoang-Xuan K, Bottomley A, Allgeier A, Seute T, Gijtenbeek AM, De Gans J, Enting RH, Tijssen CC, Van den Bent MJ, Reijneveld JC, Xu H, Halbert K, Bliss R, Trusheim J, Hunt MA, Bunevicius A, Tamasauskas S, Tamasauskas A, Deltuva V, Field KM, Guyatt N, Fleet M, Rosenthal MA, Drummond KJ, Field KM, Fleet M, Guyatt N, Drummond KJ, Rosenthal MA, Oliver H, Tobias M, Eva V, Matthias S, Johannes S, Oliver S, Christian TJ, Dietmar K, Gabriele S, Thomas R, Nikkhah G, Uwe S, Markus L, Michael W, Manfred W, Strowd RE, Swett K, Harmon M, Pop-Vicas A, Chan M, Tatter SB, Ellis TL, Blevins M, High K, Lesser GJ, Benouaich-Amiel A, Taillandier L, Vercueil L, Valton L, Szurhaj W, Idbaih A, Delattre JY, Loiseau H, Klein I, Block V, Ramirez C, Laigle-Donadey F, Le Rhun E, Harrison C, Van Horn A, Sapienza C, Schlimper C, Schlag H, Weber F, Acquaye AA, Gilbert MR, Armstrong TS, Acquaye AA, Vera-Bolanos E, Gilbert MR, Armstrong TS, Walbert T, Armstrong TS, Elizabeth VB, Gilbert M, Affronti ML, Woodring S, Allen K, Herndon JE, McSherry F, Peters KB, Friedman HS, Desjardins A, Freeman W, Cheshire S, Cone C, Kalinowski KH, Kim JY, Lay HH, Poillucci V, Southerland C, Tetterton J, Kirkpatrick J, Vredenburgh JJ, Affronti ML, Woodring S, Herndon JE, McSherry F, Peters KB, Friedman HS, Desjardins A, Freeman W, Cheshire S, Cone C, Kalinowski KH, Kim JY, Lay HH, Poillucci V, Southerland C, Tetterton J, Vredenburgh JJ, Edelstein K, Coate L, Mason WP, Jewitt NC, Massey C, Devins GM, Lin L, Chiang HH, Acquaye AA, Vera-Bolanos E, Cahill JE, Gilbert MR, Armstrong TS, Amidei CM, Lovely M, Page MD, Mogensen K, Arzbaecher J, Lupica K, Maher ME, Lin L, Acquaye AA, Vera-Bolanos E, Cahill JE, Gilbert MR, Armstrong TS, Duong HT, Kelly DF, Peters KB, Woodring S, Herndon JE, McSherry F, Vredenburgh JJ, Desjardins A, Friedman HS, Gning I, Armstrong TS, Wefel JS, Acquaye AA, Vera-Bolanos E, Mendoza TR, Gilbert MR, Cleeland CS, Guthikonda B, Thakur JD, Banerjee A, Shorter C, Sonig A, Khan IS, Gardner GL, Nanda A, Reddy K, Gaspar L, Kavanagh B, Waziri A, Chen C, Boele F, Hoeben W, Hilverda K, Lenting J, Calis AL, Sizoo E, Collette E, Heimans J, Postma T, Taphoorn M, Reijneveld J, Klein M. CLIN-SYMPTOM MANAGEMENT/QUALITY OF LIFE. Neuro Oncol 2012; 14:vi153-vi159. [PMCID: PMC3488794 DOI: 10.1093/neuonc/nos240] [Citation(s) in RCA: 2] [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: 12/07/2023] Open
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14
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Mallick U, Ramamurty S, Carr RE, Willis N, Ball S, Bliss R, Mott JH, Wilsdon JB, Johnson S. FDG-PET based dose escalated adjuvant tomotherapy (image-guided intensity-modulated radiotherapy) utilizing 4D-CT planning for high-risk adrenocortical carcinoma (ACC): A case study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e13522] [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: 11/20/2022] Open
Abstract
e13522 Background: ACC is a rare endocrine malignancy with an annual incidence of 0.5-2/million/year. Surgery is the mainstay of treatment but relapse rate is high and the prognosis is dismal (20-50% 5 year survival). Adjuvant Radiotherapy improves local control in cases with high risk of local failure and dose escalation may achieve better results. Dose Escalation with 3-Dimensional computed tomography (CT) based radiotherapy is difficult for ACC due to unacceptable toxicity to several adjacent organs at risk (OARs) e.g., the kidneys, stomach bowel, liver, spinal cord. FDG-PET helps delineation of areas of higher metabolic activity and density of clonogenic cells within the target (Biological Target Volume or BTV) where focal dose escalation could be directed safely for improving local control as in other solid tumours. Tomotherapy (IMRT with daily image guidance) delivers precision radiotherapy with integrated boost to the BTV, lower dose to OARs, improved coverage of the targets, and better dose delivery across the targets which are essential for tumour control. 4-Dimensional CT for planning allows adequate Clinical Target Volume(CTV) coverage despite respiratory movements. Methods: A 63 year old lady had left adrenalectomy for an adrenocortical carcinoma measuring 29 x 18 x 25mm (TNM pT1NXMX) thought to be microscopically incompletely excised (R1) with a proliferation index ( Ki-67) of 40% for which adjuvant radiotherapy was advised. PET-CT, 4D-CT and Tomotherapy were used for planning. A total dose of 50.4Gy to PTV with a simultaneous integrated boost to BTV taking it up to 59.40Gy (1.98Gy/ fraction) in 30 daily fractions was prescribed. Results: Target dose and coverage were very satisfactory. The doses to OARs were well within tolerance despite dose escalation; she completed treatment with only grade- fatigue. She had metastatic disease at 11 months follow-up without local relapse. Conclusions: To our knowledge this is the first report of using FDG –PET based dose escalation, 4D CT and Tomotherapy in high risk ACC to improve local control and needs further study.
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Affiliation(s)
- Ujjal Mallick
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - S Ramamurty
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | | | - Nick Willis
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - S Ball
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - R Bliss
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Judith H. Mott
- Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - John B. Wilsdon
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - S Johnson
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
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Dickson E, Vogel RI, Bliss R, McGlennen R, Downs L. Changes in type-specific HPV infection rates in the United States. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.088] [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: 11/29/2022]
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Beitinjaneh A, Bliss R, Kumar P, Leach JW, Kratzke RA, Dudek A. A phase II study of topotecan and bevacizumab in advanced refractory non-small cell lung cancer: Interim analysis. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18040] [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: 11/20/2022] Open
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Fortune J, Griffith C, Griffiths A, Bliss R, Lennard T. Can metastases be predicted in breast cancer patients with local recurrence? Eur J Surg Oncol 2009. [DOI: 10.1016/j.ejso.2009.07.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
Arterial aneurysms are defined as localized abnormal dilatations in an arterial wall. We report the first case of multiple true aneurysms in the female breast in a patient with a history of chronic amphetamine abuse who presented with a probable subarachnoid haemorrhage (SAH).
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Affiliation(s)
- J Cox
- Breast Screening Unit, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle-upon-Tyne, UK
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Abstract
INTRODUCTION The rule of "tens" is often stated to reflect the distribution and histology of pheochromocytomas, with 10% being bilateral, 10%; ectopic in origin, and 10%; malignant. The objective of this study was to review the ectopic pheochromocytomas in a tertiary endocrine center and to establish whether the rule of tens holds true. METHODS Retrospective data were collected on all adrenalectomies and ectopic pheochromocytoma resections performed between 1993 and 2005 at our institution. RESULTS In total, 77 patients had pheochromocytomas: 75%; (58/77) adrenal and 25%; (19/77) ectopic. Of the adrenal pheochromocytomas, 10%; (6/58) were bilateral. The anatomic locations of the ectopic pheochromocytomas were as follows: 26%; (5/19) adjacent to the adrenals, 53%; (10/19) in the organ of Zuckerkandl, 11%; (2/19) in the bladder, 5%; (1/19) in the mediastinum, and 5%;(1/19) in the neck. CONCLUSIONS Our series demonstrates an incidence of 10%; for bilateral pheochromocytoma, which is similar to that in the published reports. However, 25%; of the pheochromocytomas were ectopic. Zuckerkandl pheochromocytomas were the most common among the ectopic lesions. Rarely, these tumors present outside the abdominal cavity.
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Affiliation(s)
- R Madani
- Department of Surgery, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, Tyne and Wear, NE1 4LP, UK
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Sheach L, Griffith C, Richardson I, Griffiths A, Lennard T, Bliss R. 272 POSTER Mastectomy versus breast conservation rate for breast cancer; the breast surgeon is an independant variable factor. Eur J Surg Oncol 2006. [DOI: 10.1016/s0748-7983(06)70707-7] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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21
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Sibal L, Jovanovic A, Agarwal SC, Peaston RT, James RA, Lennard TWJ, Bliss R, Batchelor A, Perros P. Phaeochromocytomas presenting as acute crises after beta blockade therapy. Clin Endocrinol (Oxf) 2006; 65:186-90. [PMID: 16886958 DOI: 10.1111/j.1365-2265.2006.02571.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Phaeochromocytoma crisis is a life-threatening emergency that may be undiagnosed because of its numerous, nonspecific manifestations. We analysed, retrospectively, the presentation, management and outcome of patients who were admitted to our institution with phaeochromocytoma crises over a 5-year period. RESULTS Five patients (two males, three females; mean age 34.6 years, range 19-51 years) who presented as emergencies requiring intensive care, with multiple non-specific manifestations and previously undiagnosed pheochromocytoma, were identified. The initial presentation included features of cardiomyopathy (n = 3), atypical pneumonia with myocarditis (n = 1) and acute abdomen (n = 1). Only one of the five cases had a raised blood pressure at the time of the acute presentation. Initiation of beta blockers in four patients was associated with further deterioration in haemodynamic status, labile blood pressure and cardiac arrhythmias, which led to the diagnosis of the underlying phaeochromocytoma. Following intensive supportive therapy and alpha blockade, all five patients recovered and underwent elective surgical removal of phaeochromocytoma, uneventfully. CONCLUSION Unexplained cardiopulmonary dysfunction, particularly after the institution of beta blockers, should alert clinicians to the possibility of phaeochromocytoma. A high index of suspicion is essential to reduce morbidity and mortality in these patients through early diagnosis and aggressive management.
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Affiliation(s)
- L Sibal
- Department of Endocrinology, Newcastle upon Tyne Acute Hospitals, Newcastle upon Tyne, UK.
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Henne WM, Oomman S, Attridge J, Finckbone V, Coates P, Bliss R, Strahlendorf H, Strahlendorf J. AMPA-Induced Excitotoxicity Increases Nuclear Levels of CAD, Endonuclease G, and Acinus and Induces Chromatin Condensation in Rat Hippocampal Pyramidal Neurons. Cell Mol Neurobiol 2006; 26:321-39. [PMID: 16767516 DOI: 10.1007/s10571-006-9031-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Accepted: 12/08/2005] [Indexed: 10/24/2022]
Abstract
Programmed cell death has been linked to AMPA-receptor-mediated excitotoxicity in pyramidal neurons of the hippocampus. The intent of this study was to investigate the roles of caspase-dependent and independent nuclear death-related factors in mediating AMPA-induced nuclear changes in PyNs by use of immunohistochemistry and transmission electron microscopy (TEM). Data indicate increases in the nuclear levels of caspase-activated acinus and DNase and Endonuclease G (a caspase-independent endonuclease) in CA1 and CA3 PyN nuclei with different temporal patterns following an AMPA-insult. Hoechst staining and TEM confirm AMPA-induced chromatin condensation. The presence of active acinus in nuclei suggests it mediates chromatin condensation. Interestingly, a DNA fragmentation labeling protocol showed that there was no chromatin cleavage up to 90 min after AMPA-insult. Overall, we conclude that: 1) AMPA-induced excitotoxicity increases nuclear immunoreactivity of pro-death enzymes from multiple programmed cell death pathways, 2) differential chromatin condensation patterns occur between CA1 and CA3, and 3) there is no chromatin cleavage within our experimental timeframe.
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Affiliation(s)
- W M Henne
- Department of Physiology, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
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23
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Mehrotra P, Hubbard JGH, Johnson SJ, Richardson DL, Bliss R, Lennard TWJ. Ultrasound scan-guided core sampling for diagnosis versus freehand FNAC of the thyroid gland. Surgeon 2005; 3:1-5. [PMID: 15789785 DOI: 10.1016/s1479-666x(05)80002-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [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: 10/20/2022]
Abstract
BACKGROUND AND AIM Freehand fine needle aspiration cytology (FNAC) is an obligatory investigation of the thyroid nodule. Between 5.0-43.1% of FNAC samples are reported as being initially unsatisfactory. In our unit, thyroid freehand FNAs are performed with a small needle (21 or 23G). Non-dominant nodules as part of multinodular goitres, difficult to palpate nodules or nodules with previously unsatisfactory freehand FNACs are sampled under ultrasound scan (USS) guidance with the larger 20G cutting core sampling technique. We aimed to compare the satisfactory sampling rate and safety of the two different methods. PATIENTS AND METHODS Cytology forms were reviewed for 262 freehand FNACs and USS-guided core samples, performed in our unit over a two-year interval (1 July 1999 to 30 June 2001). RESULTS Ultrasound-guided core samples for cytology were unsatisfactory (AC0-1) in 19/121 (15.6%) of the cases, compared with 66/141 (46.8%) of freehand FNACs (p value = < 0.0001). Ten out of eleven patients (91%) had a satisfactory USS-guided core after an unsatisfactory freehand FNA; 7/15 patients (46.7%) had satisfactory repeat freehand FNACs following an initial unsatisfactory freehand FNAC (p value = 0.0191). There were no complications as a result of either freehand FNAC or USS-guided core sampling. CONCLUSION USS-guided cores provided more satisfactory samples for assessment than freehand FNACs. The USS-guided technique is safe despite the use of the larger cuffing needle. The USS-guided core sampling was also a useful tool for repeat thyroid nodule sampling after an unsatisfactory freehand FNAC.
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Affiliation(s)
- P Mehrotra
- University of Newcastle upon Tyne, London.
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Aspinall S, Cook D, Brotherick I, Griffiths A, Griffith C, Bliss R, Lennard T. Breast 13. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.89.s.1.32_8.x] [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: 11/20/2022]
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25
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Aspinall S, Stamp S, Brotherick I, Cook D, Shenton B, Griffiths A, Griffith C, Bliss R, Lennard T. Breast 12. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.89.s.1.32_7.x] [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: 11/20/2022]
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Hatsukami DK, Grillo M, Boyle R, Allen S, Jensen J, Bliss R, Brown S. Treatment of spit tobacco users with transdermal nicotine system and mint snuff. J Consult Clin Psychol 2000; 68:241-9. [PMID: 10780124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The purpose of this study was to examine the effects of nicotine patch and mint snuff (a nonnicotine product) on craving, withdrawal symptoms, and treatment outcome. This study involved a 2 x 2 factorial design, with Active Nicotine Versus Placebo Patch as one of the factors and Mint Snuff Versus No Mint Snuff as the other factor. Spit tobacco users (N = 402, n = 100-101 in each condition) were randomly assigned to 1 of the 4 treatment conditions for a period of 10 weeks. Treatment outcome was measured up to 62 weeks. The results showed that the nicotine patch was effective in increasing short-term abstinence over the placebo patch and in reducing craving and withdrawal signs and symptoms from spit tobacco. Although mint snuff was not effective in enhancing treatment outcome, it reduced craving and withdrawal symptoms. No interaction effects were observed. At this time, the use of the nicotine patch and mint snuff should be primarily considered for the reduction of craving and withdrawal symptoms.
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Affiliation(s)
- D K Hatsukami
- University of Minnesota, Department of Psychiatry, Minneapolis 55455, USA.
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Abstract
BACKGROUND There is increased risk of surgical treatment in elderly patients, but little has been written on the safety and efficacy of thyroid surgery in this group. OBJECTIVE To determine if there is an increased risk of morbidity and mortality of thyroid surgery in patients over 75 years old. PATIENTS AND METHODS During the period 1986-96, 1631 patients aged 50 and over underwent 1673 procedures by two surgeons in our unit. We retrospectively compared indications for surgery, procedures, pathology complications and mortality in three groups: 50-60-year-olds (725 patients), 61-74-year-olds (685 patients) and those aged 75 years and over (221 patients) RESULTS The main indication for surgery in all three groups was compression or risk of malignancy. Total thyroidectomy was the main procedure performed. Although benign multinodular goitre was the commonest diagnosis, the over-75-year-olds had fewer benign multinodular goitres than the 61-74 group and more malignancy than the other two groups. There was no significant difference in mortality between the three groups. CONCLUSIONS Surgery in patients over 75 is as safe as in younger patients with no increase in morbidity and mortality. Benign multinodular goitre is the most common indication for surgery.
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Affiliation(s)
- R Bliss
- Department of Surgery, University of Sydney, Royal North Shore Hospital, Australia
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Abstract
Previous studies have described smokeless tobacco (ST) treatment seekers with minimal detail. In the present study, ST users (N = 402), who enrolled in a ST cessation treatment study, were asked to complete an extensive questionnaire that inquired about their ST use patterns, use of other tobacco products, extent of dependence, previous attempts to quit, situations associated with use and support for quitting. The results showed that this population experiences a high level of nicotine exposure and physical dependence on ST. ST use frequently is associated with negative affect situations and times of hunger. A high frequency of users have smoked cigarettes as well as cigars. A supportive social environment for ST cessation exists for these individuals. These results have implications for ST treatment content.
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Affiliation(s)
- D K Hatsukami
- Department of Psychiatry, University of Minnesota, Minneapolis 55455, USA.
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Abstract
BACKGROUND Hyperparathyroidism associated with long-term lithium therapy is well described. However, few studies have clearly defined the pathological findings or looked at the outcome of surgical treatment. METHODS The study was a retrospective review of 11 patients with bipolar affective disorder who had surgery for lithium-associated hyperparathyroidism. RESULTS Twelve patients were identified who had received lithium therapy, of whom 11 (nine women and two men, aged 46-84 (mean 65) years) had prolonged treatment from 2 to 30 (mean 15.3) years. At operation a single adenoma was identified in six patients, whereas multigland disease was seen in five patients. All patients resumed lithium treatment after operation. One patient had recurrent hyperparathyroidism at 3 years, while another had an increased serum level of parathyroid hormone in the presence of a normal serum calcium level after 1 year. CONCLUSION Hyperparathyroidism associated with lithium may be due to either parathyroid hyperplasia or adenoma. Observations in the present study supported a true cause and effect relationship. Routine bilateral neck exploration should be performed because of a relatively high frequency of multigland involvement. However, parathyroid resection should be limited to evident disease.
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Affiliation(s)
- H Abdullah
- Endocrine Surgical Unit, University of Sydney, Royal North Shore Hospital, New South Wales, Australia
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Affiliation(s)
- J Wayman
- Department of Interventional Radiology, The Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
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Abstract
Preliminary data suggest that cotinine, the major metabolite of nicotine, may be behaviorally active. Studies involving the administration of cotinine at doses that produce high blood concentrations (in excess of those produced by cigarette smoking) may be of interest. This inpatient, 10-day human study examined the safety and the effects from several high doses of oral cotinine fumarate (40, 80, or 160 mg) or placebo in abstinent cigarette smokers. All subjects smoked cigarettes ad lib during the first 2 days of the study, then were required to be abstinent beginning on the third day. All subjects were given placebo on this day to wash out nicotine before the administration of cotinine. Subjects were subsequently randomly assigned in a double-blind manner to cotinine or placebo for the next 3 days to determine the safety profile of cotinine. All subjects were given placebo on the final 3 days to examine cotinine withdrawal symptoms. The results showed no significant physiologic, subjective, or performance effects across the various doses of cotinine and placebo. Furthermore, no cotinine withdrawal effects were observed. This study demonstrates that short-term administration of cotinine to humans at levels as high as 10 times that attained from cigarette smoking is safe with no observable acute or withdrawal effects from cotinine in this setting.
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Affiliation(s)
- D K Hatsukami
- Department of Psychiatry, University of Minnesota, Minneapolis 55455, USA
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Hatsukami D, Jensen J, Allen S, Grillo M, Bliss R. Effects of behavioral and pharmacological treatment on smokeless tobacco users. J Consult Clin Psychol 1997. [PMID: 8907095 DOI: 10.1037//0022-006x.64.1.153] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to examine the effects of 2 mg of nicotine polacrilex versus placebo gum and of group behavioral treatment versus minimal contact on cessation of smokeless tobacco use. Participants (N = 210) were randomly assigned 1 of the 4 treatment conditions. Withdrawal symptoms were assessed throughout the treatment. Follow-up assessments were made at 1, 6, and 12 months posttreatment. Survival curve analysis showed that any of the 3 treatment groups involving group behavioral therapy or placebo gum were equally effective and superior to the minimal contact plus 2 mg of nicotine gum treatment in terms of abstinence. On the other hand, withdrawal symptoms were significantly reduced by nicotine gum, compared with placebo during the initial phases of cessation. The ineffectiveness of nicotine gum on treatment outcome may be attributed to its similarity with smokeless tobacco.
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Affiliation(s)
- D Hatsukami
- Department of Psychiatry, Tobacco Research Program, University of Minneapolis, Minnesota 55455, USA
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Abstract
The purpose of this study was to examine the effects of 2 mg of nicotine polacrilex versus placebo gum and of group behavioral treatment versus minimal contact on cessation of smokeless tobacco use. Participants (N = 210) were randomly assigned 1 of the 4 treatment conditions. Withdrawal symptoms were assessed throughout the treatment. Follow-up assessments were made at 1, 6, and 12 months posttreatment. Survival curve analysis showed that any of the 3 treatment groups involving group behavioral therapy or placebo gum were equally effective and superior to the minimal contact plus 2 mg of nicotine gum treatment in terms of abstinence. On the other hand, withdrawal symptoms were significantly reduced by nicotine gum, compared with placebo during the initial phases of cessation. The ineffectiveness of nicotine gum on treatment outcome may be attributed to its similarity with smokeless tobacco.
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Affiliation(s)
- D Hatsukami
- Department of Psychiatry, Tobacco Research Program, University of Minneapolis, Minnesota 55455, USA
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Abstract
BACKGROUND Studies show sustained levels of nicotine among young males using smokeless tobacco, causing concern for subsequent cardiovascular risk. Also, there is little information on effects of nicotine replacement on cardiovascular risk in cessation programs. This study investigates the effects of nicotine gum replacement in smokeless tobacco cessation on cardiovascular risk factors. METHODS Smokeless tobacco users, ages 18-65, were randomly assigned in a double-blind fashion to 2-mg nicotine or placebo gum. At baseline, Week 4, and Week 8, dependent measurements, heart rate, blood pressure, and weight were recorded, and fasting lipoprotein profiles were drawn. RESULTS This paper focuses on the smokeless tobacco users who refrained from use during the study period (N = 56). The nicotine gum group weighed less (P = 0.033) than the placebo group throughout the study and weight increased at a significant rate between Weeks 4 and 8 for both groups as gum decreased. Triglycerides were higher for the nicotine gum group than the placebo group (P = 0.031), with triglycerides decreasing between Weeks 4 and 8, with a similar effect seen among nonabstinent smokeless tobacco users. There was no dose, time, or dose by time effect for the other dependent measures. CONCLUSIONS Among smokeless tobacco users who were abstinent, weight increased, with subjects on nicotine gum weighing less throughout the study. The lipoprotein profile, heart rate, and blood pressure did not improve over time, contrary to smokers in whom HDL increases and heart rate decreases with cessation. This could relate to different routes of administration, pharmacokinetics, or by-products of tobacco smoking being absent in smokeless tobacco. In addition, nicotine gum appeared to have neither an adverse nor a positive effect on heart rate, blood pressure, LDL, HDL, or total cholesterol.
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Affiliation(s)
- S S Allen
- Department of Family Practice, University of Minnesota Medical School, Minneapolis 55455, USA
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Jacobson AM, Hauser ST, Lavori P, Wolfsdorf JI, Herskowitz RD, Milley JE, Bliss R, Gelfand E, Wertlieb D, Stein J. Adherence among children and adolescents with insulin-dependent diabetes mellitus over a four-year longitudinal follow-up: I. The influence of patient coping and adjustment. J Pediatr Psychol 1990; 15:511-26. [PMID: 2258798 DOI: 10.1093/jpepsy/15.4.511] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
An onset cohort of adolescents and children with insulin-dependent diabetes mellitus was studied over a 4-year period. Individual patient psychosocial and demographic factors were assessed at study inception and used to examine aspects of adherence over the follow-up. We found that initial assessment of patient coping (defense level, adaptive strength, and locus of control) and adjustment at study inception were predictive of the level of patient adherence to diabetic regimen over the 4 years of study. Psychosocial variables predicted adherence outcomes independent of patient age. This was found for three domains of adherence, i.e., diet, insulin adjustment, and metabolic monitoring, and for the composite index derived from the separate adherence scales. Preadolescents (ages 9-12) at study entry were more adherent than patients who were already adolescent (ages 13-16) when diagnosed. Using multiple regression, three factors (age, adjustment, ego defense level) accounted for 47% of the variance in adherence. No factors were predictive of change in adherence during the follow-up. Thus, psychosocial characteristics of diabetic children assessed shortly after diagnosis predicted typical or average adherence over a 4-year period. Identification of such characteristics may be useful in developing strategies for intervention early in the course of illness.
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Hauser ST, Jacobson AM, Lavori P, Wolfsdorf JI, Herskowitz RD, Milley JE, Bliss R, Wertlieb D, Stein J. Adherence among children and adolescents with insulin-dependent diabetes mellitus over a four-year longitudinal follow-up: II. Immediate and long-term linkages with the family milieu. J Pediatr Psychol 1990; 15:527-42. [PMID: 2258799 DOI: 10.1093/jpepsy/15.4.527] [Citation(s) in RCA: 152] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cross-sectional and longitudinal findings drawn from a 4-year longitudinal study of an onset cohort of preadolescents and early adolescents with insulin-dependent diabetes and their families are presented. Patient and parent perceptions of the family environment near the time of diagnosis are used to examine patterns of adherence in the first year of illness as well as over the four follow-up years. We found that family conflict, cohesion, and organization were strongly associated with independently rated first-year adherence levels. The strongest predictor of longer term adherence was family conflict, as experienced by the patients. In addition, parents' and youngsters' perceptions of family cohesion predicted improved adherence as well as overall higher levels of patient adherence. The findings are discussed with respect to the clinical implications of discovering those family characteristics that can, shortly after diagnosis, predict short- and long-term adherence. In addition, we present planned investigations intended to further clarify paths from family perceptions to individual diabetes behaviors.
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Affiliation(s)
- S T Hauser
- Harvard Medical School, Boston, Massachusetts
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Robinson JW, Kiesel EL, Goodbread JP, Bliss R, Marshall R. The development of a gas chromatography--furnace atomic absorption combination for the determination of organic lead compounds. Atomization processes in furnace atomizers. Anal Chim Acta 1977; 92:321-8. [PMID: 907166 DOI: 10.1016/s0003-2670(01)93506-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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