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Menard M, Kurtz M, Duclos A, Vial J, Maurey C, Canonne-Guibert M, Fabrès V, Rosenberg D, Coyne M, Murphy R, Trumel C, Lavoué R, Benchekroun G. Description of serum symmetric dimethylarginine concentration and of urinary SDS-AGE pattern in dogs with ACTH dependent hyperadrenocorticism. Vet J 2024; 305:106108. [PMID: 38580156 DOI: 10.1016/j.tvjl.2024.106108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/30/2024] [Accepted: 04/02/2024] [Indexed: 04/07/2024]
Abstract
Serum symmetric dimethylarginine (SDMA) and patterns of urinary protein separated by sodium dodecyl sulfate agarose gel electrophoresis (SDS-AGE) have not been investigated as biomarkers in dogs with ACTH-dependent hyperadrenocorticism (ADHAC). This exploratory prospective study aimed to evaluate SDMA, serum creatinine (sCR), and SDS-AGE in dogs with ADHAC with and without proteinuria (ADHAC-P and ADHAC-nP, respectively). Thirty-five pet dogs classified as ADHAC-P (n=16), ADHAC-nP (n=6) and healthy (n=13) were included. Renal biomarkers were evaluated in all dogs at diagnosis. Baseline concentration of SDMA was not significantly different between the three groups (P = 0.15) whereas sCr was significantly lower in dogs in ADHAC dogs compared to healthy dogs (88.0 µmol/L [70.4-132.6; 79.2-114.4]) whether they had proteinuria or not (P = 0.014 and 0.002, respectively). However, baseline concentrations of sCr and SDMA were not significantly different between dogs with ADHAC-P dogs (SDMA, 8 µg/dL [5-12; 7-9]; sCr, 57.2 µmol/L [35.2-212.2; 52.8-92.4]) and ADHAC-nP dogs (SDMA, 8.5 µg/dL [7-13; 8-10]; sCr, 70.4 µmol/L [61.6-79.2; 61.6-70.4]) (P = 0.35 and P = 0.41, respectively). Proteinuria in dogs with ADHAC-P was mainly of glomerular origin (SDS-AGE pattern: glomerular in 10/16 dogs; mixed glomerular/tubular in four dogs). In our study, SDMA was neither significantly different in dogs with ADHAC whether they were proteinuric or not, nor between ADHAC and healthy dogs. Urinary electrophoresis provides additional information to the UPC and further investigations are needed to determine whether it may help identify dogs with ADHAC-P requiring specific antiproteinuric treatment.
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Affiliation(s)
- M Menard
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France
| | - M Kurtz
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France
| | - A Duclos
- IRSD, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | - J Vial
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France
| | - C Maurey
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France
| | - M Canonne-Guibert
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France; Ecole Nationale Vétérinaire d'Alfort, Univ Paris Est Créteil, INSERM, IMRB, Maisons-Alfort 94700, France
| | - V Fabrès
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France
| | - D Rosenberg
- Department of Internal Medicine, Micen Vet, Créteil, France
| | - M Coyne
- IDEXX Laboratories, Inc., Westbrook, ME, United States
| | - R Murphy
- IDEXX Laboratories, Inc., Westbrook, ME, United States
| | - C Trumel
- CREFRE, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | - R Lavoué
- IRSD, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | - G Benchekroun
- Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de médecine interne, Maisons-Alfort F-94700, France; Ecole Nationale Vétérinaire d'Alfort, Univ Paris Est Créteil, INSERM, IMRB, Maisons-Alfort 94700, France.
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2
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Smith CH, Yiu ZZN, Bale T, Burden AD, Coates LC, Eckert E, Longley N, Mahil SK, McGuire A, Murphy R, Nelson-Piercy C, Owen CM, Parslew R, Woolf RT, Mansour Kiaee Z, Constantin AM, Ezejimofor MC, Exton LS, Mohd Mustapa MF. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2023: a pragmatic update. Br J Dermatol 2024; 190:270-272. [PMID: 37740557 DOI: 10.1093/bjd/ljad347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Indexed: 09/24/2023]
Abstract
The article provides a pragmatic update of the British Association of Dermatologists guidelines for biologic therapy for psoriasis.
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3
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Harman KE, Barha J, Chalmers JR, Dart JKG, Davies I, Ellis P, Grindlay D, Hampton PJ, Hill S, Hockey S, Lloyd-Lavery A, McPhee M, Murphy R, Rauz S, Setterfield JF, Thompson I, Westmoreland M, Waistell C. The top 10 research priorities for the treatment of bullous pemphigoid, mucous membrane pemphigoid and pemphigus vulgaris in the UK: results of a James Lind Alliance Priority Setting Partnership. Br J Dermatol 2023; 189:469-498. [PMID: 37201904 DOI: 10.1093/bjd/ljad140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/25/2023] [Accepted: 07/06/2023] [Indexed: 05/20/2023]
Abstract
To identify priorities for future research into the treatment of bullous pemphigoid, mucous membrane pemphigoid and pemphigus vulgaris, we conducted a Priority Setting Partnership (PSP) using James Lind Alliance methodology. The top 10 priorities identified in this PSP represent the key questions that patients, carers and healthcare professionals have about the treatment of these diseases and which future research will hopefully address.
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Affiliation(s)
- Karen E Harman
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham
- University Hospitals Leicester NHS Trust, Leicester
| | - Jag Barha
- Patient research partner, PEM Friends patient support group
| | - Jo R Chalmers
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham
| | - John K G Dart
- Moorfields Eye Hospital NHS Foundation Trust, London
- National Institute of Health Research (NIHR), Moorfields Biomedical Research Centre, London
| | - Isobel Davies
- Patient research partner, PEM Friends patient support group
| | | | - Douglas Grindlay
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham
| | | | - Sharleen Hill
- Chelsea and Westminster Hospital NHS Foundation Trust
| | - Sharon Hockey
- Patient research partner, PEM Friends patient support group
| | - Antonia Lloyd-Lavery
- Department of Dermatology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Maggie McPhee
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham
| | - Ruth Murphy
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - Saaeha Rauz
- Institute of Inflammation and Ageing, University of Birmingham
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust
| | - Jane F Setterfield
- Host Microbiome Interaction (CHMI), Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London
- St John's Institute of Dermatology & Dept Oral Medicine, Guy's and St Thomas's NHS Foundation Trust, London; all in theUK
| | | | - Melanie Westmoreland
- Department of Dermatology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford
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4
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Gruneir A, Hoben M, Easterbrook A, Jensen C, Buencamino M, Tompalski J, Chamberlain SA, Ekhlas S, Bever G, Murphy R, Estabrooks CA, Keefe J, Marshall S. Exploring nursing home resident and their care partner priorities for care using the Action-Project Method. BMC Geriatr 2023; 23:133. [PMID: 36882719 PMCID: PMC9993719 DOI: 10.1186/s12877-023-03863-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 03/01/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Nursing home (NH) residents' experiences are embedded within their relationships to others. Our objectives were to describe how residents and care partners (family or staff members) jointly construct, discuss, and act on care priorities. METHODS We used Action-Project Method, a qualitative method focused on action within social context. We recruited 15 residents and 12 care partners (5 family and 7 staff members) from 3 urban NHs in Alberta, Canada. Residents and care partners participated in a video-recorded conversation about their experiences in the NH, then individually reviewed the video-recording to add context to the conversation. Following transcription, preliminary narrative construction, and participant feedback, the research team conducted in-depth analysis to identify participant actions, goals, and projects, including those jointly shared by dyad members. RESULTS All participants' intentions could be broadly described as "making time in the NH as good as possible" and projects were grouped into five categories: resident identity, relationships (both presence and absence), advocacy, positivity, and respectful care. Participants often raised issues of short-staffing as a significant barrier to respectful care. Care partners, especially staff, used positivity to redirect residents from difficult topics. Joint projects could be identified in some, but not all, cases. CONCLUSIONS We found that maintaining a sense of identity, fostering relationships, and receiving respectful care were important to residents but that short-staffing created barriers. Methods to capture these aspects of the resident experience are needed but should not be influenced by care partners' tendency towards positivity in resident interactions.
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Affiliation(s)
- Andrea Gruneir
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada.
| | - Matthias Hoben
- Faculty of Nursing, College of Health Sciences, University of Alberta, 116 St. and 85 Ave, Edmonton, AB, T6G 2R3, Canada
| | - Adam Easterbrook
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard St., Vancouver, BC, V6Z IY6, Canada
| | - Charlotte Jensen
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Monica Buencamino
- Faculty of Nursing, College of Health Sciences, University of Alberta, 116 St. and 85 Ave, Edmonton, AB, T6G 2R3, Canada
| | - Jaclyn Tompalski
- Department of Sociology and Anthropology, Carleton University, B750 Loeb Building, 1125 Colonel By Dr, Ottawa, ON, K1S 5B6, Canada
| | - Stephanie A Chamberlain
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Sadaf Ekhlas
- Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Gillian Bever
- Department of Occupational Science and Occupational Therapy, University of British Columbia, T325-2211, Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Ruth Murphy
- Translating Research in Elder Care (TREC) Research Program, Faculty of Nursing, College of Health Sciences, University of Alberta, 116 St. and 85 Ave, Edmonton, AB, T6G 2R3, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, 116 St. and 85 Ave, Edmonton, AB, T6G 2R3, Canada
| | - Janice Keefe
- Department of Family Studies and Gerontology and Nova Scotia Centre On Aging, Mount Saint Vincent University, 166 Bedford Highway, Halifax, NS, B3M 2J6, Canada
| | - Sheila Marshall
- School of Social Work, University of British Columbia, Jack Bell Building, 2080 West Mall, Vancouver, BC, V6T 1Z2, Canada
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Suckling J, Morse S, Murphy R, Astley S, Halford JCG, Harrold JA, Le-Bail A, Koukouna E, Musinovic H, Perret J, Raben A, Roe M, Scholten J, Scott C, Stamatis C, Westbroek C. Environmental life cycle assessment of production of the high intensity sweetener steviol glycosides from Stevia rebaudiana leaf grown in Europe: The SWEET project. Int J Life Cycle Assess 2023; 28:221-233. [PMID: 36686846 PMCID: PMC9839952 DOI: 10.1007/s11367-022-02127-9] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE There is an increasing interest in the use of non-nutritive sweeteners to replace added sugar in food and beverage products for reasons of improving consumer health. Much work has been done to understand safety of sweeteners, but very little on sustainability. To address that gap, this study presents the results of a life cycle assessment (LCA) of production of rebaudioside A 60%, 95% pure (RA60) steviol glycoside mix from Stevia rebaudiana leaf grown in Europe. METHODS An attributional cradle-to-factory-gate life cycle assessment was conducted on growing of stevia leaves and extraction of steviol glycosides in Europe. Primary data were used from a case study supply chain. Results are reported in impact categories from the ReCiPe 2016 (H) method, with focus given to global warming potential, freshwater eutrophication, water consumption, and land use. Impacts are expressed both in terms of production mass and sweetness equivalence, a common metric for understanding high intensity sweetener potency. Sweetness equivalence of RA60 is typically 200 to 300 times that of sugar. Comparison of environmental impact is made to sugar (sucrose) produced from both cane and beets. The research is part of the EU project SWEET (sweeteners and sweetness enhancers: impact on health, obesity, safety, and sustainability). RESULTS AND DISCUSSION Global warming potential for production of RA60 was found to be 20.25 kgCO2-eq/kgRA60 on a mass basis and 0.081 kgCO2-eq/kgSE on a sweetness equivalence basis. Field production of stevia leaves was found to be the main source of impact for most impact categories, and for all four focus categories. Extraction of the RA60 was the main source of impact for the others. Leaf processing and seedling propagation were minor contributors to life cycle impact. Removal of international transport from the supply chain reduced global warming potential by 18.8%. Compared with sugar on a sweetness equivalence basis, RA60 has approximately 5.7% to 10.2% the impact for global warming potential, 5.6% to 7.2% the impact for land use, and is lower across most other impact categories. CONCLUSION This is the first LCA of steviol glycoside mix RA60 produced from leaf in Europe. The results indicate that RA60 can be used to reduce environmental impact of providing a sweet taste by replacing sugar across all impact categories. However, it is important to note that specific formulations in which RA60 is used will have a bearing on the final environmental impact of any food or beverage products. For solid foods, this requires further research. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s11367-022-02127-9.
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Affiliation(s)
- J. Suckling
- Centre for Environment and Sustainability, University of Surrey, Guildford, UK
| | - S. Morse
- Centre for Environment and Sustainability, University of Surrey, Guildford, UK
| | - R. Murphy
- Centre for Environment and Sustainability, University of Surrey, Guildford, UK
| | | | - J. C. G. Halford
- School of Psychology, University of Leeds, Leeds, UK
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - J. A. Harrold
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - A. Le-Bail
- ONIRIS, UMR GEPEA CNRS 6144, Nantes, France
| | | | | | | | - A. Raben
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Clinical Research, Copenhagen University Hospital – Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - M. Roe
- EuroFIR AISBL, Brussels, Belgium
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Murphy R, Doyle E, O'Connor A, Coen M, Connolly A, Breen C, Carty J, Waters R, Canavan M, Robinson S. 332 THE PATIENT EXPERIENCE OF THE OLDER PERSONS REHAB AT HOME (OPRAH) SERVICE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The Older Persons Rehab at Home (OPRAH) team is a novel service developed to provide patients with intensive domiciliary based therapy to regain function, mobility and social care goals. This provides rehabilitation in the patients’ own home and accelerates discharge from the acute care sector. In this study patient and carer experiences of the service were explored.
Methods
Patients were sent a postal questionnaire after discharge from the service to collect information on the patient experience of the OPRAH service. The following measures were collected: satisfaction with the service, experience of interacting with therapy staff, involvement in shared goal setting and achievement of rehabilitation goals. Data from participants who responded to feedback questionnaires from the first 12 months of the service were analysed using descriptive statistics.
Results
Ninety-five participants were sent feedback questionnaires with 31 responses received (33%). 96% of participants reported that they were satisfied with the service, with the same proportion expressing that they both felt they were treated with respect and dignity and that they had confidence and trust in the staff. All respondents felt that they could understand the answers to any questions they had while receiving rehabilitation and 92% of participants understood their rehabilitation goals, with 88% of participants feeling they achieved their rehabilitation goals. 88% of participants felt they were adequately involved in their care planning with 83% of participants feeling their family members had ample opportunity to ask questions during their rehabilitation experience. Results did not different by age group of patient or by time with the service.
Conclusion
In this structured evaluation of the OPRAH team participants highly rated the service. Our results highlight that this integrated approach to care allowed patients to be involved in shared goal setting with the majority of patients satisfied that they achieved their goals.
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Affiliation(s)
- R Murphy
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - E Doyle
- Galway University Hospital Department of Occupational Therapy, , Galway, Ireland
| | - A O'Connor
- Galway University Hospital Department of Medical Social Work, , Galway, Ireland
| | - M Coen
- Department of Physiotherapy , Galway, Ireland
| | - A Connolly
- Galway University Hospital Department of Occupational Therapy, , Galway, Ireland
| | - C Breen
- Galway University Hospital Department of Occupational Therapy, , Galway, Ireland
| | - J Carty
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - R Waters
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - M Canavan
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - S Robinson
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
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Griffith V, Murphy R, Sheil O, Roche E, Devaney T, Geoghegan J, Robinson S, Waters R, O'Donnell M, Canavan M. 311 FROM ONE FRONT DOOR TO ANOTHER: OUTCOMES OF PATIENTS DIRECTLY DISCHARGED FROM THE FRAILTY AT THE FRONT DOOR SERVICE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The Frailty at the Front Door service is a novel service that provides comprehensive geriatric assessment in the emergency department for older adults who have an unplanned emergency presentation to hospital. It is important to monitor outcomes of patients discharged by the service to ensure appropriate patient selection.
Methods
Patients over the age of 75 with a Manchester Triage Score of between three and five and a possible frailty syndrome are eligible for review by the service. After initial review patients are either discharged directly or recommended for admission. We reviewed the outcomes of patients who were discharged directly after Emergency Department (ED) assessment by the service.
Results
Discharge disposition was available for review in 413 (95%) of patients since initiation of the service in October 2021. 30% (n= 122) of patients were discharged directly after initial ED review. Elevated 4AT score (p = 0.002) but not frailty (p = 0.80) was associated with decreased chances of direct discharge. Of patients discharged directly from ED 13% were reviewed post discharge by the community integrated care team (GICOP), with 43% of these reviews taking place within 30 days. Overall, 16% of patients discharged directly represented to ED within 30 days. There was a trend towards lower rates of representation to ED among patients who were seen by GICOP after discharge from ED (p = 0.12).
Conclusion
There was a high rate of direct discharge after review by the service, with low rates of representation to hospital. While limited by low numbers there was a trend towards lower representation rates in patients reviewed post-discharge by the integrated care team. Future quality improvement initiatives will aim to improve the integration between the services and highlighting patients who would benefit from more timely reviews.
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Affiliation(s)
- V Griffith
- Galway University Hospital , Galway, Ireland
| | - R Murphy
- Galway University Hospital , Galway, Ireland
| | - O Sheil
- Galway University Hospital , Galway, Ireland
| | - E Roche
- Galway University Hospital , Galway, Ireland
| | - T Devaney
- Galway University Hospital , Galway, Ireland
| | - J Geoghegan
- Galway University Hospital , Galway, Ireland
| | - S Robinson
- Galway University Hospital , Galway, Ireland
| | - R Waters
- Galway University Hospital , Galway, Ireland
| | - M O'Donnell
- Galway University Hospital , Galway, Ireland
| | - M Canavan
- Galway University Hospital , Galway, Ireland
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Coen M, Murphy R, Connolly A, O'Connor A, Doyle E, Byrne S, Carty J, Breen C, Canavan M, Waters R, Robinson S. 225 OLDER PERSONS REHAB AT HOME (OPRAH) INDICATES AN EFFECTIVE ALTERNATIVE PATHWAY TO INPATIENT REHABILITATION. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Older adults have longer hospital stays, higher incidence of nosocomial complications and higher readmissions rates. Older persons rehabilitation at home (OPRaH) is a novel service developed to provide patients with intensive domiciliary based therapy to regain function, mobility and social care goals. OPRaH offers a comprehensive geriatric and interdisciplinary approach. The model enables a safe and accelerated discharge from acute care to home.
Methods
Patients are identified and screened by a team coordinator. On Discharge to OPRaH the following measures were collected; basic demographics, referral source, clinical frailty score and Functional Independence Measures (FIM). Outcomes evaluated are the FIM change, readmission rates, length of inpatient stay savings and time on the service. Data from the first year of operation was analysed using descriptive statistics.
Results
109 patients have undergone rehabilitation with the service with a median age of 82 years (63-103 range). Over two thirds (68%) were classified as frail, with 44% living alone. An injurious fall was the most common reason for index hospitalisation (50%). Referral source was inpatient acute medical team in 50% of cases, with 21% from acute geriatrics , 13 % ortho geriatrics, 13% surgical. Average functional independence measure scores improved from 89 to 102 (p = 0.007). There was no difference in the magnitude of improvement by frailty status (13 vs 14, p = 0.85). The average length of stay saving was 7 days per case, with a total of 757 days saved in one year. Readmission rate within 30 days was 9.3 %. Participants highly rated the service through structured evaluation.
Conclusion
This novel service provides a valuable intervention to a wide case-mix of older adults with evidence of improvements in formal markers of functional impairment after intervention. Referral was based on definable rehabilitation goals and not just on frailty status, age, or gender.
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Affiliation(s)
- M Coen
- Galway University Hospital , Galway, Ireland
| | - R Murphy
- Galway University Hospital , Galway, Ireland
- National University of Ireland , Galway, Ireland
| | - A Connolly
- Galway University Hospital , Galway, Ireland
| | - A O'Connor
- Galway University Hospital , Galway, Ireland
| | - E Doyle
- Galway University Hospital , Galway, Ireland
| | - S Byrne
- Galway University Hospital , Galway, Ireland
| | - J Carty
- Galway University Hospital , Galway, Ireland
- National University of Ireland , Galway, Ireland
| | - C Breen
- Galway University Hospital , Galway, Ireland
| | - M Canavan
- Galway University Hospital , Galway, Ireland
- National University of Ireland , Galway, Ireland
| | - R Waters
- Galway University Hospital , Galway, Ireland
- National University of Ireland , Galway, Ireland
| | - S Robinson
- Galway University Hospital , Galway, Ireland
- National University of Ireland , Galway, Ireland
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Doran N, Murphy R, Clarke E, Quigley S, Kiernan S, Malone A. 275 “MOVING ON UP”: FEASIBILITY OF A WARD-BASED THERAPY INITIATIVE TO IMPROVE PATIENT ACTIVITY LEVELS IN NEUROLOGICAL REHABILITATION. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients admitted for neurological rehabilitation are not receiving sufficient dosage of activity to facilitate optimal recovery. Previous research has reported issues with feasibility and patient adherence to intensity programs.
Methods
Mixed methods were employed for this feasibility study. The “Moving On Up” program encompassed “Activitea” structured practice of sit to stands prompted by mealtimes, “Step It Up” a gradual walking program using pedometers and “Weekend Workout” increasing practice of exercise programs. These activities were in addition to daily therapy sessions over a four-week intervention period. Primary feasibility outcomes investigated recruitment, retention, adherence, adverse events, facilitators, barriers and acceptability of the program and preliminarily assessed changes in activity levels using the ActivPAL accelerometer. Functional tests assessed mobility, health-related quality of life and fear of falls. Descriptive statistics were used for analysing quantitative data. Braun and Clarke’s thematic analysis was adopted when reviewing qualitative data.
Results
Ten participants were recruited with zero dropouts. Median age was 72 years and five had a diagnosis of brain tumour excision. Eight participants demonstrated excellent adherence with completion of daily activity logs. There was one participant non-injurious fall, no other adverse events. Clinical outcomes demonstrated improvement in median daily step count, stepping and standing time. The median daily step count for the group increased from 1,375 steps (IQR 2,867, range 82-4,248) to 1,724 steps (IQR 2,914, range 80-8,207). All functional tests improved. Seven participants and three therapists completed semi-structured interviews. Five themes emerged; motivation to move more, empowerment, barriers to increasing activity, weekends long and boring and job satisfaction.
Conclusion
The “Moving On Up” program was feasible to implement without additional staffing and was accepted by key stakeholders. Future research is warranted into the program's effectiveness, incorporating a larger sample and randomised pilot trial. Inclusion of a follow-up of participants after discharge would be desirable to investigate long-term effects on activity.
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Affiliation(s)
- N Doran
- Clontarf Hospital , Dublin, Ireland
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | - R Murphy
- Clontarf Hospital , Dublin, Ireland
| | - E Clarke
- Clontarf Hospital , Dublin, Ireland
| | | | | | - A Malone
- Royal College of Surgeons in Ireland , Dublin, Ireland
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10
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Mannion E, Murphy R, Robinson S, Waters R, Donnell MO, Walsh T, Geoghegan J, Conry M, Canavan M. 342 THE DISCRIMINATORY VALUE OF ANP-LED CGA ON PATIENT REPORTED SYMPTOMS AND IMPACT ON CARERS: A CROSS-SECTIONAL STUDY. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Comprehensive Geriatric Assessment (CGA) is a cornerstone in geriatric care. Objective findings from CGA may differ to patient and carer reported symptoms. This study compared patient reported symptoms with objective metrics collected during CGA and explored the relationship with carer burnout.
Methods
Cross-sectional study of patients attending an Advanced Nurse Practitioner (ANP)-led integrated care clinic. Patient-reported geriatric syndromes included low mood, memory concerns, incontinence, falls or dizziness. CGA metrics collected included Barthel Index, Lawton IADLs, MOCA scores, Geriatric depression scale scores, Rockwood Clinical Frailty Scale (CFS) scores and presence or absence of carer burnout. Descriptive statistics were used to compare the relationship between these variables and logistic regression explored the magnitude of association with carer burnout.
Results
We reviewed 99 CGAs over three months. Median age was 81 (IQR 75–86) with 62% female. Cognitive impairment was present in 96% of patients. Self-reported memory trouble was associated with lower MOCA scores (9 vs 23, p < 0.001) and the presence of dizziness was associated with an increased prevalence of falls (89% vs 24%, < 0.001). The presence of incontinence and functional dependency on IADL were both associated with carer strain and a larger magnitude of association with carer strain was seen with increasing frailty (OR 13.7, 95% CI 3.8-58.8 for moderate to severe frailty) than moderate to severe cognitive impairment (OR 8, 95% CI 3.0–24.1)
Conclusion
Older people reported a wide range of symptoms often subtle, some of which are unmasked during CGA. The resultant frailty syndromes often represent increasing degrees of functional impairment impacting on patient and carer quality of life. Striking the balance between patient reported symptoms and objective measurement is important to allow individualised care pathways to be developed as well as highlighting patients at risk of functional and cognitive decline.
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Affiliation(s)
- E Mannion
- Galway University Hospital , Galway, Ireland
- Galway Integrated Care Older Person , Galway, Ireland
| | - R Murphy
- Galway University Hospital , Galway, Ireland
- National University of Ireland Galway , Galway, Ireland
| | - S Robinson
- Galway Integrated Care Older Person , Galway, Ireland
| | - R Waters
- Galway Integrated Care Older Person , Galway, Ireland
| | - MO Donnell
- National University of Ireland Galway , Galway, Ireland
| | - T Walsh
- Galway University Hospital , Galway, Ireland
| | - J Geoghegan
- Galway Integrated Care Older Person , Galway, Ireland
| | - M Conry
- Galway Integrated Care Older Person , Galway, Ireland
| | - M Canavan
- Galway Integrated Care Older Person , Galway, Ireland
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11
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Whelan A, Murphy R, Shiel E, Griffith V, Mannion K, Neachtain MN, Mannion E, Conry M, Geoghegan J, Waters R, O'Donnell M, Robinson S, Canavan M. 355 PREDICTORS OF HOME SUPPORT SERVICES AND THE CONSEQUENCES OF MISMATCH BETWEEN ALLOCATED AND RECEIVED SERVICES IN COGNITIVELY-IMPAIRED OLDER ADULTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Home support services aim to support older people to remain at home. Despite substantial investment in home support hours (€600 million), this has not translated into increased carers on the ground for older people. We aimed to report patterns of home support service utilisation in older patients with memory problems, and identify any mis-matches between allocated and received hours, and the impact on patients and caregivers.
Methods
Retrospective analysis of consecutive patients referred to community geriatric clinic from January 2021 to May 2022. 95/104 patients who were identified were suitable for inclusion.
Results
Participants had a median age of 82 (IQR 78-86) of whom 57% were female (n=54). 80% (n=76) were frail (CFS ≥4), with 82% dependent for IADLs (Lawton-Brody IADL Scale ≤6). Median MOCA score was 18, with 44% having moderate to severe cognitive impairment (MOCA ≤17). 40% of patients lived with alone (n=38). 52% (n=49) received formal home supports while 80% (n=76) had an informal carer. 37% (n=18) had a mismatch between hours allocated and hours received. There was a significant difference between median hours of care allocated (7) and median hours of care received (5), p <0.001. Increasing age and frailty, worsening cognitive and functional impairment and living status (living alone) predicted allocation of home supports. Patients who lived with family members were 3 times more likely not to receive allocated hours (OR 3.84 (95% CI 1.2–13.7))
Conclusion
In this vulnerable population with cognitive and functional decline, just over half received formal home support hours. A large proportion experienced significant mismatch between allocated and received hours. Family and informal caregivers often have to fill gaps, adding to existing carer strain. Future models of home support should prioritise early intervention for people with IADL loss to remain independent at home and broaden of the scope of practice of carers to facilitate this.
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Affiliation(s)
- A Whelan
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
| | - R Murphy
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- School of Medicine, National University of Ireland, Galway , Galway, Ireland
| | - E Shiel
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- University Hospital Galway Department of Nursing, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - V Griffith
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
| | - K Mannion
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- University Hospital Galway Department of Nursing, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - M Ní Neachtain
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- University Hospital Galway Department of Nursing, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - E Mannion
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- University Hospital Galway Department of Nursing, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - M Conry
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
- University Hospital Galway Department of Social Work, , Galway, Ireland
| | - J Geoghegan
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - R Waters
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - M O'Donnell
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - S Robinson
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - M Canavan
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
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12
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Reddin C, Hanrahan C, Murphy R, Costello M, Waters R, O'Donnell M. 312 DOES EXCLUDING PATIENTS WITH ORTHOSTATIC HYPOTENSION AFFECT SAFETY ESTIMATES IN HYPERTENSION TRIALS? A SYSTEMATIC REVIEW AND COMPARATIVE META-ANALYSIS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In order to apply the findings of antihypertensive randomised controlled trials to older adults, it is important to understand the populations included and consider the generalizability of the results to cohorts that may have been excluded. The purpose of this study was to determine whether participants with orthostatic hypotension were included in randomised controlled trial of antihypertensive therapy and whether adverse event rates of particular importance to this cohort; namely falls or syncope differed based on their exclusion.
Methods
We performed a systematic review and meta-analysis of randomised controlled trials comparing antihypertensives to placebo, combination of antihypertensive agents compared to fewer antihypertensive or higher compared to lower blood pressure targets that reports falls or syncope outcomes. A random-effects meta-analysis was used to estimate a pooled treatment-effect overall in subgroups of trials which excluded patients with orthostatic hypotension and trials which did not exclude patients with orthostatic hypotension. Difference in treatment effect was assessed by testing P for interaction. The primary outcome measure was falls events.
Results
Forty-Seven trials were included, including 18 trials which excluded those with orthostatic hypotension and 29 trials which did not exclude those with orthostatic hypotension. Thirteen trials (n=94,222) reported falls. The baseline incidence of falls in the control group was 4.8% in trials which excluded orthostatic hypotension compared to 8.8% in trials which did not exclude participants with orthostatic hypotension. The association of antihypertensive treatment and falls was similar for trials which excluded those with orthostatic hypotension (OR 1.00; 95%CI, 0.89-1.13) and trials which did not exclude those with orthostatic hypotension (OR, 1.02; 95%CI, 0.88 –1.18).
Conclusion
The exclusion of patients with orthostatic hypotension may under-estimate the event rate of adverse events such as falls but does not appear to affect relative risk estimates associated with antihypertensives.
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Affiliation(s)
- C Reddin
- University Hospital Galway , Galway, Ireland
- National University of Ireland , Galway, Galway, Ireland
- Wellcome Trust – HRB, Irish Clinical Academic Training , Ireland, Ireland
| | - C Hanrahan
- University Hospital Galway , Galway, Ireland
| | - R Murphy
- University Hospital Galway , Galway, Ireland
- National University of Ireland , Galway, Galway, Ireland
| | - M Costello
- University Hospital Galway , Galway, Ireland
- National University of Ireland , Galway, Galway, Ireland
| | - R Waters
- University Hospital Galway , Galway, Ireland
| | - M O'Donnell
- University Hospital Galway , Galway, Ireland
- National University of Ireland , Galway, Galway, Ireland
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13
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Mc Carthy CE, Murphy R, McAteer C, Okon M, O'Donnell M. 279 INCLUSION OF OLDER PATIENTS IN CLINICAL TRIALS: A REVIEW OF A SINGLE, HIGH IMPACT, MEDICAL JOURNAL OVER A 2-YEAR PERIOD. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Older patients have the highest rates of multimorbidity and prescription drug use. Despite this, previous research has found that these patients are not well represented in Randomised-Control Trials (RCTs), limiting external validity. In recent years many guidelines have been issued to help facilitate the inclusion of older patients in RCTs. We aimed to explore the inclusion of older patients in recent RCTs publications.
Methods
A single, high impact, medical journal was systematically reviewed, with all full text publications between March 2019 and March 2021 being screened. All adult, Phase III, RCTs were selected. The age descriptors of controls were extracted, in addition to information on eligibility criteria that could lead to exclusion based on age, comorbidity, or cognition.
Results
Of 123 RCT publications, the mean age was ≥65 in 42.1% and ≥75 in 8.3%, while the 75th centile age was ≥65 in 72% and ≥75 in 25%. An explicit capacity requirement was present in 41.5% and those with cognitive impairment were excluded in 15.4%. Eligibility determined at the discretion of the investigator and a life-expectancy exclusion criteria were present in 33.3% and 36.6%, respectively. A maximum age limit was present in 18.7%. No RCTs excluded on the basis of polypharmacy. The mean/75th centile age differed significantly by speciality (p<0.05), oldest in cardiovascular and medical RCTs. Having a maximum age limit was significantly associated with a lower mean/75th centile age (p<0.01), while having a life-expectancy exclusion criteria was associated with a higher mean/75th centile age (p<0.05). The age did not differ significantly between pre/post-COVID-19 RCTs, or for other eligibility criteria studied.
Conclusion
While those ≥65 were well represented, those ≥75 were not. Eligibility criteria that could potentially lead to exclusion based on age, comorbidity, or cognition were also common, although the majority did not significantly affect age.
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Affiliation(s)
- CE Mc Carthy
- National University of Ireland , Galway, Galway, Ireland
| | - R Murphy
- National University of Ireland , Galway, Galway, Ireland
| | - C McAteer
- University Hospital Galway Department of Geriatric Medicine, , Galway, Ireland
| | - M Okon
- University Hospital Galway Department of Geriatric Medicine, , Galway, Ireland
| | - M O'Donnell
- National University of Ireland , Galway, Galway, Ireland
- University Hospital Galway Department of Geriatric Medicine, , Galway, Ireland
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14
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Murphy R, McCarthy C, Reddin C, Canavan M, O’Dwyer C, Mulroy M, O'Donnell M. 310 A COMPARATIVE ANALYSIS OF THE IRISH POST-GRADUATE GERIATRIC TRAINING SCHEME WITH THE EUROPEAN POST-GRADUATE CURRICULUM IN GERIATRIC MEDICINE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Minimum training recommendations to become a specialist geriatrician in the EU have been published. In this study we sought to evaluate the curriculum of the higher specialist training scheme in Geriatric Medicine in Ireland and examine how it compares with the knowledge recommendations from the European post-graduate curriculum in Geriatric medicine, which is endorsed by both the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA).
Methods
In this study we examined the content of didactic study-day lectures given over a five-year rolling period which is the minimum duration of the higher specialist training programme in Geriatric medicine in Ireland. We also examined the published Irish curriculum and compared how both the Irish curriculum and content of the study-days matches up with the 36 items that are identified as the core knowledge content in the European post-graduate curriculum.
Results
There were 24 study days delivered over a five-year time period. The Irish geriatric medicine curriculum formally outlined that 30 of the 36 knowledge areas proposed in the European curriculum should be formally covered during post-graduate geriatric training in Ireland. The European curriculum recommended formal teaching in sarcopenia, sleep disorders, tissue viability, iatrogenic care delivered disorders, sexuality in older adults and geron-technology/e-health, none of which were referred to in the Irish curriculum. However, despite this discrepancy, formal teaching was delivered on 92% (n = 33) of proposed areas. Pain assessment, sleep disorders and tissue viability were areas not covered in Irish didactic study-days. 24 of 36 topics were covered at least twice.
Conclusion
There was high concordance between the content of the Irish and European post-graduate curriculum in Geriatric medicine. Benchmarking against European training standards is an opportunity to ensure that parity of education and training is achieved across the EU.
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Affiliation(s)
- R Murphy
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - C McCarthy
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - C Reddin
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - M Canavan
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - C O’Dwyer
- St. Vincent’s University Hospital Department of Geriatric Medicine, , Ireland
| | - M Mulroy
- Our Lady of Lourdes Hospital , Drogheda, Louth, Ireland
| | - M O'Donnell
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
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15
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Rohde D, Foley C, Murphy R, Kelly M, Drummond L. Patient experiences of hospital care during the COVID-19 pandemic in Ireland. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The COVID-19 pandemic has greatly impacted healthcare service delivery. This study explored patient experiences of hospital care during the COVID-19 pandemic in Ireland, using National Inpatient Experience Survey (NIES) 2021 data.
Methods
NIES is a repeat cross-sectional survey of inpatient experiences in all public acute hospitals in Ireland. Patients who spent 24+ hours in hospital and were discharged in September 2021 were eligible to participate. 7 questions addressed experiences specific to the pandemic. Comparisons between 2019 and 2021 were conducted using t-tests. Effect sizes (d) are reported. Qualitative data were thematically analysed.
Results
10,743 patients participated (42% response rate). While 68% did not feel at risk of catching COVID-19, 9% felt at risk. 35% reported that staff always helped them to keep in touch with family. There were small, statistically significant differences between 2019 and 2021 ratings, with questions on opportunity for family to talk to a doctor (d=-.328), provision of information to family (d=-.136), and being able to find staff to talk to about worries and fears (d=-.167) recording the biggest decreases. Scores for cleanliness of wards (d = 0.063) and bathrooms (d=.075), and privacy during examination or treatment in the ED (d = 0.085) improved significantly. Patients commented on their appreciation of staff, but missed having visitors, with restrictions posing challenges for those with sensory or physical impairments.
Conclusions
Given the unique challenges experienced by acute healthcare services during the COVID-19 pandemic, comparisons with pre-pandemic patient experiences should be interpreted with caution. Continuing to gather patient feedback during a pandemic presents a unique opportunity to understand the resilience of healthcare systems as they continue to operate under unprecedented pressure, with the potential to inform responses and delivery of care during future pandemics or other emergencies.
Key messages
• Visiting restrictions posed many challenges for patients and affected communication both between patients and their family members, as well as between healthcare staff and patients’ family.
• Gathering patient feedback during a pandemic presents a unique opportunity to inform responses and delivery of care during future pandemics or other emergencies.
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Affiliation(s)
- D Rohde
- National Care Experience Programme, Health Information and Quality Authority , Dublin, Ireland
| | - C Foley
- National Care Experience Programme, Health Information and Quality Authority , Dublin, Ireland
| | - R Murphy
- National Care Experience Programme, Health Information and Quality Authority , Dublin, Ireland
| | - M Kelly
- National Care Experience Programme, Health Information and Quality Authority , Dublin, Ireland
| | - L Drummond
- National Care Experience Programme, Health Information and Quality Authority , Dublin, Ireland
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16
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Gahan Y, Hunt P, Duggan C, Geraghty K, Murphy R. CN47 Future-proofing the Irish Association for Nurses in Oncology: Identifying the professional and educational needs of members. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.372] [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: 11/26/2022] Open
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17
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, Choo LY, Clark L, Daniels M, Goh J, Handa A, Hanna J, Huynh L, Jeon A, Kanbour A, Lee A, Lee J, Lee T, Leigh J, Ly D, McGregor F, Moss J, Nejatian M, O'Loughlin E, Ramos I, Sanchez B, Shrivathsa A, Sincari A, Sobhi S, Swart R, Trimboli J, Wignall P, Bourke E, Chong A, Clayton S, Dawson A, Hardy E, Iqbal R, Le L, Mao S, Marinelli I, Metcalfe H, Panicker D, R HH, Ridgway S, Tan HH, Thong S, Van M, Woon S, Woon-Shoo-Tong XS, Yu S, Ali K, Chee J, Chiu C, Chow YW, Duller A, Nagappan P, Ng S, Selvanathan M, Sheridan C, Temple M, Do JE, Dudi-Venkata NN, Humphries E, Li L, Mansour LT, Massy-Westropp C, Fang B, Farbood K, Hong H, Huang Y, Joan M, Koh C, Liu YHA, Mahajan T, Muller E, Park R, Tanudisastro M, Wu JJG, Chopra P, Giang S, Radcliffe S, Thach P, Wallace D, Wilkes A, Chinta SH, Li J, Phan J, Rahman F, Segaran A, Shannon J, Zhang M, Adams N, Bonte A, Choudhry A, Colterjohn N, Croyle JA, Donohue J, Feighery A, Keane A, McNamara D, Munir K, Roche D, Sabnani R, Seligman D, Sharma S, Stickney Z, Suchy H, Tan R, Yordi S, Ahmed I, Aranha M, El Sabawy D, Garwood P, Harnett M, Holohan R, Howard R, Kayyal Y, Krakoski N, Lupo M, McGilberry W, Nepon H, Scoleri Y, Urbina C, Ahmad Fuad MF, Ahmed O, Jaswantlal D, Kelly E, Khan MHT, Naidu D, Neo WX, O'Neill R, Sugrue M, Abbas JD, Abdul-Fattah S, Azlan A, Barry K, Idris NS, Kaka N, Mc Dermott D, Mohammad Nasir MN, Mozo M, Rehal A, Shaikh Yousef M, Wong RH, Curran E, Gardner M, Hogan A, Julka R, Lasser G, Ní Chorráin N, Ting J, Browne R, George S, Janjua Z, Leung Shing V, Megally M, Murphy S, Ravenscroft L, Vedadi A, Vyas V, Bryan A, Sheikh A, Ubhi J, Vannelli K, Vawda A, Adeusi L, Doherty C, Fitzgerald C, Gallagher H, Gill P, Hamza H, Hogan M, Kelly S, Larry J, Lynch P, Mazeni NA, O'Connell R, O'Loghlin R, Singh K, Abbas Syed R, Ali A, Alkandari B, Arnold A, Arora E, Azam R, Breathnach C, Cheema J, Compton M, Curran S, Elliott JA, Jayasamraj O, Mohammed N, Noone A, Pal A, Pandey S, Quinn P, Sheridan R, Siew L, Tan EP, Tio SW, Toh VTR, Walsh M, Yap C, Yassa J, Young T, Agarwal N, Almoosawy SA, Bowen K, Bruce D, Connachan R, Cook A, Daniell A, Elliott M, Fung HKF, Irving A, Laurie S, Lee YJ, Lim ZX, Maddineni S, McClenaghan RE, Muthuganesan V, Ravichandran P, Roberts N, Shaji S, Solt S, Toshney E, Arnold C, Baker O, Belais F, Bojanic C, Byrne M, Chau CYC, De Soysa S, Eldridge M, Fairey M, Fearnhead N, Guéroult A, Ho JSY, Joshi K, Kadiyala N, Khalid S, Khan F, Kumar K, Lewis E, Magee J, Manetta-Jones D, Mann S, McKeown L, Mitrofan C, Mohamed T, Monnickendam A, Ng AYKC, Ortu A, Patel M, Pope T, Pressling S, Purohit K, Saji S, Shah Foridi J, Shah R, Siddiqui SS, Surman K, Utukuri M, Varghese A, Williams CYK, Yang JJ, Billson E, Cheah E, Holmes P, Hussain S, Murdock D, Nicholls A, Patel P, Ramana G, Saleki M, Spence H, Thomas D, Yu C, Abousamra M, Brown C, Conti I, Donnelly A, Durand M, French N, Goan R, O'Kane E, Rubinchik P, Gardiner H, Kempf B, Lai YL, Matthews H, Minford E, Rafferty C, Reid C, Sheridan N, Al 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Qureshi A, Sawhney R, Sigurdson B, Stephenson L, Vora K, Zacken A, Cope P, Di Traglia R, Ferarrio I, Hackett N, Healicon R, Horseman L, Lam LI, Meerdink M, Menham D, Murphy R, Nimmo I, Ramaesh A, Rees J, Soame R, Dilaver N, Adebambo D, Brown E, Burt J, Foster K, Kaliyappan L, Knight P, Politis A, Richardson E, Townsend J, Abdi M, Ball M, Easby S, Gill N, Ho E, Iqbal H, Matthews M, Nubi S, Nwokocha JO, Okafor I, Perry G, Sinartio B, Vanukuru N, Walkley D, Welch T, Yates J, Yeshitila N, Bryans K, Campbell B, Gray C, Keys R, Macartney M, Chamberlain G, Khatri A, Kucheria A, Lee STP, Reese G, Roy choudhury J, Tan WYR, Teh JJ, Ting A, Kazi S, Kontovounisios C, Vutipongsatorn K, Amarnath T, Balasubramanian N, Bassett E, Gurung P, Lim J, Panjikkaran A, Sanalla A, Alkoot M, Bacigalupo V, Eardley N, Horton M, Hurry A, Isti C, Maskell P, Nursiah K, Punn G, Salih H, Epanomeritakis E, Foulkes A, Henderson R, Johnston E, McCullough H, McLarnon M, Morrison E, Cheung A, Cho SH, Eriksson F, Hedges J, 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Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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18
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Oldroyd AGS, Lilleker JB, Amin T, Aragon O, Bechman K, Cuthbert V, Galloway J, Gordon P, Gregory WJ, Gunawardena H, Hanna MG, Isenberg D, Jackman J, Kiely PDW, Livermore P, Machado PM, Maillard S, McHugh N, Murphy R, Pilkington C, Prabu A, Rushe P, Spinty S, Swan J, Tahir H, Tansley SL, Truepenny P, Truepenny Y, Warrier K, Yates M, Papadopoulou C, Martin N, McCann L, Chinoy H. British Society for Rheumatology guideline on management of paediatric, adolescent and adult patients with idiopathic inflammatory myopathy. Rheumatology (Oxford) 2022; 61:1760-1768. [PMID: 35355064 PMCID: PMC9398208 DOI: 10.1093/rheumatology/keac115] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 02/21/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexander G S Oldroyd
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK.,Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
| | - James B Lilleker
- Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - Tania Amin
- Department of Paediatric Rheumatology, Leeds Children's Hospital, Leeds, UK
| | - Octavio Aragon
- Pharmacy Department, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.,School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Katie Bechman
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Verna Cuthbert
- Department of Paediatric Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - James Galloway
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Patrick Gordon
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
| | - William J Gregory
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK.,Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Harsha Gunawardena
- Department of Rheumatology, North Bristol NHS Trust, Bristol, UK.,Department of Clinical and Academic Rheumatology, University of Bristol, Bristol, UK
| | - Michael G Hanna
- Queen Square Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - David Isenberg
- Department of Rheumatology, Division of Medicine, University College London, London, UK
| | - John Jackman
- Department of Rheumatology, Nuffield Orthopaedic Centre, Oxford, UK
| | - Patrick D W Kiely
- Department of Rheumatology, St George's University Hospitals NHS Foundation Trust, London, UK.,Institute of Medical and Biomedical Education, St George's, University of London, London, UK
| | - Polly Livermore
- Department of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK.,NIHR Great Ormond Street and University College London Biomedical Research Centre, London, UK
| | - Pedro M Machado
- Department of Neuromuscular Diseases, Centre for Rheumatology, University College London, London, UK.,NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals (UCLH) NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Sue Maillard
- Department of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Neil McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Ruth Murphy
- Department of Dermatology, Sheffield University Teaching Hospitals, Sheffield, UK
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Athiveeraramapandian Prabu
- Rheumatology Research Group, Institute of Inflammation and Aging, University of Birmingham, Birmingham, UK.,Department of Rheumatology, Sandwell and West Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Stefan Spinty
- Department of Paediatric Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Joanne Swan
- Juvenile Dermatomyositis Parent Representative
| | - Hasan Tahir
- Department of Rheumatology, Royal Free London NHS Trust, London, UK.,Division of Medicine, University College London, London, UK
| | - Sarah L Tansley
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.,Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | | | - Kishore Warrier
- Department of Paediatric Rheumatology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Mark Yates
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Charalampia Papadopoulou
- Department of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Neil Martin
- Department of Paediatric Rheumatology, Royal Hospital for Children, Glasgow, UK.,Scottish Paediatric & Adolescent Rheumatology Network, Glasgow, Scotland
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Hector Chinoy
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
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Murphy R, Payan N, Osman S, Prise K, Hounsell A, O'Sullivan J, McGarry C, Jain S. PO-1769 Prostate cancer radiogenomics machine learning classification for predicting disease progression. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03733-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Sharma M, Murphy R, Doody GA. Barriers and facilitators for implementation of a national recommended specialty core-curriculum across UK medical schools: a cross-sectional study using an online questionnaire. BMJ Open 2022; 12:e053565. [PMID: 35351703 PMCID: PMC8966526 DOI: 10.1136/bmjopen-2021-053565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The National Health Service (NHS) Long-Term plan published in 2019 set out healthcare reforms to meet the healthcare demands of UK. Undergraduate specialty core-curricula like dermatology aligns well to the training needs of the future workforce but lacks representation, consistency and implementation. This study explores the barriers and facilitators influencing the implementation of a specialty-specific (dermatology) national core-curriculum across UK medical schools. DESIGN A constructivist approach was used to develop an online questionnaire and data collected using mixed methodology. PARTICIPANTS Undergraduate dermatology teaching leads across all UK medical schools. RESULTS 30 out of 42 UK medical schools responded to the survey (71%). 16 out of 30 (53%) responders were unaware of the planned Medical Licensing Assessments (MLA) for all UK graduates in 2024-2025; 43% were unaware if dermatology was mapped to national standards; 50% were unsure if the dermatology was blueprinted on school curricula. Barriers to implementation included competing NHS service commitments, the specialty not seen as a priority and difficulty influencing curricula changes at school level. Facilitators included workforce planning and transparency in funding to support leadership in undergraduate education. Domains identified for curriculum implementation were: (1) awareness of the role of General Medical Council and the MLA, (2) medical education training for teaching leads, (3) lack of recognition and resources for leadership, (4) skills development to map, blueprint and assess specialty core-components, (5) medical school and specialty engagement. CONCLUSIONS This study identifies the potential barriers and facilitators to specialty specific core-curricular implementation across UK medical schools. Lack of standardised training in medical education, time and resources undermine the role of specialty teaching leads as medical educators. Medical school engagement with specialties with mutual support would aid the forthcoming educational reforms.
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Affiliation(s)
- Maulina Sharma
- British Association of Dermatologists, London, UK
- Medical Education, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ruth Murphy
- British Association of Dermatologists, London, UK
- Medical Education, School of Medicine, University of Nottingham, Nottingham, UK
| | - Gillian A Doody
- Medical Education, School of Medicine, University of Nottingham, Nottingham, UK
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21
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Odukoya O, Nenrot D, Adelabu H, Katam N, Christian E, Holl J, Okonkwo A, Kocherginsky M, Kim KY, Akanmu S, Abdulkareem FB, Anorlu R, Musa J, Lesi O, Hawkins C, Okeke O, Adeyemo WL, Sagay S, Murphy R, Hou L, Ogunsola FT, Wehbe FH. Application of the research electronic data capture (REDCap) system in a low- and middle income country- experiences, lessons, and challenges. Health Technol (Berl) 2022; 11:1297-1304. [PMID: 35251887 PMCID: PMC8896572 DOI: 10.1007/s12553-021-00600-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The challenges of reliably collecting, storing, organizing, and analyzing research data are critical in low- and middle-income countries (LMICs), particularly in Sub-Saharan Africa where several healthcare and biomedical research organizations have limited data infrastructure. The Research Electronic Data Capture (REDCap) System has been widely used by many institutions and hospitals in the USA for data collection, entry, and management and could help solve this problem. This study reports on the experiences, challenges, and lessons learned from establishing and applying REDCap for a large US-Nigeria research partnership that includes two sites in Nigeria, (the College of Medicine of the University of Lagos (CMUL) and Jos University Teaching Hospital (JUTH)) and Northwestern University (NU) in Chicago, Illinois in the United States. The largest challenges to this implementation were significant technical obstacles: the lack of REDCap-trained personnel, transient electrical power supply, and slow/intermittent internet connectivity. However, asynchronous communication and on-site hands-on collaboration between the Nigerian sites and NU led to the successful installation and configuration of REDCap to meet the needs of the Nigerian sites. An example of one lesson learned is the use of Virtual Private Network (VPN) as a solution to poor internet connectivity at one of the sites, and its adoption is underway at the other. Virtual Private Servers (VPS) or shared online hosting were also evaluated and offer alternative solutions. Installing and using REDCap in LMIC institutions for research data management is feasible; however, planning for trained personnel and addressing electrical and internet infrastructural requirements are essential to optimize its use. Building this fundamental research capacity within LMICs across Africa could substantially enhance the potential for more cross-institutional and cross-country collaboration in future research endeavors.
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Affiliation(s)
- O Odukoya
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos State, Nigeria
| | - D Nenrot
- College of Health Sciences, University of Jos, Plateau state, Nigeria
| | - H Adelabu
- AIDS Prevention Initiative of Nigeria, Lagos University Teaching Hospital, Lagos State, Nigeria
| | - N Katam
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - E Christian
- Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - J Holl
- Department of Neurology and Center for Healthcare Delivery Science and Innovation, Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - A Okonkwo
- Research Management Office, College of Medicine, University of Lagos, Lagos, Nigeria
| | - M Kocherginsky
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.,Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - K-Y Kim
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.,Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - S Akanmu
- AIDS Prevention Initiative of Nigeria, Lagos University Teaching Hospital, Lagos State, Nigeria
| | - F B Abdulkareem
- Department of Anatomic & Molecular Pathology, College of Medicine, University of Lagos, Lagos State, Nigeria
| | - R Anorlu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos State, Nigeria
| | - J Musa
- College of Health Sciences, University of Jos, Plateau state, Nigeria.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.,Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - O Lesi
- Department of Medicine, College of Medicine, University of Lagos, Lagos State, Nigeria
| | - C Hawkins
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.,Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - O Okeke
- College of Health Sciences, University of Jos, Plateau state, Nigeria
| | - W L Adeyemo
- Department of Maxillofacial Surgery, College of Medicine, University of Lagos, Lagos State, Nigeria
| | - S Sagay
- College of Health Sciences, University of Jos, Plateau state, Nigeria
| | - R Murphy
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.,Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - L Hou
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.,Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - F T Ogunsola
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos State, Nigeria
| | - F H Wehbe
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
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22
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Azhar M, Murphy R, Hart C, Sachdeva A, Jain S, Brown M, Clarke N. Expression analysis of prostate cancer Hoechst 33342 side populations identifies the differing origins of CRPC. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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23
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Lerner A, Keshwani K, Okines A, Sanderson B, Board R, Flynn M, Sharkey E, Konstantis A, Roylance R, Hanna D, King J, Murphy R, Rehman F, Guppy A, Westbury C, Takeuchi E, Spurrell E, Jayaweera H, Raja F. A Multicentre Retrospective Study of Fulvestrant Use and Efficacy in Advanced/Metastatic Breast Cancer. Clin Oncol (R Coll Radiol) 2022; 34:261-266. [DOI: 10.1016/j.clon.2021.12.012] [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] [Received: 05/17/2021] [Revised: 11/17/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
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24
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Kwiatkowska M, Ahmed S, Ardern‐Jones M, Bhatti LA, Bleiker TO, Gavin A, Hussain S, Huws DW, Irvine L, Langan SM, Millington GWM, Mitchell H, Murphy R, Paley L, Proby CM, Thomson CS, Thomas R, Turner C, Vernon S, Venables ZC. An updated report on the incidence and epidemiological trends of keratinocyte cancers in the United Kingdom 2013-2018. Skin Health Dis 2021; 1:e61. [PMID: 35663774 PMCID: PMC9060124 DOI: 10.1002/ski2.61] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 12/29/2022]
Abstract
Introduction The most common cancers in the UK are keratinocyte cancers (KCs): the combined term for basal cell carcinomas (BCCs) and cutaneous squamous cell carcinomas (cSCCs). Registration of KC is challenging due to high numbers and multiplicity of tumours per person. Methods We provide an updated report on the descriptive epidemiology of trends in KC incidence for the resident populations of UK countries (England, Northern Ireland, Scotland and Wales) using population-based cancer registry and pathology report data, 2013-18. Results Substantial increases in cSCC incidence in England, Scotland and Northern Ireland can be detected for the period of 2013-18, and the incidence of cSCC also increased in Wales from 2016 to 2018. In contrast, however, the pattern of annual change in the incidence of BCC across the nations differs. In England, the incidence of BCC declined slightly from 2016 to 2018, however, the overall trend across 2013-18 is not statistically significant. In Scotland, the incidence of BCC shows some variability, declining in 2017 before increasing in 2018, and the overall trend across 2013-18 was also not statistically significant. In Northern Ireland, the incidence of BCC increased significantly over the study period, and in Wales, the incidence of BCC increased from 2016 to 2018. One in five people will develop non-melanoma skin cancers (NMSC) in their lifetime in England. This estimate is much higher than the lifetime risk of melanoma (1 in 36 males and 1 in 47 females born after 1960 in the UK), which further highlights the burden of the disease and importance of early prevention strategies. Conclusions We highlight how common these tumours are by publishing the first ever lifetime incidence of NMSC. Additionally, the first time reporting of the age standardised incidence of KC in Wales further confirms the scale of the disease burden posed by these cancers in the UK. With approximately one in five people developing NMSC in their lifetime, optimisation of skin cancer prevention, management and research are essential.
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Affiliation(s)
- M. Kwiatkowska
- National Cancer Registration and Analysis ServiceLondonUK
- British Association of DermatologistsLondonUK
| | - S. Ahmed
- British Association of DermatologistsLondonUK
| | - M. Ardern‐Jones
- Department of Clinical Experimental SciencesFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | | | - T. O. Bleiker
- University Hospitals of Derby and Burton NHS Foundation TrustDerbyUK
| | - A. Gavin
- North Ireland Cancer RegistryBelfastUK
| | - S. Hussain
- British Association of DermatologistsLondonUK
| | | | - L. Irvine
- National Cancer Registration and Analysis ServiceLondonUK
| | - S. M. Langan
- London School of Hygiene & Tropical MedicineSt. John's Institute of DermatologyLondonUK
| | - G. W. M. Millington
- Department of DermatologyNorfolk and Norwich University HospitalNorwichUK
- University of East Anglia Norwich Medical SchoolNorwichUK
| | | | - R. Murphy
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - L. Paley
- National Cancer Registration and Analysis ServiceLondonUK
| | - C. M. Proby
- Department of DermatologyNinewells Hospital and Medical SchoolDundeeUK
| | | | | | - C. Turner
- National Cancer Registration and Analysis ServiceLondonUK
| | - S. Vernon
- National Cancer Registration and Analysis ServiceLondonUK
| | - Z. C. Venables
- National Cancer Registration and Analysis ServiceLondonUK
- Department of DermatologyNorfolk and Norwich University HospitalNorwichUK
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Murphy R, Sayers K, Ryan S, Maher J, Pillay I. 179 WHAT MATTERS TO THE FRAIL OLDER PERSON CHANGES DURING COVID-19 AND SHOULD INFORM PATIENT CENTRED CHANGE. Age Ageing 2021; 50:afab219.179. [PMCID: PMC8689994 DOI: 10.1093/ageing/afab219.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- R Murphy
- Tipperary University Hospital, Tipperary, Ireland,CHO 5, Tipperary, Ireland
| | - K Sayers
- Tipperary University Hospital, Tipperary, Ireland,Community Health Organisation 5, Tipperary, Ireland
| | - S Ryan
- Tipperary University Hospital, Tipperary, Ireland
| | - J Maher
- Tipperary University Hospital, Tipperary, Ireland,CHO 5, Tipperary, Ireland
| | - I Pillay
- Tipperary University Hospital, Tipperary, Ireland,Community Health Organisation 5, Tipperary, Ireland
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26
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McGettigan S, Farrell A, Murphy R, MacGearailt C, O'Keeffe S, Mulkerrin E. 59 IMPROVED OUTCOMES WITH DELAYED ADMISSION TO POST-ACUTE CARE: RESULTS OF A NATURAL EXPERIMENT. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.59] [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: 02/25/2023] Open
Abstract
Abstract
Background
In Ireland, the national Health Service Executive developed a post-acute care (PAC) scheme in 2016 to provide funds to acute hospitals for beds in nursing homes to allow discharge of patients who would benefit from a period of recovery in a nursing home before returning home when medically fit for discharge with no need for rehabilitation or long-term care (LTC). However, budgetary restrictions introduced from June 2019 resulted in a delay in access to funding. This change in funding was used as a natural experiment of the effectiveness of this scheme in a single large general hospital before and after delays due to funding restrictions.
Methods
Data regarding PAC admissions for those aged 65 years or more from July to October 2017, when there were no budgetary restrictions, and from July to October 2019, when funding was delayed, were compared. Chi-square tests were used to compare proportions, and the nonparametric Mann–Whitney U test was used to compare continuous data.
Results
Compared with the 2017 cohort, those in 2019 spent 6 days longer in the acute hospital following a delay in 2019 between being approved clinically as needing PAC and subsequent admission to a facility. However, readmissions to hospital within 90 days of discharge and directly from PAC were significantly higher in 2017, as was discharge from PAC directly to LTC.
Conclusion
This retrospective study demonstrates restrictive practices regarding discharge to PAC introduced for budgetary reasons caused longer acute bed LOS with reduced LOS in PAC, reduced hospital RAR and reduced admissions to LTC suggesting that a pre-existing liberal selection process may result in poorer identification of appropriate patients for PAC.
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Affiliation(s)
| | - A Farrell
- University Hospital Galway , Galway, Ireland
| | - R Murphy
- University Hospital Galway , Galway, Ireland
| | | | - S O'Keeffe
- University Hospital Galway , Galway, Ireland
| | - E Mulkerrin
- University Hospital Galway , Galway, Ireland
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27
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Hennelly N, Lalor G, Gibney S, Murphy R, Kenny RA, Ward M. 190 FACTORS ASSOCIATED WITH ADHERENCE TO COVID-19 PUBLIC HEALTH GUIDELINES AMONG OLDER ADULTS IN IRELAND. Age Ageing 2021. [PMCID: PMC8690070 DOI: 10.1093/ageing/afab219.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Older adults are at high risk from coronavirus 2019 (COVID-19). Even with the introduction of a widespread vaccination programme, adherence to public health guidelines continue to be of vital importance to reducing the spread of COVID-19. This study examines the factors associated with adherence to two public health guidelines, social distancing and mask wearing, among older adults (50 years and over) in Ireland. Methods Data from the Irish Longitudinal Study on Ageing (TILDA) COVID-19 study and previous waves of TILDA was used. The COVID-19 study data was collected between July 2020 and November 2020. Logistic regression analysis was conducted separately to examine the relationship between the independent variables and social distancing and mask wearing respectively. Along with socio-demographic variables, the Health Belief Model (HBM) was used to identify variables for inclusion in the analysis. Results In total, 2,816 participants were included in this study. Females were more likely than males to adhere to social distancing and mask wearing guidelines. Those most concerned about COVID-19 were more likely to adhere to both behaviours. Education levels were associated with adherence to both behaviours but the direction of the relationship differed. Those who trusted the Health Service Executive as a news source were more likely to socially distance, while those with less understanding of government guidance and those who trusted in government news sources were less likely to socially distance. Participants who were working were less likely to socially distance than those who weren’t. While, participants who were over 70 and those who returned the survey after the introduction of mandatory mask wearing were more likely to wear a mask. Participants who lived outside of Dublin were less likely to wear a mask. Conclusion Factors associated with adherence to public health guidelines vary according to the guideline. Differences between groups need to be considered when implementing policy around public health guidelines.
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Affiliation(s)
- N Hennelly
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland,Department of Health, The Healthy and Positive Ageing Initiative, Dublin, Ireland
| | - G Lalor
- Department of Health, The Healthy and Positive Ageing Initiative, Dublin, Ireland
| | - S Gibney
- Department of Health, The Healthy and Positive Ageing Initiative, Dublin, Ireland
| | - R Murphy
- Department of Health, Research Services and Policy Unit, Dublin, Ireland
| | - R A Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland,Department of Medical Gerontology, St James's Hospital, Dublin, Ireland
| | - M Ward
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
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28
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Sayers K, Maher J, King L, Ryan S, Murphy R, Pillay I. 44 BONE HEALTH AND FRACTURE RISK: KNOWLEDGE, OPINION AND PRACTICE OF PHYSIOTHERAPISTS. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.44] [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: 02/25/2023] Open
Abstract
Abstract
Background
Osteoporotic-related fractures are responsible for excess mortality, morbidity, chronic pain, reduction in quality of life, admission to long-term care and health and social care costs (Papaioannou et al, 2010).
Evidence for using Fracture Risk Assessment Tool (FRAX®) based community-screening in older people is increasing (Kanis et al, 2020). There is no published evidence on the use of FRAX® by Physiotherapists.
Methods
A questionnaire was sent to South Eastern Branch members of the Irish Society of Chartered Physiotherapists (ISCP).
Survey themes were: participant characteristics, knowledge and opinion in the areas of Bone Health and Fracture Risk. Responses were downloaded from Survey Monkey and analysed using descriptive statistics.
Results
The response rate was 27% (n = 56). 72% (n = 40) of those surveyed had at least 10 years clinical experience. For 65% (n = 37) of participants, older people made up more than half of their clinical caseload. 96% (n = 54) of participants treated people with frailty and other bone health risk factors; falls (93%), osteoporosis (89%), fracture or reduced mobility (87%).
On a scale of 1–10 (1 = least confident, 10 = most confident) 49% of respondents rated confidence in prescribing Bone Health Physiotherapy interventions at ≤5.
When interpreting results of a DEXA scan; 80% reported confidence to be ≤5.
Half (49%) of participants had never heard of FRAX®.
95% of respondents felt fracture risk was under addressed in clinical practice. All felt it was within their professional responsibility to discuss fracture risk with patients.
Conclusion
This is the first evaluation of bone health and fracture risk knowledge, opinion and practice of physiotherapists. The need for more knowledge of DEXA, FRAX® and bone health was highlighted. The use of FRAX® may improve fracture risk assessment in patients attending Physiotherapy. Based on these results, FRAX® has been introduced into a Rehabilitation Unit by Physiotherapists as part of Quality Improvement Project.
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Affiliation(s)
- K Sayers
- Tipperary University Hospital , Clonmel, Ireland
| | - J Maher
- Tipperary University Hospital , Clonmel, Ireland
| | - L King
- Tipperary University Hospital , Clonmel, Ireland
| | - S Ryan
- Tipperary University Hospital , Clonmel, Ireland
| | - R Murphy
- Tipperary University Hospital , Clonmel, Ireland
| | - I Pillay
- Tipperary University Hospital , Clonmel, Ireland
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Shiel E, Costello M, McCarthy C, Murphy R, McDermott C, Geoghegan J, Mannion E, Conry M, Flanagan L, Moroney E, Bhaoill CU, Walsh C, Coffey K, Waters R, Robinson S, O'Donnell M, Canavan M. 112 INTEGRATED CARE PROGRAMME FOR OLDER PEOPLE (ICPOP) IN A RURAL SETTING—ROLE OF ADVANCED NURSE PRACTITIONER (ANP). Age Ageing 2021. [DOI: 10.1093/ageing/afab219.112] [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: 02/25/2023] Open
Abstract
Abstract
Background
Sláintecare advocates for right care, in the right place at the right time. ANPs for Older Persons in the community are uniquely placed to deliver care as close as possible to the older person’s home and to lead a holistic, flexible model of care minimising admission to acute care and maximising existing local resources. A pilot programme aimed at providing ANP led comprehensive geriatric assessment (CGA) (with Geriatrician support) to older people in a defined area commenced in June 2019. This pilot was part of a larger Hub and Spoke model funded by Sláintecare which gave additional MDT support.
Methods
A referral template was designed. Criteria for referral included; age > 75 years, Rockwood Frailty Scale 4–6 (focusing on Falls, Cognitive Impairment and Complex Frailty). Older people on the cusp of requiring long term care (LTC) were also prioritised. A prospective database of patients was maintained by the ANP to evaluate the service.
Results
From June 2019 to August 2021, 156 patients received an ANP led CGA, mostly conducted in the home. 247 reviews were conducted at the local spoke clinic and 46 joint ANP/Geriatrician home visits. Majority of referrals were from GP (n = 69), hospital (n = 30), LTC reviews (n = 22) and Community Nursing Units (CNUs) (n = 19). 449 outpatient appointments have been removed from the tertiary referral centre. Independent case load management from the ANP includes further appointments, telephone follow up/advice and she is a point of contact where crises arise before referral to acute services. 99% of patients surveyed reported satisfaction with the service especially the ease of local access and home visits.
Conclusion
Older Persons’ ANP can provide longitudinal care pathways for older adults in the community in conjunction with ICPOP and local CNUs, intervening before crises emerge and providing continuity of care and an alternative to acute care.
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Affiliation(s)
- E Shiel
- University Hospital Galway\St. Brendan's CNU , Galway, Ireland
| | - M Costello
- University Hospital Galway , Galway, Ireland
| | - C McCarthy
- University Hospital Galway , Galway, Ireland
| | - R Murphy
- University Hospital Galway , Galway, Ireland
| | - C McDermott
- University Hospital Galway , Galway, Ireland
| | - J Geoghegan
- University Hospital Galway , Galway, Ireland
| | - E Mannion
- University Hospital Galway , Galway, Ireland
| | - M Conry
- University Hospital Galway , Galway, Ireland
| | - L Flanagan
- Community Healthcare West , Galway, Ireland
| | - E Moroney
- Community Healthcare West , Galway, Ireland
| | | | - C Walsh
- Community Healthcare West , Galway, Ireland
| | - K Coffey
- Community Healthcare West , Galway, Ireland
| | - R Waters
- University Hospital Galway , Galway, Ireland
| | - S Robinson
- University Hospital Galway , Galway, Ireland
| | - M O'Donnell
- University Hospital Galway , Galway, Ireland
| | - M Canavan
- University Hospital Galway , Galway, Ireland
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Mc Carthy CE, O'Malley K, Mannion E, Geoghegan J, Costello M, Conry M, Flanagan L, Corry M, Reddin C, Murphy R, Waters R, O'Donnell M, Robinson S, Canavan M. 102 PROMOTING BRAIN HEALTH IN AN INTEGRATED CARE OUTREACH PROGRAMME. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.102] [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: 02/25/2023] Open
Abstract
Abstract
Background
Lifestyle modifications, in older at risk populations, may prevent or slow the rate of cognitive decline. Promotion of brain health has been recommended by the WHO and other governing bodies. Supporting patients in making these lifestyle changes, however, can be complex. Generic guidance may not apply to all in a heterogenous and frail patient cohort, when physical mobility may be limited and weight loss/nutrition a concern. We sought to review current practices and barriers to brain health guidance in a regional integrated care outreach programme (ICOP).
Methods
From March–June’21 the comprehensive geriatric assessment (CGA) of consecutive patients were reviewed. Those presenting with cognitive complaints, for their first assessment, were included. Demographic data and data on screening for hearing impairment and sleep disturbance were collected, in addition to information on physical activity and nutritional risk. Whether information and guidance on aspects of brain health was given was also assessed.
Results
30 patients met the inclusion criteria. The mean age was 80.3 and the mean clinical frailty scale (CFS) was 4.4. Hearing impairment was present in 20% (n = 6), with no information available in 10% (n = 3). All patients were screened for sleep disturbance, with 13% (n = 4) not fully satisfied with their sleep. Mobility aids, assistance or supervision were required in 40% (n = 12), and 23% (n = 7) were at medium or high malnutrition risk. Only 30% (n = 9) cooked their own meals. Generic brain health advice, or advice about sleep was documented in 30 (n = 9), without hearing impairment advice documented in any patient.
Conclusion
There are several barriers to brain health advice in the ICOP setting, with only 30% of patients having brain health advice documented. We are currently developing patient information leaflets on brain health, that will take potential barriers into account. Dedicated and specific information on local hearing services is also in development, as part of an ongoing quality improvement project.
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Affiliation(s)
- C E Mc Carthy
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - K O'Malley
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - E Mannion
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - J Geoghegan
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - M Costello
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - M Conry
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - L Flanagan
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - M Corry
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - C Reddin
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - R Murphy
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - R Waters
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - M O'Donnell
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - S Robinson
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - M Canavan
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
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Penugonda M, Walsh J, Barry JJ, Govern RM, Bradley D, Bolger M, English G, Moore J, Nolan N, Treacy E, Burke J, Dwyer N, Gallagher D, Macken S, McCaffrey S, Moloney S, Murphy R, Murray M, Hanlon EO. 231 ESTABLISHING AN INTERVENTIONS BUNDLE TO IMPROVE INPATIENT CARE FOR PATIENTS WITH PARKINSON’S DISEASE: A MULTIDISCIPLINARY QUALITY IMPROVEMENT PROJECT. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.231] [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: 02/25/2023] Open
Abstract
Abstract
Background
Patients with Parkinson’s (PwP) are at a higher risk of complications once admited to hospital compared to their age-matched peers. Medication mismanagement is a well-known obstacle, which puts PwP at risk of sub-optimal treatment leading to an unnecessary deterioration of baseline and potentially increases risk of adverse sequelae.
Methods
Retrospective electronic patient records (EPR)/chart review of 47 admissions was conducted, across three hospital sites.
Data attaining to correct prescribing of medication on admission and discharge, prescribing of contraindicated medications, reasons for medication lapses and complications of inpatient stay were collected. EPR of 17 patients’ were reviewed to assess if Parkinson’s disease (PD) medication administrations occurred within 30 minutes of patient schedule, as recommended by NICE guidelines. Key areas for improvement were identified based on the results.
Results
47 charts (30 Males, 17 Females) with mean age 72 (range:57–90), were reviewed. Average number of co-morbidities:4.5 and Clinical Frailty Scale ranged 5–9 (n = 30). LOS averaged 12.4 days and 43% of patients had ≥2 hospital admissions in the preceeding year.
38% (17/44) of admissions correctly documented patient specific medication times. Only 48% of patients (n = 638) received their medications within 30 minutes of the scheduled time. 47% (22/47) experienced complications attributable to PD. Contraindicated medications were noted in 5 cases. 84% of discharging prescriptions did not mention timing of PD medication and 3 prescriptions had errors with regards to dosage/omission of medication.
Conclusion
We implemented across two sites: 1) Care protocol flag in patient’s chart highlighting simple avoidable complications. 2) Laminated over the bed signpost alerting ‘time critical medication’. 3) ‘Time critical medication’ stickers in drug kardex 4) Education sessions for Medical, Nursing and Ward staff. 6) Establishing out of hours access to PD medications and protocols for NPO/poor swallow. We plan to reassess significance of efforts post intervention.
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Affiliation(s)
| | - J Walsh
- St. Luke's General Hospital , Kilkenny, Ireland
| | - J J Barry
- St. Michael's Hospital , Dublin, Ireland
| | - R M Govern
- St. Luke's General Hospital , Kilkenny, Ireland
| | - D Bradley
- St. James Hospital , Dublin, Ireland
| | - M Bolger
- St. Luke's General Hospital , Kilkenny, Ireland
| | - G English
- St. Luke's General Hospital , Kilkenny, Ireland
| | - J Moore
- St. Luke's General Hospital , Kilkenny, Ireland
| | - N Nolan
- St. Luke's General Hospital , Kilkenny, Ireland
| | - E Treacy
- St. Luke's General Hospital , Kilkenny, Ireland
| | - J Burke
- St. Michael's Hospital , Dublin, Ireland
| | - N Dwyer
- St. Michael's Hospital , Dublin, Ireland
| | | | - S Macken
- St. Michael's Hospital , Dublin, Ireland
| | | | - S Moloney
- St. Michael's Hospital , Dublin, Ireland
| | - R Murphy
- St. Michael's Hospital , Dublin, Ireland
| | - M Murray
- St. Michael's Hospital , Dublin, Ireland
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Murphy R, Sabnis A, Harrison J, Schelenz S, Edwards A, Vorup-Jensen T, Davies J. 520: The antimicrobial peptide glatiramer acetate disrupts pseudomonal cell membranes through interaction with lipopolysaccharide. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01944-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Abstract
Background
While breastfeeding may be among the most effective ways to ensure child health and survival, breastfeeding rates in Ireland are consistently low. This study aimed to explore women's experiences of infant feeding in Ireland.
Methods
Thematic analysis of feeding-related free-text comments from the National Maternity Experience Survey 2020 was undertaken. The survey collected data on the experiences of women who were 16 years or older and gave birth in one of Ireland's 19 maternity hospitals or units or had a home birth.
Results
3,204 women participated in the survey (50% response rate). In the first few days after birth, 41.9% of women breastfed exclusively, 29.0% used formula and breast milk, and 29.1% bottle fed only. 824 comments related to feeding were received. A number of themes were identified, including support and encouragement from healthcare professionals, information and education regarding feeding, and pressure and respect for personal preferences. Women highlighted that while breastfeeding was encouraged in antenatal care, this was not always the case in the postnatal ward, where formula was readily available, with an apparent lack of resources for breastfeeding women. Some women described feeling pressured to use a feeding method that was not their first preference, with some feeling pushed to breastfeed when this may not have been their wish, while women who wished to breastfeed felt pressured to supplement with formula. Staffing shortages on postnatal wards, a lack of lactation consultants and contradictory advice from healthcare professionals exacerbated difficulties with both feeding methods.
Conclusions
Some women experience a lack of practical support with infant feeding, regardless of feeding method, and clear and concise information on feeding practices is needed. The addition of lactation consultants, home supports and further education and training could benefit mothers on their breastfeeding journey.
Key messages
Barriers to breastfeeding included a lack of support from healthcare professionals and conflicting information. It is important to support women regardless of their chosen feeding method.
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Affiliation(s)
- R Murphy
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - D Rohde
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - C Foley
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - T O'Carroll
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - R Flynn
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
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Murphy R, Kerley RK, Kearney PK. A systematic review of the use of magnetic resonance imaging in non-conditional pacemakers and implantable defibrillators. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac implantable electronic devices (CIEDs) were long considered a contraindication for magnetic resonance imaging (MRI). Modern devices are now MRI conditional, but still the majority of CIEDs in the population are legacy devices and are classified as unsafe for MRI. There is growing consensus that MRI is also safe in these patients.
Purpose
The purpose of this study was to perform an up to date systematic review of the evidence evaluating the use of MRI in patients with non-conditional CIEDs.
Methods
Searches of the PubMed, CINAHL and Embase databases were performed. Studies that assessed the rate of adverse outcomes after MRI in patients with non-conditional CIEDs were included. Studies were excluded if they did not disclose the conditionality of patients CIEDs. Case reports or case series were not included.
Results
36 cohort studies were identified. No patient in these studies died during or immediately after MRI.
Symptom associated with either torque or heating occurred in <1% of patients. Electrical resets occurred 1–2% of patients. There were no cases of non-conditional lead or generator failure. Inappropriate pacing occurred in <1% of patients. No ICD shocks occurred during MRI. Changes in CIED parameters occurred in 1–4% of patients.
Conclusions
This systematic review highlights the relative safety of the use of MRI in patients with non-conditional CIEDs. Demonstrated be the fact that no deaths or device shocks have been suffered as a consequence of MRI in any of these studies, and the extremely low incidence of device or lead related complications. Still strict selection and monitoring protocol should be used when imaging these patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Murphy
- University College Cork, Cork, Ireland
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Ravi V, Murphy R, Moverley R, Derias M, Phadnis J. 654 Outcome and Complications Following Revision Shoulder Arthroplasty. A Systematic Review and Meta-Analysis. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.931] [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
Introduction
It is important to understand the rate of complications associated with the increasing burden of revision shoulder arthroplasty. Currently, this has not been well quantified. This review aims to address that deficiency with a focus on (i) shoulder outcome scores, (ii) complication and reoperation rates and (iii) comparison of anatomic and reverse prostheses when used in revision surgery.
Method
A PRISMA systematic review was performed to identify clinical data for patients undergoing revision shoulder arthroplasty. Data were extracted from the literature and pooled for analysis. Complication and reoperation rates were analysed using a meta-analysis of proportion and continuous variables underwent comparative subgroup analysis.
Results
107 studies (5,010 shoulders) were eligible for inclusion, although complete clinical data was not ubiquitous. Indications for revision included component loosening 20% (n = 584/2872), instability 20% (n = 577/2872), rotator cuff failure 18% (n = 528/2872) and infection 17% (n = 490/2872). Revision surgery resulted in a clinically important improvement in patient-reported outcome measures (PROMs). Intraoperative complication, postoperative complication and reoperation rates were 3% (n = 205/4919), 22% (n = 722/3474) and 15% (n = 533/3474) respectively. Intraoperative and postoperative complications included iatrogenic humeral fractures (n = 134/205, 65%) and instability (n = 209/772, 27%). Revision to reverse TSA, rather than revision to anatomic TSA from any index prosthesis resulted in lower complication rates (22% vs. 29%, p < 0.001 odds ratio 1.5) and superior Constant scores (59.9 vs. 53.8, p < 0.001), although no difference in ASES scores.
Conclusions
Satisfactory improvement in PROMs are reported following revision shoulder arthroplasty; however, revision surgery is associated with high complication rates and better outcomes may be evident following revision to reverse TSA.
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Affiliation(s)
- V Ravi
- Brighton and Sussex Medical School, Brighton, United Kingdom
| | - R Murphy
- Brighton and Sussex University Hospitals NHS trust, Brighton, United Kingdom
| | - R Moverley
- University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom
| | - M Derias
- Brighton and Sussex University Hospitals NHS trust, Brighton, United Kingdom
| | - J Phadnis
- Brighton and Sussex University Hospitals NHS trust, Brighton, United Kingdom
- Brighton and Sussex Medical School, Brighton, United Kingdom
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Pain CE, Beresford MW, Fortune F, Lai ETC, Murphy R, Taylor-Robinson D, Brogan PA, Moots RJ. Behçet's syndrome in children and young people in the United Kingdom and the Republic of Ireland: a prospective epidemiological study. Rheumatology (Oxford) 2021; 60:4728-4736. [PMID: 33527995 DOI: 10.1093/rheumatology/keab084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/02/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To define the incidence and prevalence of Behçet's syndrome (BS) in children and young people (CYP) up to the age of 16 years in the United Kingdom (UK) and Republic of Ireland (ROI). METHODS A prospective epidemiological study was undertaken with the support of the British Paediatric Surveillance Unit (BPSU) and the British Society of Paediatric Dermatologists (BSPD). Consultants reported anonymised cases of BS seen. A follow-up study at one year examined progression of disease and treatment. RESULTS Over a two-year period, 56 cases met the International Criteria for Behçet's Disease. For children under 16 years of age, the two-year period prevalence estimate was 4.2 per million (95% CI: 3.2, 5.4) and the incidence was 0.96 per million person years (95% CI: 0.66, 1.41). Mucocutaneous disease was the most common phenotype (56/100%), with ocular (10/56; 17.9%), neurological (2/56; 3.6%) and vascular involvement (3/56; 5.4%) being less common. Median age at onset was 6.34 years and at diagnosis was 11.72 years. There were slightly more female than male children reported (32/56; 55.6%). The majority of cases (85.7%) were white Caucasian. Apart from genital ulcers, which were more common in females, there were no significant differences in frequency of manifestations between male or females, nor between ethnicities. Over 83% of cases had three or more non-primary care healthcare professionals involved in their care. CONCLUSION BS is extremely rare in CYP in the UK and ROI and most have mucocutaneous disease. Healthcare needs are complex, and coordinated care is key.
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Affiliation(s)
- Clare E Pain
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust
| | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust.,Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool
| | - Farida Fortune
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London
| | - Eric T C Lai
- Department of Public Health and Policy, University of Liverpool, Liverpool
| | - Ruth Murphy
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | | | - Paul A Brogan
- Department of Paediatric Rheumatology, Great Ormond St Hospital NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London
| | - Robert J Moots
- Department of Rheumatology, Liverpool University Hospitals NHS Foundation Trust.,Faculty of Health, Social Care and Medicine, Edge Hill University, Liverpool, UK
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Kwiatkowska MM, Ahmed S, Ardern-Jones MR, Bhatti LA, Bleiker TO, Gavin A, Hussain S, Huws DW, Irvine L, Langan SM, Millington GWM, Mitchell H, Murphy R, Paley L, Proby CM, Thomson C, Thomas R, Turner C, Vernon S, Venables ZC. A summary of the updated report on the incidence and epidemiological trends of keratinocyte cancers in the United Kingdom 2013-2018. Br J Dermatol 2021; 186:367-369. [PMID: 34564854 DOI: 10.1111/bjd.20764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/04/2021] [Accepted: 09/22/2021] [Indexed: 11/30/2022]
Abstract
Skin cancer is the commonest cancer in the UK. Skin cancer referrals via the two-week wait (urgent suspected cancer) pathway outnumber any other suspected malignancy.1, 2 The commonest skin cancers are keratinocyte cancers (KCs) which represents Basal Cell Carcinomas (BCC) and Cutaneous Squamous Cell Carcinomas (cSCC). Accurate KC incidence reporting is crucial for healthcare planning.
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Affiliation(s)
- M M Kwiatkowska
- Public Health England London Region, London, U.K.,British Association of Dermatologists, London, U.K
| | - S Ahmed
- British Association of Dermatologists, London, U.K
| | - M R Ardern-Jones
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, U.K
| | - L A Bhatti
- London School of Hygiene and Tropical Medicine and St. John's Institute of Dermatology, London, U.K
| | - T O Bleiker
- British Association of Dermatologists, London, U.K.,University Hospital of Derby, Burton NHS Foundation Trust, Derby, U.K
| | - A Gavin
- Northern Ireland Cancer Registry, Belfast, U.K
| | - S Hussain
- British Association of Dermatologists, London, U.K
| | - D W Huws
- Welsh Cancer Intelligence and Surveillance Unit, Health Intelligence Division
| | - L Irvine
- Public Health England London Region, London, U.K
| | - S M Langan
- London School of Hygiene and Tropical Medicine and St. John's Institute of Dermatology, London, U.K
| | - G W M Millington
- British Association of Dermatologists, London, U.K.,Department of Dermatology, Norfolk and Norwich University Hospital, U.K.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - H Mitchell
- Northern Ireland Cancer Registry, Belfast, U.K
| | - R Murphy
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | - L Paley
- Public Health England London Region, London, U.K
| | - C M Proby
- Ninewells Hospital & Medical School, University of Dundee, Dundee, U.K
| | - C Thomson
- Scottish Cancer Registry, Public Health Scotland (PHS)
| | - R Thomas
- Welsh Cancer Intelligence and Surveillance Unit, Health Intelligence Division
| | - C Turner
- Public Health England London Region, London, U.K
| | - S Vernon
- Public Health England London Region, London, U.K
| | - Z C Venables
- Public Health England London Region, London, U.K.,British Association of Dermatologists, London, U.K.,Department of Dermatology, Norfolk and Norwich University Hospital, U.K
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Burden-Teh E, Murphy R, Gran S, Nijsten T, Hughes C, Abdul-Wahab A, Bewley A, Burrows N, Darne S, Gach JE, Katugampola R, Jury CS, Kuet K, Llewellyn J, McPherson T, Ravenscroft JC, Taibjee S, Wilkinson C, Thomas KS. Identifying the best predictive diagnostic criteria for psoriasis in children (< 18 years): a UK multicentre case-control diagnostic accuracy study (DIPSOC study). Br J Dermatol 2021; 186:341-351. [PMID: 34477218 PMCID: PMC9298773 DOI: 10.1111/bjd.20689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND In children, psoriasis can be challenging to diagnose. Difficulties arise from differences in the clinical presentation compared with adults. OBJECTIVES To test the diagnostic accuracy of previously agreed consensus criteria and to develop a shortlist of the best predictive diagnostic criteria for childhood psoriasis. METHODS A case-control diagnostic accuracy study in 12 UK dermatology departments (2017-2019) assessed 18 clinical criteria using blinded trained investigators. Children (< 18 years) with dermatologist-diagnosed psoriasis (cases, N = 170) or a different scaly inflammatory rash (controls, N = 160) were recruited. The best predictive criteria were identified using backward logistic regression, and internal validation was conducted using bootstrapping. RESULTS The sensitivity of the consensus-agreed criteria and consensus scoring algorithm was 84·6%, the specificity was 65·1% and the area under the curve (AUC) was 0·75. The seven diagnostic criteria that performed best were: (i) scale and erythema in the scalp involving the hairline, (ii) scaly erythema inside the external auditory meatus, (iii) persistent well-demarcated erythematous rash anywhere on the body, (iv) persistent erythema in the umbilicus, (v) scaly erythematous plaques on the extensor surfaces of the elbows and/or knees, (vi) well-demarcated erythematous rash in the napkin area involving the crural fold and (vii) family history of psoriasis. The sensitivity of the best predictive model was 76·8%, with specificity 72·7% and AUC 0·84. The c-statistic optimism-adjusted shrinkage factor was 0·012. CONCLUSIONS This study provides examination- and history-based data on the clinical features of psoriasis in children and proposes seven diagnostic criteria with good discriminatory ability in secondary-care patients. External validation is now needed.
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Affiliation(s)
- E Burden-Teh
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R Murphy
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Dermatology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - S Gran
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - T Nijsten
- Department of Dermatology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - C Hughes
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - A Abdul-Wahab
- Department of Dermatology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - A Bewley
- Department of Dermatology, Barts Health NHS Trust, London, UK
| | - N Burrows
- Department of Dermatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S Darne
- Department of Dermatology, The James Cook University Hospital, Middlesbrough, UK
| | - J E Gach
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - R Katugampola
- Department of Dermatology, Cardiff and Vale University Health Board, Cardiff, UK
| | - C S Jury
- Department of Dermatology, Royal Hospital for Children, Glasgow, UK
| | - K Kuet
- Department of Dermatology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - J Llewellyn
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - T McPherson
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J C Ravenscroft
- Department of Paediatric Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Taibjee
- Department of Dermatology, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - C Wilkinson
- Department of Dermatology, University Hospital Plymouth NHS Trust, Plymouth, UK
| | - K S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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Sinha IP, Murphy R, Biffin H, Gait L, Abrams EM, Lee AR, Gray-ffrench M, Fernandes RM, Watson E, Hawcut DB, Southern KW, Brown A. COVID-19 and the mental health of children with respiratory illness. Lancet Respir Med 2021; 9:952-954. [PMID: 34217380 PMCID: PMC9765704 DOI: 10.1016/s2213-2600(21)00319-2] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Ian P Sinha
- Alder Hey Children's Hospital, Liverpool, UK,Department of Women's and Children's Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Ruth Murphy
- Department of Women's and Children's Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | - Lucy Gait
- Alder Hey Children's Hospital, Liverpool, UK
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Thompson, MB, Canada,Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Alice R Lee
- Royal Manchester Children's Hospital, Manchester, UK
| | | | - Ricardo M Fernandes
- Clinical Pharmacology Unit, Faculty of Medicine and Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal,Department of Pediatrics, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Edward Watson
- West Cheshire Child and Adolescent Mental Health Services, Chester, UK
| | - Daniel B Hawcut
- Alder Hey Children's Hospital, Liverpool, UK,Department of Women's and Children's Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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McCaffrey C, Corrigan A, Moynagh P, Murphy R. Effect of yeast cell wall supplementation on intestinal integrity, digestive enzyme activity and immune traits of broilers. Br Poult Sci 2021; 62:771-782. [PMID: 34009070 DOI: 10.1080/00071668.2021.1929070] [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: 10/21/2022]
Abstract
1. The protective layer formed by intestinal epithelial cells acts as a barrier preventing the adhesion of pathogenic bacteria, aids digestion and passage of nutrients and reduces damage caused from toxins on the gastrointestinal tract. This study was conducted to investigate the effects of a yeast cell wall-based product (YCW), on broiler intestinal integrity, digestive enzyme capacity and immune function.2. A 35-d trial involving 246, one-d-of-hatch male broiler chickens was carried out at a trial facility at Agri-Food Biosciences Institute (AFBI, Belfast, UK). Birds were randomly allocated into 6 pens at day of hatch (41 birds/pen; 123 birds/group). Pens were divided into two groups: (1) basal diet and (2) basal diet that incorporated YCW at the manufacturers' recommended inclusion levels (Alltech Inc., Lexington, Kentucky, USA).3. In this study, YCW supplementation affected broiler intestinal morphology resulting in greater crypt depth, villus height and surface area, goblet cell density and mucus layer thickness and lower muscularis mucosae thickness. The digestive enzymes, maltase, sucrase and alkaline phosphatase, were significantly higher in the YCW supplemented group compared to the control. The expression levels of pro-inflammatory cytokines, IL-1β, IL-12 and IL-18, were significantly lower as was necroptotic cell death in YCW supplemented birds.4. In conclusion, under the conditions of this study, YCW supplementation positively affected intestinal health parameters in broilers following 35-d supplementation.
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Affiliation(s)
- C McCaffrey
- Institute of Immunology, Department of Biology, National University of Ireland Maynooth, Maynooth, Ireland
| | - A Corrigan
- Alltech Biotechnology Centre, Dunboyne, Ireland
| | - P Moynagh
- Institute of Immunology, Department of Biology, National University of Ireland Maynooth, Maynooth, Ireland
| | - R Murphy
- Alltech Biotechnology Centre, Dunboyne, Ireland
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Kerley R, Dolphin H, Cronin H, Murphy R, O"lionaird R, O"regan N, Pope G, Fahy G. Cognitive outcomes post-catheter ablation for atrial fibrillation: a systematic review and meta-analysis. Europace 2021. [DOI: 10.1093/europace/euab116.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Atrial fibrillation (AF) is a known risk factor for cognitive impairment and dementia. Recent data suggests that successful restoration of sinus rhythm by catheter ablation improves cognitive outcomes. Purpose: Our aim was to perform a systematic review and meta-analysis of the available data regarding the effectiveness of AF catheter ablation on neurocognitive outcomes. Methods: A comprehensive literature search was performed through December 1, 2020, for all eligible studies comparing neurocognitive outcomes in AF patients with or without AF catheter ablation. Clinical outcomes included rate of dementia, cognitive function by Montreal Cognitive Assessment (MOCA) and Mini-Mental State Examination (MMSE) scores. Additional outcomes included the impact of time in sinus rhythm on neurocognitive outcomes. Results: We identified 11 studies which evaluated the effect of AF catheter ablation on dementia rate, MMSE and MOCA score. Meta-analysis of observational results indicates a decreased risk of dementia (risk ratio 0.51; 95% CI: 0.43 to 0.60; p <0.001) and an improvement in MOCA scores (2.92 points, p < 0.001) but not MMSE scores in patients undergoing AF catheter ablation compared to medical therapy. In addition, the maintenance of sinus rhythm was identified as a significant factor in dementia rate and improvement of MMSE and MOCA scores observed post catheter ablation therapy. Conclusion: AF catheter ablation may reduce the incidence of dementia and improve cognitive function. A large-scale randomized control trial is warranted before recommendations can be made regarding AF ablation and cognitive outcomes. Abstract Figure.
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Affiliation(s)
- R Kerley
- Cork University Hospital, Cork, Ireland
| | - H Dolphin
- University Hospital Waterford, Waterford, Ireland
| | - H Cronin
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - R Murphy
- Cork University Hospital, Cork, Ireland
| | | | - N O"regan
- University Hospital Waterford, Waterford, Ireland
| | - G Pope
- University Hospital Waterford, Waterford, Ireland
| | - G Fahy
- Cork University Hospital, Cork, Ireland
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Concarr M, Sinkunaite I, Murphy R. The effect of trace minerals on the stability of retinol acetate, cholecalciferol and selenomethionine stability within premixes. Journal of Applied Animal Nutrition 2021. [DOI: 10.3920/jaan2021.0002] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This study compared the effect of an organic proteinate mineral source and an inorganic sulphate mineral source in relation to their effect on the stability of retinol acetate and cholecalciferol within simulated premixes, while comparing the stability of two different selenomethionine (SeMet) sources (selenium enriched yeast (SeYeast) and the chemically synthesised L-SeMet) in the presence of inorganic sulphate mineral sources within simulated premixes. Four vitamin-trace mineral premixes, two containing organic trace mineral sources in the form of proteinates and two containing inorganic trace mineral sources in the form of sulphates, were formulated so that, when added to a complete broiler feed at the appropriate inclusion rates, they contained the same amount of retinol acetate and cholecalciferol and varying levels of trace minerals (National Research Council recommended level, commonly used industry level or a reduced inclusion level). The two SeMet-trace mineral premixes were formulated to contain commonly used industry levels of vitamins and trace minerals. The two SeMet-trace mineral premixes differed in the source of SeMet. One premix contained chemically synthesised L-SeMet while the other contained SeYeast. The vitamin content of the four vitamin-trace mineral premixes was analysed after 14 and 84 days in storage by ultra-high performance liquid chromatography and the amount present within each of the premixes was compared to the quantity determined prior to storage. In general, the premixes formulated with the sulphate trace mineral source were found to have higher losses of retinol acetate and cholecalciferol than those formulated with the proteinate trace mineral source. The inclusion of the proteinate minerals at both National Research Council and reduced inclusion levels significantly (P≤0.05) increased the stability of both the vitamins when compared to the inorganic sulphate mineral sources included at commonly used industry levels. The SeMet content of the two SeMet-trace mineral premixes was analysed after 49 days in storage by high performance liquid chromatography – inductively coupled plasma mass spectrometry and the amount of SeMet present within each of the samples was compared to the quantity determined prior to storage. SeMet present within the SeYeast was found to be significantly more stable (P≤0.05) than the chemically synthesised L-SeMet.
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Affiliation(s)
- M. Concarr
- Alltech Ireland, Summerhill Road, Sarney, Dunboyne, Co. Meath, Ireland
| | - I. Sinkunaite
- Alltech Ireland, Summerhill Road, Sarney, Dunboyne, Co. Meath, Ireland
| | - R. Murphy
- Alltech Ireland, Summerhill Road, Sarney, Dunboyne, Co. Meath, Ireland
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Mccaughey C, Ranganathan D, Murphy G, Kerins M, Murphy R. Dyslipidaemia management in the cardiac rehabilitation clinic of a tertiary referral centre; analysis of the impact of new ESC guidance on LDL-C target achievement. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cardiac rehabilitation (CR) programs provide an opportunity to measure low density lipoprotein cholesterol (LDL-C) levels and optimise lipid lowering therapy (LLT) accordingly. New ESC guidelines released in August 2019 recommend lower absolute LDL-C target levels and an >50% reduction from baseline in those at the highest risk.
Purpose
This study investigated the proportion of those patients who finished CR in 2019 that reached both their absolute and relative reduction in LDL-C levels, before and after the introduction of these new guidelines. We also analysed the choice and appropriateness of LLT.
Methods
A retrospective chart review of 163 patients who completed CR in 2019. A database was created containing baseline patient characteristics and LDL-C levels both prior and post CR; as well as the patient’s contemporary LLT. Those patients who did not have a previous diagnosis of atherosclerotic cardiovascular disease (ASCVD) were risk stratified as per ESC guidance.
Baseline LDL-C levels were recorded, where possible, and otherwise calculated using pre-CR LDL profile with an adjustment made based on the projected effects of their LLT.
Results
Mean (SD) patient age was 62 (10) years, 123/163 (75%) were male and 142 (87%) patients had established ASCVD. 90/142 (63%) of very high-risk patients were treated with a high intensity LLT and 5/163 overall (3%) were prescribed ezetimibe.
Overall, 96/163 (59%) patients in 2019 met their absolute LDL-C targets; 62% of applicable patients achieved an >50% reduction in LDL-C levels. 104 (64%) of patients were treated in compliance with their contemporary guidelines.
Both pre (n = 112) and post (n = 51) September 2019 cohorts were well matched. Fewer patients who were treated under the August 2019 guidelines reached their absolute LDL-C (51% v 63%, p < 0.005) targets; achieved a >50% reduction in LDL-C from baseline (48% vs 61%, p < 0.005), or were compliant with the guidelines for their risk category (43% vs 73%, p < 0.005).
Conclusions
Both high intensity statin therapy and ezetimibe are under-prescribed. Fewer patients are meeting the lower absolute LDL-C targets set out in the 2019 ESC guidelines. For those at high risk, determining the reduction in LDL-C from baseline reveals that even those meeting their absolute LDL-C targets may still be undertreated.
LDL-C Target Achievement N Mean LDL Pre-CR (95% CI) Mean LDL-C Post CR (95% CI) Absolute LDL-C Target Met (%) Mean % LDL-C Reduction from Baseline (95% CI) > 50% Reduction (% of applicable patients) Guidelines Achieved Pre-Sept"20 112 2.7 (2.46-2.93) 1.64 (1.49- 1.79) 70 (63) 61 (56-66) 50 (65) 82 (73) Post Sept 20 51 2.83 (2.41-3.25) 1.83 (1.41-2.25) 26 (51) 48 (37-59) 11 (34) 22 (43) Total 163 2.72 (2.52- 2.91) 1.69 (1.57-1.82) 96 (59) 57 (52- 62) 61 (52) 104 (64 LDL-C targets met, stratified by contemporary guidelines followed.
Abstract Figure. Choice of lipid lowering therapy in 2019
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Affiliation(s)
| | | | - G Murphy
- St. James"s Hospital, Dublin, Ireland
| | - M Kerins
- St. James"s Hospital, Dublin, Ireland
| | - R Murphy
- St. James"s Hospital, Dublin, Ireland
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Vaghefi E, Yang S, Xie L, Hill S, Schmiedel O, Murphy R, Squirrell D. THEIA™ development, and testing of artificial intelligence-based primary triage of diabetic retinopathy screening images in New Zealand. Diabet Med 2021; 38:e14386. [PMID: 32794618 PMCID: PMC8048953 DOI: 10.1111/dme.14386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2020] [Indexed: 12/14/2022]
Abstract
AIM To develop and evaluate an artificial intelligence triage system with high sensitivity for detecting referable diabetic retinopathy and maculopathy, while maintaining high specificity for non-referable disease, for clinical implementation within the New Zealand national diabetic retinopathy screening programme. METHODS The THEIA™ artificial intelligence system for retinopathy and maculopathy screening, was developed at Toku Eyes using routinely collected retinal screening datasets from two of the largest district health boards in Auckland, New Zealand: the Auckland District Health Board and the Counties Manukau District Health Board. All retinal images from consecutive individuals receiving retinal screening between January 2009 and December 2018 were used. Images were labelled as non-sight-threatening, potentially referable or sight-threatening for New Zealand implementation, or as referable (potentially referable + sight-threatening)/non-referable (non-sight-threatening) for global comparison. RESULTS Data from 32 354 unique people with diabetes (63 843 when including multiple visits) were available, of which 95-97%, 0.9-2.4% and 1.1-3.1% were categorized as non-sight-threatening, potentially referable and sight-threatening, respectively. Using the referable/non-referable categories, THEIA achieved overall sensitivity of 94% (95% CI 92-95) in the Auckland District Health Board and 95% (95% CI 92-97) in the Counties Manukau District Health Board datasets, while preserving specificity of 63% (95% CI 62-64) for the Auckland District Health Board and 61% (95% CI 60-62) for the Counties Manukau District Health Board. Implementing THEIA into a New Zealand national diabetic screening programme could significantly reduce the manual grading load. CONCLUSION THEIA, an artificial intelligence tool to assist in clinical decision-making, tailored to the needs of the New Zealand national diabetic screening programme, delivered high sensitivity for detecting referable retinopathy within the multi-ethnic New Zealand population with diabetes.
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Affiliation(s)
- E. Vaghefi
- Toku EyesAucklandNew Zealand
- School of Optometry and Vision ScienceAucklandNew Zealand
| | - S. Yang
- School of Optometry and Vision ScienceAucklandNew Zealand
- School of Computer SciencesUniversity of AucklandAucklandNew Zealand
| | - L. Xie
- School of Optometry and Vision ScienceAucklandNew Zealand
| | - S. Hill
- Department of OphthalmologyAucklandNew Zealand
| | - O. Schmiedel
- Auckland Diabetes CentreAuckland District Health Board
| | - R. Murphy
- School of MedicineAucklandNew Zealand
| | - D. Squirrell
- Toku EyesAucklandNew Zealand
- Department of OphthalmologyAucklandNew Zealand
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Visconti A, Bataille V, Rossi N, Kluk J, Murphy R, Puig S, Nambi R, Bowyer RCE, Murray B, Bournot A, Wolf J, Ourselin S, Steves CJ, Spector TD, Falchi M. Diagnostic value of cutaneous manifestation of SARS-CoV-2 infection. Br J Dermatol 2021; 184:880-887. [PMID: 33448030 PMCID: PMC8014275 DOI: 10.1111/bjd.19807] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 01/08/2023]
Abstract
Background One of the challenging aspects of SARS‐CoV‐2 infection is its diverse multisystemic disease presentation. Objectives To evaluate the diagnostic value of cutaneous manifestations of SARS‐CoV‐2 infection and investigate their duration and timing in relation to other COVID‐19 symptoms. Methods We used data from 336 847 UK users of the COVID Symptom Study app to assess the diagnostic value of body rash or an acral rash in SARS‐CoV‐2 infection, and data from an independent online survey of 11 544 respondents to investigate skin‐specific symptoms and collect their photographs. Results Using data from the app, we show significant association between skin rashes and a positive swab test result (odds ratio 1·67, 95% confidence interval 1·42–1·97). Strikingly, among the respondents of the independent online survey, we found that 17% of SARS‐CoV‐2‐positive cases reported skin rashes as the first presentation, and 21% as the only clinical sign of COVID‐19. Together with the British Association of Dermatologists, we have compiled a catalogue of images of the most common skin manifestations of COVID‐19 from 400 individuals (https://covidskinsigns.com), which we have made publicly available to assist clinicians in recognition of this early clinical feature of COVID‐19. Conclusions Skin rashes cluster with other COVID‐19 symptoms, are predictive of a positive swab test, and occur in a significant number of cases, either alone or before other classical symptoms. Recognizing rashes is important in identifying new and earlier cases of COVID‐19.
What is already known about this topic?
Several studies conducted in hospital settings reported that patients with COVID‐19 presented with unusual skin rashes, including urticarial rashes, vesicular lesions and, less frequently, chilblains in fingers or toes.
What does this study add?
We confirmed, in a community‐based setting that also includes milder forms of the disease, that the presence of a skin rash is predictive of SARS‐CoV‐2 infection. We provide a website with photos of skin manifestations to help healthcare professionals in diagnosing COVID‐19. Skin rashes should be taken into account to provide a quick COVID‐19 diagnosis to curb the spread of the disease.
Linked Comment: Naldi. Br J Dermatol 2021; 184:793–794.
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Affiliation(s)
- A Visconti
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - V Bataille
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK.,Dermatology Department, West Herts NHS Trust, Watford, UK
| | - N Rossi
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - J Kluk
- Zoe Global Limited, London, UK
| | - R Murphy
- Dermatology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S Puig
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - R Nambi
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - R C E Bowyer
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - B Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | - J Wolf
- Zoe Global Limited, London, UK
| | - S Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - C J Steves
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - T D Spector
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - M Falchi
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
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Ashraf I, Chowdhury MMU, Murphy R, Griffiths TW, Esmail A, Young HS. Next steps in dermatology training: choosing to enter higher speciality training and the transition from trainee to consultant dermatologist. Clin Exp Dermatol 2021; 46:687-693. [PMID: 33222209 DOI: 10.1111/ced.14524] [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] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Junior doctors are required to make career decisions at an early stage in their postgraduate training. Trainees also feel inadequately prepared for the transition to consultant roles. AIM To explore the key factors influencing the choice of dermatology as a postgraduate medical career and to identify the training needs required for transition from trainee to consultant. METHODS An online questionnaire was designed to identify (i) why trainees chose a postgraduate medical career in dermatology, and (ii) the training required for transition from trainee to consultant. RESULTS In total, 46 responses were received from trainees in their first to final years (ST3-6), of whom 89% had undertaken an undergraduate dermatology placement, with a median duration of 2 weeks. Dermatology was considered as a career during medical school by 61% of trainees, and 41% confirmed their decision to pursue a career in dermatology during foundation training. The most influential factors involved in speciality selection were first, enjoyment of the work, second, postgraduate experience and equal third, the variety of the speciality and the regularity of working hours (P < 0.05). Mentoring was pivotal to career decision-making. Significant numbers of trainees expressed a need for training in medical leadership, such as running an outpatient clinic and supervising clinical multidisciplinary teams. Although larger numbers of trainees had training in management of dermatology services, such as service improvement (52%) and local governance/National Health Service structures (43%), significant numbers of trainees had no training in writing job plans (89%) or business plans (85%). Training was significantly deficient for personal management and self-awareness. CONCLUSION Our study highlights important considerations in career decision-making for trainees. Training in medical leadership, management and self-awareness could be enhanced to ensure that trainees feel adequately equipped for consultant roles.
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Affiliation(s)
- I Ashraf
- Department of Dermatology, Birmingham Skin Centre, City Hospital, Birmingham, UK
| | - M M U Chowdhury
- The Welsh Institute of Dermatology, University Hospital of Wales, Cardiff, UK
| | - R Murphy
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield, UK
| | - T W Griffiths
- Department of Dermatology, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - A Esmail
- National School of Primary Care Research, The University of Manchester, Manchester, UK
| | - H S Young
- Department of Dermatology, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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Bronckers IMGJ, Paller AS, West DP, Lara-Corrales I, Tollefson MM, Tom WL, Hogeling M, Belazarian L, Zachariae C, Mahé E, Siegfried E, Blume-Peytavi U, Szalai Z, Vleugels RA, Holland K, Murphy R, Puig L, Cordoro KM, Lambert J, Alexopoulos A, Mrowietz U, Kievit W, Seyger MMB. A Comparison of Psoriasis Severity in Pediatric Patients Treated With Methotrexate vs Biologic Agents. JAMA Dermatol 2020; 156:384-392. [PMID: 32022846 DOI: 10.1001/jamadermatol.2019.4835] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Few studies have compared the use of methotrexate and biologics, the most commonly used systemic medications for treatment of moderate to severe psoriasis in children. Objective To assess the real-world, 6-month reduction in psoriasis severity and long-term drug survival (rate and duration of adherence to a specific drug) of methotrexate vs biologics in plaque psoriasis in children. Design, Setting, and Participants A retrospective medical records review was conducted at 20 European and North American centers. Treatment response was based on site-reported Psoriasis Area and Severity Index (PASI) and/or Physician Global Assessment (PGA) scores at baseline and within the first 6 months of treatment. Participants included all 234 consecutively seen children with moderate to severe psoriasis who received at least 3 months of methotrexate or biologics from December 1, 1990, to September 16, 2014, with sufficient data for analysis. Data analysis was performed from December 14, 2015, to September 1, 2016. Main Outcomes and Measures PASI, with a range from 0 to 72 (highest score indicating severe psoriasis), and/or PGA, with a scale of 0 (clear), 1 (minimal), 2 (mild), 3 (moderate), 4 (severe), and 5 (very severe). Results Of 234 pediatric patients (103 boys [44.0%]; 131 girls [56.0%]) treated with methotrexate and/or biologics, 163 patients (69.7%) exclusively received methotrexate, 47 patients (20.1%) exclusively received biologics, and 24 children (10.2%) received methotrexate and biologics sequentially. Of the latter cohort, 23 children were treated initially with methotrexate. Mean (SD) age at initiation was 11.6 (3.7) years for methotrexate and 13.3 (2.9) years for biologics (73.2% for etanercept) (P = .002). Among patients evaluated by a scoring method at 6-month follow-up, 75% or greater improvement in PASI (PASI75) was achieved in 12 of 30 patients (40.0%) receiving methotrexate and 20 of 28 patients (71.4%) receiving biologics, and PGA was clear/almost clear (PGA 0/1) in 41 of 115 patients (35.6%) receiving methotrexate and 18 of 37 patients (48.6%) receiving biologics. Achieving PASI75 and/or PGA 0/1 between baseline and 6 months was more likely with biologics than methotrexate (PASI75: odds ratio [OR], 4.56; 95% CI, 2.02-10.27; P < .001; and PGA 0/1: OR, 2.00; 95% CI, 0.98-4.00; P = .06). Decreased mean PASI and PGA scores were associated with biologics more than with methotrexate (PASI effect, -3.13; 95% CI, -4.33 to -1.94; P < .001; and PGA effect, -0.31; 95% CI, -0.56 to -0.06; P = .02). After 1, 3, and 5 years of use, overall drug survival rates for methotrexate were 77.5%, 50.3%, and 35.9%, and for biologics, the rates were 83.4%, 64.3%, and 57.1%, respectively. Biologics were associated with a better confounder-corrected drug survival than methotrexate (hazard ratio [HR], 2.23; 95% CI, 1.21-4.10; P = .01). Discontinuation owing to lack of response was comparable (HR, 1.64; 95% CI, 0.80-3.36; P = .18). Conclusions and Relevance Methotrexate and biologics appear to be associated with improvement in pediatric psoriasis, although biologics seem to be associated with greater reduction in psoriasis severity scores and higher drug survival rates than methotrexate in the real-world setting. Additional studies directly comparing these medications should be performed for confirmation.
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Affiliation(s)
| | - Amy S Paller
- Department of Dermatology, Northwestern University, Chicago, Illinois.,Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Dennis P West
- Department of Dermatology, Northwestern University, Chicago, Illinois.,Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Irene Lara-Corrales
- Department of Pediatric Medicine, Dermatology Section, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Wynnis L Tom
- Department of Dermatology, Rady Children's Hospital San Diego, University of California, San Diego.,Department of Pediatrics, Rady Children's Hospital San Diego, University of California, San Diego
| | - Marcia Hogeling
- Department of Dermatology, Phoenix Children's Hospital, Phoenix, Arizona.,now with the Department of Dermatology, UCLA (University of California, Los Angeles)
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Medical School, Worcester
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Emmanuel Mahé
- Department of Dermatology, Hôpital Victor Dupouy Argenteuil, Argenteuil, France
| | - Elaine Siegfried
- Department of Dermatology, St Louis University School of Medicine, St Louis, Missouri.,Department of Pediatrics, St Louis University School of Medicine, St Louis, Missouri
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergy, Charité- Universitätsmedizin, Berlin, Germany
| | - Zsuzsanna Szalai
- Department of Dermatology, Heim Pál Children's Hospital, Budapest, Hungary
| | - Ruth Ann Vleugels
- Department of Dermatology, Boston Children's Hospital, Boston, Massachusetts
| | - Kristen Holland
- Department of Dermatology, Medical College of Wisconsin, Milwaukee.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Ruth Murphy
- Paediatric Dermatology Department, Nottingham University Hospitals, Nottingham, England
| | - Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco Medical Center, San Francisco.,Department of Pediatrics, University of California, San Francisco Medical Center, San Francisco
| | - Jo Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Alex Alexopoulos
- First Department of Pediatrics, Agia Sofia Children's Hospital, University of Athens Medical School, Athens, Greece
| | - Ulrich Mrowietz
- Psoriasis Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Wietske Kievit
- Department for Health Evidence, Radboud University, Nijmegen, the Netherlands
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University, Nijmegen, the Netherlands
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48
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Smith CH, Mahil SK, Yiu ZZN, Bale T, Burden AD, Coates LC, McGuire A, Murphy R, Owen CM, Parslew R, Uthman OA, Woolf RT, Manounah L, Ezejimofor MC, Exton LS, Mohd Mustapa MF. Quantitative Evaluation of Biologic Therapy Options for Psoriasis: A Systematic Review and Network Meta-Analysis-Correction. J Invest Dermatol 2020; 141:177-181. [PMID: 33342507 DOI: 10.1016/j.jid.2020.02.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Catherine H Smith
- St. John's Institute of Dermatology, King's College London, London, United Kingdom.
| | - Satveer K Mahil
- St. John's Institute of Dermatology, King's College London, London, United Kingdom
| | - Zenas Z N Yiu
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Tracy Bale
- British Dermatology Nursing Group representative, Aneurin Bevan Health Board, Wales, United Kingdom
| | - A David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Laura C Coates
- British Society for Rheumatology, London, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Arlene McGuire
- Pharmacy Department, Guy's and St. Thomas' Hospitals NHS Trust, London, United Kingdom
| | - Ruth Murphy
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Department of Dermatology, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom; University of Nottingham, University Park, Nottingham, United Kingdom
| | - Caroline M Owen
- Department of Dermatology, East Lancashire Hospitals NHS Trust, Burnley, United Kingdom
| | - Richard Parslew
- Department of Dermatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Olalekan A Uthman
- Division of Health Sciences, Warwick Centre for Applied Health Research and Delivery, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Richard T Woolf
- St. John's Institute of Dermatology, King's College London, London, United Kingdom
| | - Lina Manounah
- British Association of Dermatologists, London, United Kingdom
| | | | - Lesley S Exton
- British Association of Dermatologists, London, United Kingdom
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49
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Okeke E, Mark Davwar P, Mullen B, Duguru M, Agbaji O, Sagay A, Murphy R, Hawkins C. The impact of HIV on hepatocellular cancer survival in Nigeria. Trop Med Int Health 2020; 26:335-342. [PMID: 33244817 DOI: 10.1111/tmi.13532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/11/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is an increasing cause of mortality in HIV-infected individuals. We compared host and tumour characteristics between HIV-infected and HIV-uninfected Nigerians with HCC and examined the impact of HIV on survival. METHODS This prospective observational study was conducted at Jos University Teaching Hospital in Jos, Nigeria, among adults (>18 years) with HCC enrolled between September 2015 and September 2017 and followed until April 2019. Demographics, tumour characteristics and survival were compared between HCC subjects with and without HIV. RESULTS 101 (10 HIV-infected and 91 HIV-uninfected) subjects were enrolled [male 72%; median age 48 (IQR 35-60)]. 60% HIV-infected subjects were receiving ART; 90% had CD4 counts ≥ 200/mm3 at HCC diagnosis, and 20% had HIV RNA levels < 20 copies/mL. 57.4% were infected with chronic HBV (HBsAg+). The duration of symptoms was shorter in HIV-infected vs. HIV-uninfected subjects [93 (IQR 54-132) vs. 155 (93-248] days; p = 0.02]. At the end of follow-up, 99 of 101 (98.0%) subjects were confirmed to have died: 9 of 10 (90.0%) HIV-infected and 90 of 91 (98.9%) HIV-uninfected. The probability of survival at three months was 22% and 47% in HIV-infected and HIV-uninfected subjects, respectively (P = 0.02). Median time to death was significantly shorter in HIV-infected vs. HIV-uninfected subjects [24 days (IQR 16-88) vs. 85 days (IQR 34-178), respectively (P = 0.03)]. CONCLUSIONS High early mortality was observed in this cohort of Nigerian adults with HCC. HIV infection was associated with a faster clinical presentation and shorter survival. More aggressive HCC surveillance may be warranted in HIV-infected subjects, particularly if they are co-infected with chronic HBV.
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Affiliation(s)
- E Okeke
- Department of Medicine, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
| | - P Mark Davwar
- Department of Medicine, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
| | - B Mullen
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - M Duguru
- Department of Medicine, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
| | - O Agbaji
- Department of Medicine, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
| | - A Sagay
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
| | - R Murphy
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - C Hawkins
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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50
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Byrne L, Wheen P, Minelli C, Sheehy N, Murphy R. A Review of a Tertiary Referral Centre's CT Coronary Angiography Programme. Ir Med J 2020; 113:197. [PMID: 36331894] [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: 06/16/2023]
Abstract
Aims To investigate the implication of outpatient CT coronary angiogram (CTCA) waiting times on patient outcomes and service provision. Methods All outpatient CTCAs requested for stable chest pain during 2017 in our catchment area were included. Rate of major adverse cardiovascular events (MACE), presentations with chest pain to the emergency department (ED), cardiology outpatient attendance, time interval in alteration of Coronary artery disease (CAD) prognostic treatment, rate of angiography and percutaneous coronary intervention (PCI) were noted. Results 172 CTCAs were included. 11 (6.4%) presented to ED with chest pain. 38 (22.1%) attended outpatients prior to scan completion. 17 (9.9%) required alteration of prognostic treatment, taking on average 10.4 (+/-4.5) months to occur. 21 (12.2%) underwent coronary angiography and 7 (4.1%) had PCI, which took on average 9.9 (+/-6.6) months. One non-fatal MI requiring CABG was noted. Conclusion The low rate of MACE and revascularisation likely represents appropriately low risk patient selection for CTCA. Presentation to clinic prior to scan completion highlights a need for better administration support.
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Affiliation(s)
- L Byrne
- Department of Cardiology, St. James' Hospital, Dublin
| | - P Wheen
- Department of Cardiology, St. James' Hospital, Dublin
| | - C Minelli
- Department of Cardiology, St. James' Hospital, Dublin
| | - N Sheehy
- Department of Radiology, St James' Hospital, Dublin
| | - R Murphy
- Department of Cardiology, St. James' Hospital, Dublin
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