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Colwill M, Baillie S, Pollok R, Poullis A. Using clinical cases to guide healthcare. World J Clin Cases 2024; 12:1555-1559. [PMID: 38576735 PMCID: PMC10989429 DOI: 10.12998/wjcc.v12.i9.1555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/26/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024] Open
Abstract
Evidence-based practice (EBP) has been the gold standard in healthcare for nearly three centuries and aims to assist physicians in providing the safest and most effective healthcare for their patients. The well-established hierarchy of evidence lists systematic reviews and meta-analyses at the top however these methodologies are not always appropriate or possible and in these instances case-control studies, case series and case reports are utilised to support EBP. Case-control studies allow simultaneous study of multiple risk factors and can be performed rapidly and relatively cheaply. A recent example was during the Coronavirus pandemic where case-control studies were used to assess the efficacy of personal protective equipment for healthcare workers. Case series and case reports also play a role in EBP and are particularly useful to study rare diseases such as inflammatory bowel disease in transgender and gender non-conforming individuals. They are also vital in generating and disseminating early signals and encouraging further research. Whilst these methodologies have weaknesses, particularly with regards to bias and loss of patient confidentiality for rare pathologies, they have an important part to play in EBP and when appropriately utilised can significantly impact upon clinical practice.
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Affiliation(s)
- Michael Colwill
- Department of Gastroenterology, St George's University Hospital NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Samantha Baillie
- Department of Gastroenterology, St George's University Hospital NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Richard Pollok
- Department of Gastroenterology, St George's University Hospital NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Andrew Poullis
- Department of Gastroenterology, St George's University Hospital NHS Foundation Trust, London SW17 0QT, United Kingdom
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2
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Baillie S, Norton C, Saxena S, Pollok R. Chronic abdominal pain in inflammatory bowel disease: a practical guide. Frontline Gastroenterol 2023; 15:144-153. [PMID: 38420131 PMCID: PMC10897648 DOI: 10.1136/flgastro-2023-102471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/12/2023] [Indexed: 03/02/2024] Open
Abstract
Pain is common in inflammatory bowel disease (IBD), yet many patients feel their pain is not addressed by healthcare professionals. Listening to a patient's concerns about pain, assessing symptoms and acknowledging the impact these have on daily life remain crucial steps in addressing pain in IBD. While acute pain may be effectively controlled by pain medication, chronic pain is more complex and often pharmacological therapies, particularly opioids, are ineffective. Low-dose tricyclic antidepressants and psychological approaches, including cognitive-behavioural therapy, have shown some promise in offering effective pain management while lifestyle changes such as a trial of low-fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet in those with overlapping irritable bowel syndrome may also reduce pain. Patients benefit from a long-term, trusting relationship with their healthcare professional to allow a holistic approach combining pharmacological, psychological, lifestyle and dietary approaches to chronic pain. We present a practical review to facilitate management of chronic abdominal pain in IBD.
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Affiliation(s)
- Samantha Baillie
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sonia Saxena
- Primary Care and Public Health, Imperial College London, London, UK
| | - Richard Pollok
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
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3
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Baillie S, Limdi JK, Bassi A, Fraser A, Parkes G, Scott G, Raine T, Lamb CA, Kennedy NA, Fumis N, Smith MA, Nicolaou A, Emms H, Wye J, Lehmann A, Carbery I, Goodhand J, Lees R, Beshyah W, Luthra P, Pollok R, Selinger C. Opioid use and associated factors in 1676 patients with inflammatory bowel disease: a multicentre quality improvement project. Frontline Gastroenterol 2023; 14:497-504. [PMID: 37854782 PMCID: PMC10579551 DOI: 10.1136/flgastro-2023-102423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/30/2023] [Indexed: 10/20/2023] Open
Abstract
Objective Despite its association with poorer outcomes, opioid use in inflammatory bowel disease (IBD) is not well characterised in the UK. We aimed to examine the extent of opioid use, the associated factors and the use of mitigation techniques such as pain-service review and opioid weaning plans among individuals with IBD. Methods Data were collected from consecutive patients attending IBD outpatient appointments at 12 UK hospitals. A predefined questionnaire was used to collect data including patient demographics, IBD history, opioid use in the past year (>2 weeks) and opioid-use mitigation techniques. Additionally, consecutive IBD-related hospital stays leading up to July 2019 were reviewed with data collected regarding opioid use at admission, discharge and follow-up as well as details of the admission indication. Results In 1352 outpatients, 12% had used opioids within the past 12 months. Over half of these individuals were taking opioids for non-IBD pain and less than half had undergone an attempted opioid wean.In 324 hospitalised patients, 27% were prescribed opioids at discharge from hospital. At 12 months postdischarge, 11% were using opioids. Factors associated with opioid use in both cohorts included female sex, Crohn's disease and previous surgery. Conclusions 1 in 10 patients with IBD attending outpatient appointments were opioid exposed in the past year while a quarter of inpatients were discharged with opioids, and 11% continued to use opioids 12 months after discharge. IBD services should aim to identify patients exposed to opioids, reduce exposure where possible and facilitate access to alternative pain management approaches.
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Affiliation(s)
- Samantha Baillie
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jimmy K Limdi
- Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Ash Bassi
- Department of Gastroenterology, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - Aileen Fraser
- Department of Gastroenterology, University Hospitals Bristol and Weston Trust, Bristol, UK
| | - Gareth Parkes
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Glyn Scott
- Department of Gastroenterology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Tim Raine
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Christopher A Lamb
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Department of Gastroenterology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter IBD Research Group, University of Exeter, Exeter, UK
| | - Natalia Fumis
- Department of Gastroenterology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Melissa A Smith
- Department of Gastroenterology, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Andrew Nicolaou
- Pain Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Holly Emms
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - John Wye
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Anouk Lehmann
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Isabel Carbery
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James Goodhand
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Robert Lees
- Department of Gastroenterology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Waleed Beshyah
- Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Pavit Luthra
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Richard Pollok
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Christian Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Pollok RC, Jayasooriya N, Baillie S, Blackwell J, Petersen I, Bottle A, Saxena S. Letter: delays to diagnosis of IBD-Challenges requiring a systematic approach. Authors' reply. Aliment Pharmacol Ther 2023; 57:1479. [PMID: 37243462 DOI: 10.1111/apt.17548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Richard C Pollok
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Nishani Jayasooriya
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Samantha Baillie
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Jonathan Blackwell
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Alex Bottle
- School of Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
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Pollok RC, Baillie S, Jayasooriya N, Blackwell J, Petersen I, Bottle A, Saxena S. Letter: diagnostic delay in inflammatory bowel disease-Authors' reply. Aliment Pharmacol Ther 2023; 57:1205-1206. [PMID: 37094317 DOI: 10.1111/apt.17493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Richard C Pollok
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Samantha Baillie
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Nishani Jayasooriya
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Jonathan Blackwell
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Alex Bottle
- School of Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
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Jayasooriya N, Baillie S, Blackwell J, Bottle A, Petersen I, Creese H, Saxena S, Pollok RC. Systematic review with meta-analysis: Time to diagnosis and the impact of delayed diagnosis on clinical outcomes in inflammatory bowel disease. Aliment Pharmacol Ther 2023; 57:635-652. [PMID: 36627691 DOI: 10.1111/apt.17370] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/29/2022] [Accepted: 12/10/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The impact of diagnostic delay on the clinical course of inflammatory bowel disease (IBD) remains uncertain. AIM To perform a systematic review of time to diagnosis and the impact of delayed diagnosis on clinical outcomes in Crohn's disease (CD) and ulcerative colitis (UC). METHODS We searched EMBASE and Medline from inception to 30th November 2022 for studies reporting diagnostic interval, from symptom onset to IBD diagnosis. We calculated the median, interquartile range (IQR) and pooled weighted median, of median diagnostic intervals of eligible studies. We defined delayed diagnosis as individuals above the 75th centile of longest time to diagnosis in each study. Using random effects meta-analysis, we pooled odds ratios (ORs) with 95% confidence intervals (CI) for studies reporting clinical outcomes, according to delayed diagnosis. RESULTS One hundred and one studies representing 112,194 patients with IBD (CD = 59,359; UC = 52,835) met inclusion criteria. The median of median times to diagnosis was 8.0 (IQR: 5.0-15.2) and 3.7 months (IQR: 2.0-6.7) in CD and UC, respectively. In high-income countries, this was 6.2 (IQR: 5.0-12.3) and 3.2 months (IQR: 2.2-5.3), compared with 11.7 (IQR: 8.3-18.0) and 7.8 months (IQR: 5.2-21.8) in low-middle-income, countries, for CD and UC respectively. The pooled weighted median was 7.0 (95% CI: 3.0-26.4) and 4.6 (95% CI: 1.0-96.0) months, for CD and UC respectively. Eleven studies, representing 6164 patients (CD = 4858; UC = 1306), were included in the meta-analysis that examined the impact of diagnostic delay on clinical outcomes. In CD, delayed diagnosis was associated with higher odds of stricturing (OR = 1.88; CI: 1.35-2.62), penetrating disease (OR = 1.64; CI: 1.21-2.20) and intestinal surgery (OR = 2.24; CI: 1.57-3.19). In UC, delayed diagnosis was associated with higher odds of colectomy (OR = 4.13; CI: 1.04-16.40). CONCLUSION Delayed diagnosis is associated with disease progression in CD, and intestinal surgery in both CD and UC. Strategies are needed to achieve earlier diagnosis of IBD.
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Affiliation(s)
- Nishani Jayasooriya
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Samantha Baillie
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Jonathan Blackwell
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Alex Bottle
- School of Public Health, Imperial College London, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Hanna Creese
- School of Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's Healthcare NHS Trust, St George's University, London, UK
- Institute of Infection and Immunity, St George's University, London, UK
- School of Public Health, Imperial College London, London, UK
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7
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Honap S, Al-Hillawi L, Baillie S, Bancil A, Matini L, Lau R, Kok KB, Patel K, Walsh A, Irving PM, Samaan MA. Ustekinumab for the treatment of moderate to severe ulcerative colitis: a multicentre UK cohort study. Frontline Gastroenterol 2022; 13:517-523. [PMID: 36250172 PMCID: PMC9555129 DOI: 10.1136/flgastro-2022-102168] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/18/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Ustekinumab is an interleukin-12/interleukin-23 receptor antagonist licensed for the treatment of ulcerative colitis (UC). Clinical trial data were promising; however, real-world data are limited. We assessed the safety and effectiveness of ustekinumab in UC in a real-world setting. DESIGN/METHOD This was a multicentre, retrospective, observational cohort study between February 2020 and January 2022. Disease activity was assessed using the Simple Clinical Colitis Activity Index (SCCAI). Clinical remission was defined as a SCCAI≤2. The primary endpoints were rates of corticosteroid-free remission (CSFR) at week 16 and at week 26. Objective outcomes, including faecal calprotectin (FCAL), were also collected. RESULTS 110 patients with UC (65% male; median age 40 (IQR range 29-59); 96% with prior biologic and/or tofacitinib exposure) had a median follow-up of 28 weeks (IQR 17-47). CSFR was 36% (18/50) at week 16% and 33% (13/39) at week 26, corresponding with a significant fall in SCCAI from 6 (IQR 4-8) at baseline to 3 (IQR 0-5) at week 26, p<0.001. By week 16, there was improvement of median FCAL measurements, which fell from a baseline of 610 µg/g (IQR 333-1100) to 102 µg/g (IQR 54-674) at week 16. At the end of follow-up, 15% (17/110) had discontinued treatment; 13 patients due to primary non-response or loss of response, and 1 patient for family planning. Treatment was discontinued in three patients due to adverse events. CONCLUSION In the largest real-world study to date, ustekinumab was effective with a reassuring safety profile in a refractory cohort of patients.
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Affiliation(s)
- Sailish Honap
- IBD Centre, Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK,School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Lulia Al-Hillawi
- Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Samantha Baillie
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Aaron Bancil
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Lawrence Matini
- Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rebecca Lau
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Klaartje Bel Kok
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Kamal Patel
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Alissa Walsh
- Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Peter M Irving
- IBD Centre, Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK,School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Mark A Samaan
- IBD Centre, Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Ibraheim H, Baillie S, Samaan MA, Abu-Sbeih H, Wang Y, Talley NJ, P Jones M, Powell N. Systematic review with meta-analysis: effectiveness of anti-inflammatory therapy in immune checkpoint inhibitor-induced enterocolitis. Aliment Pharmacol Ther 2020; 52:1432-1452. [PMID: 32920854 DOI: 10.1111/apt.15998] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/29/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors have revolutionised cancer treatment, but at the cost of off-target immune-mediated organ damage. This includes checkpoint inhibitor-induced enterocolitis which frequently requires hospitalisation and may be life-threatening. Empiric treatment typically includes corticosteroids and infliximab, although no large-scale studies have confirmed their effectiveness. AIM To investigate the effectiveness of anti-inflammatory therapy in checkpoint inhibitor-induced enterocolitis METHODS: We performed a systematic review and meta-analysis of studies reporting clinical outcomes of checkpoint inhibitor-induced enterocolitis in adult cancer patients treated with anti-inflammatory agents. We searched Medline, EMBASE, and the Cochrane library through April and extracted the proportion of patients responding to anti-inflammatory therapy. Variation in effect size was studied using a random-effects meta-regression analysis, with checkpoint inhibitor agent and tumour type as the variables. RESULTS Data were pooled from 1210 treated patients across 39 studies. Corticosteroids were effective in 59% (95% CI 54- 65) of patients, with response significantly more favourable in patients treated with anti-PD-1/L1 monotherapy, compared with anti-CTLA-4 containing regimens (78%, 95% CI 69-85 vs 56 %, 95% CI 49-63, P = 0.003), and more favourable in lung cancer patients compared with melanoma patients (88%, 95% CI 62-97 vs 55%, 95% CI 47-63, P = 0.04). Infliximab was effective in 81% (95% CI 73-87) of patients, and vedolizumab in 85% (95% CI 60-96). CONCLUSION Corticosteroids, infliximab and vedolizumab, are effective in the treatment of checkpoint inhibitor-induced enterocolitis. Checkpoint inhibitor regimen and cancer type were significant moderators in response to corticosteroid therapy.
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Affiliation(s)
- Hajir Ibraheim
- Division of Digestive Diseases, Faculty of Medicine, Imperial College London, London, UK.,The Royal Marsden Hospital, London, UK
| | | | - Mark A Samaan
- Department of Gastroenterology, Guy's and St Thomas' Hospital, London, UK
| | | | - Yinghong Wang
- The University of Texas MD Anderson Cancer Cente, Houston, TX, USA
| | | | - Michael P Jones
- Psychology Department, Macquarie University, North Ryde, NSW, Australia
| | - Nick Powell
- Division of Digestive Diseases, Faculty of Medicine, Imperial College London, London, UK.,The Royal Marsden Hospital, London, UK
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Dean R, Brennan M, Ewers R, Hudson C, Daly JM, Baillie S, Eisler MC, Place EJ, Brearley J, Holmes M, Handel I, Shaw D, McLauchlan G, McBrearty A, Cripps P, Jones P, Smith R, Verheyen K. The challenge of teaching undergraduates evidence-based veterinary medicine. Vet Rec 2017; 181:298-299. [PMID: 28916694 DOI: 10.1136/vr.j3441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The Royal College of Veterinary Surgeons now lists 'How to evaluate evidence' as a day one competence for newly qualified vets. In this article, representatives from each of the veterinary schools in the UK discuss how the challenge of delivering and assessing the concepts of evidence-based veterinary medicine in a crowded undergraduate curriculum can be met.
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Affiliation(s)
- R Dean
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire LE12 5RD, UK
| | - M Brennan
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire LE12 5RD, UK
| | - R Ewers
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire LE12 5RD, UK
| | - C Hudson
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire LE12 5RD, UK
| | - J M Daly
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire LE12 5RD, UK
| | - S Baillie
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK
| | - M C Eisler
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK
| | - E J Place
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK
| | - J Brearley
- Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK
| | - M Holmes
- Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK
| | - I Handel
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush Campus, Roslin, Midlothian EH25 9RG, UK
| | - D Shaw
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush Campus, Roslin, Midlothian EH25 9RG, UK
| | - G McLauchlan
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Garscube Campus, Bearsden Road, Glasgow G61 1QH, UK
| | - A McBrearty
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Garscube Campus, Bearsden Road, Glasgow G61 1QH, UK
| | - P Cripps
- School of Veterinary Science, University of Liverpool, Neston, Cheshire CH64 7TE, UK
| | - P Jones
- School of Veterinary Science, University of Liverpool, Neston, Cheshire CH64 7TE, UK
| | - R Smith
- School of Veterinary Science, University of Liverpool, Neston, Cheshire CH64 7TE, UK
| | - K Verheyen
- Royal Veterinary College, North Mymms, Hertfordshire AL9 7TA, UK
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10
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Affiliation(s)
- K. Adam
- Royal Veterinary College; Hawkshead Lane Hatfield Hertfordshire AL9 7TA UK
| | - S. Baillie
- University of Bristol School of Veterinary Sciences; Langford House Langford Bristol BS40 5DU UK
| | - J. Rushton
- Royal Veterinary College; Hawkshead Lane Hatfield Hertfordshire AL9 7TA UK
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11
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Guillon P, Makhloufi M, Baillie S, Roucoulet C, Dolimier E, Masquelier AM. Prospective evaluation of venous access difficulty and a near-infrared vein visualizer at four French haemophilia treatment centres. Haemophilia 2014; 21:21-6. [PMID: 25335191 DOI: 10.1111/hae.12513] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 11/29/2022]
Abstract
Although a serious impediment in haemophilia patients, difficulty accessing peripheral veins has received little attention in clinical studies. New peripheral vein visualization devices could potentially ameliorate difficult venous access (DVA), but their utility remains unproved. The study aim was to survey the frequency, causes and clinical manifestations of DVA and evaluate the clinical utility of a near-infrared (NIR) vein visualizer. In this multicentre prospective study, methods, difficulties and outcomes of venous access were assessed for a single venipuncture in consecutive patients. The impact of an NIR vein visualizer on vein localization, the number of venipuncture attempts and patient stress and pain was determined. Among 450 total patients enrolled, venous access was judged to be difficult in 165 (36.7%), most often because of poor vein condition, young patient age, overweight and difficulty in finding veins. Of the patients with DVA, difficulty in locating veins was encountered in 82.4%, and more than one venipuncture attempt was required in 24.8%. Veins were difficult to locate in significantly fewer DVA patients (P = 0.002) when the NIR vein visualizer was used (76.0%) than not used (92.3%). Pain during venipuncture in DVA patients was also significantly less common (P = 0.019) with use of the NIR vein visualizer (34.0% vs. 55.4%). No effect was observed on venipuncture attempts. DVA affects more than one-third of patients at haemophilia treatment centres. An NIR vein visualizer showed significant promise for facilitating vein location and mitigating patient pain in those patients.
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Affiliation(s)
- P Guillon
- Centre Régional de Traitement de l'Hémophilie, Niveau 1 Centre de Prélèvement, Centre Hospitalier Universitaire de Caen, Caen, France
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Crowther E, Hughes K, Handel I, Whittington R, Pryce M, Warman S, Rhind S, Baillie S. Stakeholder consultation on tracking in UK veterinary degrees: part 1. Vet Rec 2014; 175:86. [DOI: 10.1136/vr.102342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- E. Crowther
- School of Veterinary Sciences; Langford House Langford Bristol BS40 5DU UK
| | - K. Hughes
- The Royal (Dick) School of Veterinary Studies; The University of Edinburgh; Easter Bush Veterinary Centre Midlothian Edinburgh EH25 9RG UK
| | - I. Handel
- The Royal (Dick) School of Veterinary Studies; The University of Edinburgh; Easter Bush Veterinary Centre Midlothian Edinburgh EH25 9RG UK
| | - R. Whittington
- The Royal (Dick) School of Veterinary Studies; The University of Edinburgh; Easter Bush Veterinary Centre; Midlothian Edinburgh EH25 9RG UK
| | - M. Pryce
- Avonlodge Veterinary Group; 283 Wells Road Bristol BS3 1PW UK
| | - S. Warman
- School of Veterinary Sciences; Langford House Langford Bristol BS40 5DU UK
| | - S. Rhind
- The Royal (Dick) School of Veterinary Studies; The University of Edinburgh; Easter Bush Veterinary Centre; Midlothian Edinburgh EH25 9RG UK
| | - S. Baillie
- School of Veterinary Sciences; Langford House Langford Bristol BS40 5DU UK
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Crowther E, Hughes K, Handel I, Whittington R, Pryce M, Warman S, Rhind S, Baillie S. Stakeholder consultation on tracking in UK veterinary degrees: part 2. Vet Rec 2014; 175:87. [DOI: 10.1136/vr.102341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- E. Crowther
- School of Veterinary Sciences; Langford House Langford Bristol BS40 5DU UK
| | - K. Hughes
- The Royal (Dick) School of Veterinary Studies; The University of Edinburgh; Easter Bush Veterinary Centre Midlothian EH25 9RG UK
| | - I. Handel
- The Royal (Dick) School of Veterinary Studies; The University of Edinburgh; Easter Bush Veterinary Centre Midlothian EH25 9RG UK
| | - R. Whittington
- The Royal (Dick) School of Veterinary Studies; The University of Edinburgh; Easter Bush Veterinary Centre Midlothian EH25 9RG UK
| | - M. Pryce
- Avonlodge Veterinary Group; 283 Wells Road Bristol BS3 1PW UK
| | - S. Warman
- School of Veterinary Sciences; Langford House Langford Bristol BS40 5DU UK
| | - S. Rhind
- The Royal (Dick) School of Veterinary Studies; The University of Edinburgh; Easter Bush Veterinary Centre Midlothian EH25 9RG UK
| | - S. Baillie
- School of Veterinary Sciences; Langford House Langford Bristol BS40 5DU UK
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Baillie S, Ireland K, Warwick S, Wareham D, Wilks M. Matrix-assisted laser desorption/ionisation-time of flight mass spectrometry: rapid identification of bacteria isolated from patients with cystic fibrosis. Br J Biomed Sci 2014; 70:144-8. [PMID: 24400425 DOI: 10.1080/09674845.2013.11669948] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Despite extensive research into the diagnosis and management of cystic fibrosis (CF) over the past decades, sufferers still have a median life expectancy of less than 37 years. Respiratory tract infections have a significant role in increasing the morbidity and mortality of patients with CF via a progressive decline in lung function. Rapid identification of organisms recovered from CF sputum is necessary for effective management of respiratory tract infections; however, standard techniques of identification are slow, technically demanding and expensive. The aim of this study is to asses the suitability of matrix-assisted laser desorption/ionisation-time of flight mass spectrometry (MALDI-TOF MS) in identifying bacteria isolated from the respiratory tract of patients with CF, and is assessed by testing the accuracy of MALDI-TOF MS in identifying samples from a reference collection of rare CF strains in conjunction with comparing MALDI-TOF MS and standard techniques in identifying clinical isolates from sputum samples of CF patients. MALDI-TOF MS accurately identified 100% of isolates from the reference collection of rare CF pathogens (EuroCare CF collection). The isolate identification given by MALDI-TOF MS agreed with that given by standard techniques for 479/481 (99.6%) clinical isolates obtained from respiratory samples provided by patients with CE In two (0.4%) of 481 samples there was a discrepancy in identification between MALDI-TOF MS and standard techniques. One organism was identified as Pseudomonas aeruginosa by MALDI-TOF but could only be identified by the laboratory's standard methods as of the Pseudomonas genus. The second organism was identified as P. beteli by MALDI-TOF MS and Stenotrophomonas maltophilia by standard methods. This study shows that MALDI-TOF MS is superior to standard techniques in providing cheap, rapid and accurate identification of CF sputum isolates.
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Affiliation(s)
- S Baillie
- Centre for Immunology and Infectious Diseases, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - K Ireland
- Centre for Immunology and Infectious Diseases, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - S Warwick
- Department of Microbiology, Barts Health NHS trust, London, UK
| | - D Wareham
- Centre for Immunology and Infectious Diseases, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - M Wilks
- Centre for Immunology and Infectious Diseases, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
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Cardwell JM, Lewis EG, Smith KC, Holt ER, Baillie S, Allister R, Adams VJ. A cross-sectional study of mental health in UK veterinary undergraduates. Vet Rec 2013; 173:266. [PMID: 23956162 DOI: 10.1136/vr.101390] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Wellbeing (positive mental health) and mental ill-health of veterinary students from a single UK school were quantified using validated psychological scales. Attitudes towards mental ill-health and suicide were also assessed. Results were compared with published data from the UK general population and veterinary profession. Of the total student population (N=1068), 509 (48 per cent) completed a questionnaire. Just over half (54 per cent) of the respondents had ever experienced mental ill-health, with the majority reporting a first occurrence before veterinary school. Student wellbeing was significantly poorer (p<0.0001) than general population estimates, but not significantly different (p=0.2) from veterinary profession estimates. Degree of mental distress in students was significantly higher than in the general population (p<0.0001). Despite the majority (94 per cent) agreeing that 'Anyone can suffer from mental health problems', students were significantly more likely than members of the general population to agree that 'If I were suffering from mental health problems, I wouldn't want people knowing about it' (p<0.0001). Students were more likely to have thought about suicide, but less likely to have made an attempt (p<0.001; p=0.005), than members of the general population. The possibility of non-response bias must be considered when interpreting findings. However, strong similarities between results from this study population and the UK veterinary profession, as well as other veterinary student populations internationally, suggest no substantial school-level bias.
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Affiliation(s)
- J M Cardwell
- Department of Production and Population Health The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK
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Bachynsky EA, Dale VHM, Kinnison T, Gazzard J, Baillie S. A survey of the opinions of recent veterinary graduates and employers regarding early career business skills. Vet Rec 2013; 172:604. [PMID: 23633459 DOI: 10.1136/vr.101376] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- E. A. Bachynsky
- The Royal Veterinary College; Hawkshead Lane, North Mymms Hatfield Hertfordshire AL9 7TA UK
- Westside Veterinary Hospital; 6034 West Broadway Pearland Texas 77581 USA
| | - V. H. M. Dale
- The Royal Veterinary College; Hawkshead Lane, North Mymms Hatfield Hertfordshire AL9 7TA UK
- E-Learning Environments; University College London; Gower Street London WC1E 6BT
| | - T. Kinnison
- The Royal Veterinary College; Hawkshead Lane, North Mymms Hatfield Hertfordshire AL9 7TA UK
| | - J. Gazzard
- The Royal Veterinary College; Hawkshead Lane, North Mymms Hatfield Hertfordshire AL9 7TA UK
- University of East Anglia; Norwich Research Park Norwich NR4 7TJ
| | - S. Baillie
- The Royal Veterinary College; Hawkshead Lane, North Mymms Hatfield Hertfordshire AL9 7TA UK
- The School of Veterinary Sciences; University of Bristol; Langford House Langford Bristol BS40 5DU
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Affiliation(s)
- T Kinnison
- The Royal Veterinary College, University of London, UK
| | - R Lumbis
- Veterinary Nursing, The Royal Veterinary College, University of London, UK
| | - H Orpet
- FdSc VN BSc VN, The Royal Veterinary College, University of London, UK
| | - P Welsh
- Veterinary Nursing, The Royal Veterinary College, University of London, UK
| | - S Gregory
- Veterinary Nursing, The Royal Veterinary College, University of London, UK
| | - S Baillie
- Veterinary Education, all at The Royal Veterinary College, University of London, UK
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Dale VHM, Kinnison T, Short N, May SA, Baillie S. Web 2.0 and the veterinary profession: current trends and future implications for lifelong learning. Vet Rec 2011; 169:467. [PMID: 21891788 DOI: 10.1136/vr.d4897] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The NOVICE project is an EU initiative under the Lifelong Learning Programme, which aims to develop an online, professional network to promote informal, lifelong learning within the veterinary profession, using Web 2.0 tools. To inform the development of the network, a need analysis study was undertaken with relevant stakeholders. Focus group discussions were undertaken with veterinary students and veterinarians and a survey was administered to first-year students and recent graduates. The results indicate that use of computers and the internet is ubiquitous among junior members of the profession and that use of Web 2.0 tools is increasing. Concerns raised in relation to participation in online communities include verifying the quality of information and issues around professionalism. Compared with face-to-face communities, online communities were perceived to offer a number of advantages. These include convenient access to expert advice on an international scale, as well as helping to alleviate certain barriers to participation in formal, continuing education such as time, distance and cost.
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Affiliation(s)
- V H M Dale
- The LIVE Centre, Royal Veterinary College, North Mymms, Hatfield, Hertfordshire, AL97TA, UK.
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Forrest N, Baillie S, Kalita P, Tan HZ. A Comparative Study of Haptic Stiffness Identification by Veterinarians and Students. IEEE Trans Haptics 2011; 4:78-87. [PMID: 26963159 DOI: 10.1109/toh.2010.57] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Palpation is an important clinical skill in both veterinary and medical health professions. The present study compares the ability of practicing veterinarians and veterinary students to identify the stiffness of virtual surfaces through palpation. An absolute identification paradigm was used where a force-feedback haptic device rendered virtual surfaces with five levels of stiffness within a "clinically relevant" range (0.2-0.5 N/mm). The mean information transfer was 0.97 bits (almost two perfectly identifiable stiffness levels) for 12 veterinarians and 0.58 bits (one correctly identified level) for 14 veterinary students. Although the difference between the two groups was significant (p <; 0.001), neither group was able to reliably identify more than two levels of stiffness, indicating that the success of veterinarians in clinical practice probably relies on additional properties such as size, shape, and texture. Analyses of force versus time and displacement versus time recordings suggest that the superior performance of the veterinarians may be partially attributable to motor strategy. Specifically, veterinarians used a greater mean maximum force (2.0 N) compared to students (1.6 N) (p <; 0.05). However, further studies are required to investigate motor strategy in more detail. The implications of our findings for veterinary education and quantitative skill assessment are discussed.
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Abstract
The discovery in 1998 that triclosan has a site-specific action in the bacterial cell as an inhibitor of NADH- or NADPH-dependent enoyl-acyl carrier protein reductase led to a lively debate in the scientific press. The thesis of this debate was that such a mode of action may allow triclosan to induce resistance and cross-resistance in bacterial cells. The debate last saw review in 2004, and this paper aims at updating our knowledge in this area, given recent research on the topic.
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Affiliation(s)
- S Saleh
- School of Pharmacy, Applied Sciences University, Amman, Jordan
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Abstract
OBJECTIVE To survey program directors in obstetrics and gynecology regarding maternity leave and to determine how programs are dealing with maternity leave coverage. METHODS Questionnaires regarding impact and policy on maternity leave were mailed to accredited obstetrics and gynecology residency programs. RESULTS A total of 188 of 274 (69%) questionnaires were returned completed. Respectively, 80% and 69% of respondents indicated that they have a formal maternity (maximum mean 8.7 weeks) and paternity (mean 5.27 days) leave policy. Approximately 75% of programs require residents to make up time if their leave exceeds 8 weeks during the first 3 years. Eighty-five percent of programs require residents to make up time if their leave exceeds 6 weeks during the fourth year. Ninety-three percent of programs require residents to make up time if their leave exceeds 20 weeks over the 4 years. Seventy-seven percent of respondents have other residents in their program cover for the absent resident. Thirty-seven percent of programs have schedules flexible enough to allow rearrangement so that some rotations go uncovered. Eighty-three percent of programs surveyed stated that maternity leave has a somewhat to very significant impact on the residents' schedules. CONCLUSION Most residency programs have written maternity/paternity leave policies. A more flexible curriculum may help to accommodate the residents on leave without overburdening the residents who are left to cover.
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Affiliation(s)
- J L Davis
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, University of California School of Medicine, Los Angeles 90048, USA.
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Hodgson CS, Baillie S, Contini J. Creating Web-based patient education to enhance students' experience in a PBL curriculum. Acad Med 2001; 76:546-547. [PMID: 11346595 DOI: 10.1097/00001888-200105000-00089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- C S Hodgson
- Office for Medical Education Research and Evaluation, University of California, San Francisco, USA
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Hodgson CS, Francisco S, Baillie S. Using a brochure to recruit faculty to teach. Acad Med 2001; 76:577. [PMID: 11346637 DOI: 10.1097/00001888-200105000-00130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- C S Hodgson
- University of California, Office for Medical Education Research and Evaluation, San Francisco, 94143-0410, USA
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Hill EW, Baillie S. Coping with the stress of pastoral counseling. J Relig Health 1993; 32:121-130. [PMID: 24271365 DOI: 10.1007/bf01008207] [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: 06/02/2023]
Abstract
Using a stratified random sample of the three membership categories of the American Association of Pastoral Counselors, this study investigated the experience of stress, related to the pastoral counseling profession, among 143 pastoral counselors and 95 of their spouses. In addition, the study examined how pastoral counselors were coping with stress by evaluating self-reported functional and dysfunctional behaviors. The data indicated that pastoral counselors and their spouses did not report high levels of stress related to the pastoral counseling profession. However, significant differences were found by work setting and age for pastoral counselors regarding the level of stress experienced. The data also indicated that pastoral counselors reported using more functional stress reduction behaviors than dysfunctional stress reduction behaviors.
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Affiliation(s)
- E W Hill
- College of Human Sciences, Department of Family, Child, and Consumer Sciences, The Florida State University in Tallahassee, USA
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Baillie S, Woodhouse K. Medical aspects of ageing. Dent Update 1988; 15:236-8, 240-1. [PMID: 3248660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Woodhouse KW, Wynne H, Baillie S, James OF, Rawlins MD. Who are the frail elderly? Q J Med 1988; 68:505-6. [PMID: 3252302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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