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Fisher OJ, Donahoo C, Bosley E, du Cloux R, Garner S, Powell S, Pickard J, Grevis-James N, Wyder M. Barriers and enablers to implementing police mental health co-responder programs: A qualitative study using the consolidated framework for implementation research. Implement Res Pract 2024; 5:26334895231220259. [PMID: 38322801 PMCID: PMC10775732 DOI: 10.1177/26334895231220259] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Background Police and mental health co-responder programs operate internationally and can be effective in providing timely and appropriate assessment, brief intervention, and referral services for people experiencing mental health crises. However, these models vary greatly, and little is known about how the design and implementation of these programs impacts their effectiveness. Method This study was a qualitative, post hoc implementation determinant evaluation of mental health co-responder units in Brisbane, Australia, comprising of verbal or written interviews with police and mental health staff with an on-road role in the co-responder units, and their managers. The Consolidated Framework for Implementation Research was used to identify barriers and enablers to the program's implementation and effectiveness. Results Participants (n = 30) from all groups felt strongly that the co-responder units are a substantial improvement over the usual police management of mental health crisis cases, and lead to better outcomes for consumers and the service. Enablers included an information-sharing agreement; the Mental Health Co-Responder (MHCORE) program's compatibility with existing police and mental health services; and the learning opportunity for both organizations. Barriers included cultural differences between the organizations, particularly risk-aversion to suicidality for police and a focus on least-restrictive practices for health; extensive documentation requirements for health; and a lack of specific mental health training for police. Conclusions Using an evidence-based implementation science framework enabled identification of a broad range of contextual barriers and enablers to implementation of police mental health co-responder programs. Adapting the program to address these barriers and enablers during the planning, implementation, monitoring, and evaluation phases increases the likelihood of the service's effectiveness. These findings will inform the spread and scale of the co-responder program across Queensland, and will be relevant to police districts internationally considering implementing a co-responder program.
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Affiliation(s)
- O. J. Fisher
- Health Services Research, Wesley Research Institute, Brisbane, Australia
- Implementation Support, Research and Evaluation Unit, Office of the Medical Director, Queensland Ambulance Service, Brisbane, Australia
- Faculty of Health, Charles Darwin University, Brisbane, Australia
| | - C. Donahoo
- Implementation Support, Research and Evaluation Unit, Office of the Medical Director, Queensland Ambulance Service, Brisbane, Australia
| | - E. Bosley
- Implementation Support, Research and Evaluation Unit, Office of the Medical Director, Queensland Ambulance Service, Brisbane, Australia
| | - R. du Cloux
- State Domestic, Family Violence and Vulnerable Persons Unit, Domestic Family Violence and Vulnerable Persons Command, Queensland Police Service, Brisbane, Australia
| | - S. Garner
- Office of the Medical Director, Queensland Ambulance Service, Brisbane, Australia
| | - S. Powell
- Addiction and Mental Health Service, Metro South Health, Queensland Health, Brisbane, Australia
| | - J. Pickard
- State Domestic, Family Violence and Vulnerable Persons Unit, Domestic Family Violence and Vulnerable Persons Command, Queensland Police Service, Brisbane, Australia
| | - N. Grevis-James
- State Domestic, Family Violence and Vulnerable Persons Unit, Domestic Family Violence and Vulnerable Persons Command, Queensland Police Service, Brisbane, Australia
| | - M. Wyder
- Addiction and Mental Health Service, Metro South Health, Queensland Health, Brisbane, Australia
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Junek ML, Zhao L, Garner S, Cuthbertson D, Pagnoux C, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland LW, Rhee RL, Seo P, Specks U, Sreih AG, Warrington K, Wechsler ME, Merkel PA, Khalidi NA. Ocular manifestations of ANCA-associated vasculitis. Rheumatology (Oxford) 2023; 62:2517-2524. [PMID: 36440847 PMCID: PMC10321114 DOI: 10.1093/rheumatology/keac663] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/12/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES ANCA-associated vasculitis (AAV) is a group of multisystem diseases that can have several ocular manifestations. There are published data on ocular manifestations of granulomatosis with polyangiitis (GPA), but few for eosinophilic granulomatosis with polyangiitis (EGPA) or microscopic polyangiitis (MPA). There is little information concerning chronicity, complications, and association with other cranial manifestations of AAV. METHODS This study retrospectively analysed longitudinal multicentre cohorts of individuals with AAV followed between 2006 and 2022. Data included diagnosis, demographics, cranial manifestations of disease, presence of manifestations at onset of disease and/or follow-up, and ocular complications of disease. Univariate and multivariable logistic regression analysis assessed associations across disease manifestations. RESULTS Data from 1441 patients were analysed, including 395 with EGPA, 876 with GPA, and 170 with MPA. Ocular manifestations were seen within 23.1% of patients: 39 (9.9%) with EGPA, 287 (32.7%) with GPA, and 12 (7.1%) with MPA at any time in the disease course. There were more ocular manifestations at onset (n = 224) than during follow-up (n = 120). The most common disease-related manifestations were conjunctivitis/episcleritis and scleritis. In multivariable analysis, dacryocystitis, lacrimal duct obstruction, and retro-orbital disease were associated with sinonasal manifestations of GPA; ocular manifestations were associated with hearing loss in MPA. The most common ocular complications and/or damage seen were cataracts (n = 168) and visual impairment (n = 195). CONCLUSION Ocular manifestations occur in all forms of AAV, especially in GPA. Clinicians should be mindful of the wide spectrum of ocular disease in AAV, caused by active vasculitis, disease-associated damage, and toxicities of therapy.
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Affiliation(s)
- Mats L Junek
- Division of Rheumatology, St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
| | - Lily Zhao
- Division of Ophthalmology, St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
| | - Stephanie Garner
- Division of Rheumatology, St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | - Paul A Monach
- Rheumatology Section, Veteran’s Affairs Boston Healthcare System, Boston, MA, USA
| | | | | | - Philip Seo
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | - Nader A Khalidi
- Division of Rheumatology, St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
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Pollard AJ, Garner S, Patel S, Jerreat M. A Retrospective Service- Evaluation of Implant Success, Survival, Periimplant Health and Prosthetic Complications in a Cohort of Head and Neck Cancer Patients. Eur J Prosthodont Restor Dent 2023; 31:92-103. [PMID: 35917210 DOI: 10.1922/ejprd_2441pollard12] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To determine the success, survival, peri-implant health and prosthetic complications in head and neck cancer patients receiving oral rehabilitation utilising dental implants between 2008 and the present day. MATERIALS AND METHODS Service evaluation. Survival Group: Retrospective review of records to determine implant survival and prosthetic complications. Success Group: Examination to determine implant success and health. RESULTS Survival Group: 260 implants in 81 individuals, median follow up 49.2 months. 89.3% implant survival at 96 months, no further failures up to 133 months. 40.9% individuals required repair or remake of prosthesis by 72 months - mostly denture re-lines. Success group: 164 implants in 48 individuals, median follow up 56 months. Peri-implant mucositis detected in 22% of fixtures (37.5% individuals); peri-implantitis in 12.8% (25% individuals); 33.3% fixtures exhibiting periimplantitis at 120 months. Previous smoking significantly associated with development of peri-implantitis (HR 2.372, p=0.032, 95CI:1.232, 93.317). Compromised survival (e.g. peri-implantitis), absolute (not in mouth) or clinical failure estimated to occur in 28.1% fixtures at 101 months, mostly due to peri-implantitis. CONCLUSIONS There is a large burden of ongoing care in this cohort, requiring interventions to improve peri-implant health and maintain complex prostheses. Oral rehabilitation and ongoing maintenance in this cohort is complex and multi-disciplinary.
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Affiliation(s)
- A J Pollard
- University of Bristol Dental Hospital, Bristol
- Musgrove Park Hospital, Taunton
- Peninsula Dental School, University of Plymouth, Plymouth
| | - S Garner
- University of Bristol Dental Hospital, Bristol
- Musgrove Park Hospital, Taunton
| | - S Patel
- Musgrove Park Hospital, Taunton
| | - M Jerreat
- Musgrove Park Hospital, Taunton
- Peninsula Dental School, University of Plymouth, Plymouth
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Dushnicky MJ, Fine C, Cellucci T, Garner S, Heale L, Matsos M, Beattie KA, Batthish M. Mind the Gap: A Longitudinal Analysis of the Experiences of Adolescents and Parents in a Rheumatology Transition Clinic. J Clin Rheumatol 2023:00124743-990000000-00121. [PMID: 37221634 DOI: 10.1097/rhu.0000000000001988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND The transition from pediatric to adult care is a critical time when adolescent patients and their families face many challenges. This period can be associated with an increase in disease-related morbidity and mortality. The aim of our study is to identify gaps in transition-related care to help guide areas for improvement. METHODS Patients (14-19 years) with juvenile idiopathic arthritis or systemic lupus erythematosus and one of their parents were recruited from the McMaster Rheumatology Transition Clinic. Both were asked to complete the Mind the Gap questionnaire, a validated tool to assess experience and satisfaction with transition care in a clinic setting. The questionnaire, addressing 3 important domains of care: management of the environment, provider characteristics, and process issues, was completed twice-once based on their current clinical experience and again based on their ideal clinical encounter. Positive scores suggest current care is less than ideal; negative scores suggest current care exceeds the ideal experience. RESULTS Most patients (n = 65, 68% female) had a diagnosis of juvenile idiopathic arthritis (87%). Patients identified mean gap scores between 0.2 and 0.3 for each domain of Mind the Gap, with female patients having higher gap scores compared with male patients. Parents (n = 51) identified gap scores between 0.0 and 0.3. Patients identified process issues as having the largest gap, whereas parents identified management of the environment as having the largest gap. CONCLUSIONS We identified several gaps in transition clinic care relative to what patients and parents identify as ideal. These can be used to improve the rheumatology transition care that is currently being provided.
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Affiliation(s)
| | | | - Tania Cellucci
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario
| | - Stephanie Garner
- Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta
| | - Liane Heale
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario
| | - Mark Matsos
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Karen A Beattie
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario
| | - Michelle Batthish
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario
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Majerovich K, Junek M, Khalidi N, Garner S. Duration of Steroid Therapy and Temporal Artery Biopsy Positivity in Giant Cell Arteritis: A Retrospective Cohort Study. J Rheumatol 2023:jrheum.220860. [PMID: 36642440 DOI: 10.3899/jrheum.220860] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Giant cell arteritis (GCA) is the most common large-vessel vasculitis that primarily affects older individuals.1 Prompt diagnosis and treatment with empiric glucocorticoids (GCs) is important because GCA can lead to ischemic complications, including visual loss.1,2.
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Affiliation(s)
- Katherine Majerovich
- University College Dublin School of Medicine, Belfield, Dublin, Ireland. Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. Division of Rheumatology, Department of Medicine, St. Joseph's Healthcare, and McMaster University, Hamilton, Ontario, Canada. NK has received consulting fees from BMS, Sanofi, and AbbVie clinical trials, and an AstraZeneca travel grant; and was a member of the Roche advisory board (2020). The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to K. Majerovich, Apartment 4, 88 Sandymount Road, Dublin, D04 K076, Ireland.
| | - Mats Junek
- University College Dublin School of Medicine, Belfield, Dublin, Ireland. Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. Division of Rheumatology, Department of Medicine, St. Joseph's Healthcare, and McMaster University, Hamilton, Ontario, Canada. NK has received consulting fees from BMS, Sanofi, and AbbVie clinical trials, and an AstraZeneca travel grant; and was a member of the Roche advisory board (2020). The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to K. Majerovich, Apartment 4, 88 Sandymount Road, Dublin, D04 K076, Ireland.
| | - Nader Khalidi
- University College Dublin School of Medicine, Belfield, Dublin, Ireland. Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. Division of Rheumatology, Department of Medicine, St. Joseph's Healthcare, and McMaster University, Hamilton, Ontario, Canada. NK has received consulting fees from BMS, Sanofi, and AbbVie clinical trials, and an AstraZeneca travel grant; and was a member of the Roche advisory board (2020). The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to K. Majerovich, Apartment 4, 88 Sandymount Road, Dublin, D04 K076, Ireland.
| | - Stephanie Garner
- University College Dublin School of Medicine, Belfield, Dublin, Ireland. Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. Division of Rheumatology, Department of Medicine, St. Joseph's Healthcare, and McMaster University, Hamilton, Ontario, Canada. NK has received consulting fees from BMS, Sanofi, and AbbVie clinical trials, and an AstraZeneca travel grant; and was a member of the Roche advisory board (2020). The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to K. Majerovich, Apartment 4, 88 Sandymount Road, Dublin, D04 K076, Ireland.
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Junek ML, Riaz S, Garner S, Khalidi N, Rebello R. Added diagnostic yield of temporal artery magnetic resonance angiography in the evaluation of giant cell arteritis. Rheumatology (Oxford) 2022:6751803. [PMID: 36205595 DOI: 10.1093/rheumatology/keac583] [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: 08/09/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Temporal artery magnetic resonance angiography (TAMRA) is a useful tool to investigate possible diagnoses of Giant Cell Arteritis (GCA). As acquired images also reveal other local structures, they may assist in finding alternative diagnoses when assessing for possible GCA. We sought to assess the utility of TAMRA in identifying other significant abnormalities either associated with a diagnosis of GCA or potentially mimicking a clinical presentation of GCA. METHODS A retrospective cohort study was undertaken at St. Joseph's Healthcare in Hamilton, Ontario, Canada between February 2007 to April 2020 and included patients who underwent TAMRA for a possible diagnosis of GCA. Patient demographics, diagnosis, and imaging findings were extracted, and descriptive analysis of findings was performed. RESULTS We included 340 individuals who underwent TAMRA for assessment of a potential diagnosis of GCA and had clinical information available; there were 126 (37.0%) diagnoses of GCA. Fourteen (4.1%) patients had findings on TAMRA that demonstrated an alternative diagnosis, findings were predominantly in the temporomandibular joint, orbit, and meninges. Eighteen (14.3%) patients with GCA had intracranial vascular changes that were demonstrative of intracranial vasculitis; one stroke was attributed to intracranial GCA. CONCLUSIONS TAMRA has proven utility in diagnosing GCA, and this data suggests that it also has utility in identifying alternative diagnoses to rule out the disease. Intracranial vasculitis was also seen in 14.3% of patients; the clinical impact of these findings is currently poorly understood and requires further study.
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Affiliation(s)
- Mats L Junek
- Division of Rheumatology, Department of Medicine, McMaster University, Ontario, Canada
| | - Shaista Riaz
- Department of Medical Imaging, Health Sciences North, Northern Ontario School of Medicine University, Greater Sudbury, Ontario, Canada
| | - Stephanie Garner
- Division of Rheumatology, Department of Medicine, McMaster University, Ontario, Canada
| | - Nader Khalidi
- Division of Rheumatology, Department of Medicine, McMaster University, Ontario, Canada
| | - Ryan Rebello
- Department of Diagnostic Imaging, McMaster University, Ontario, Canada
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Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, Watkins A, Fegan G, Cornish J, Rees B, Cole H, Jarvis H, Jones S, Russell I, Bosanquet D, Cleves A, Sewell B, Farr A, Zbrzyzna N, Fiera N, Ellis-Owen R, Hilton Z, Parry C, Bradbury A, Wall P, Hill J, Winter D, Cocks K, Harris D, Hilton J, Vakis S, Hanratty D, Rajagopal R, Akbar F, Ben-Sassi A, Francis N, Jones L, Williamson M, Lindsey I, West R, Smart C, Ziprin P, Agarwal T, Faulkner G, Pinkney T, Vimalachandran D, Lawes D, Faiz O, Nisar P, Smart N, Wilson T, Myers A, Lund J, Smolarek S, Acheson A, Horwood J, Ansell J, Phillips S, Davies M, Davies L, Bird S, Palmer N, Williams M, Galanopoulos G, Rao PD, Jones D, Barnett R, Tate S, Wheat J, Patel N, Rahmani S, Toynton E, Smith L, Reeves N, Kealaher E, Williams G, Sekaran C, Evans M, Beynon J, Egan R, Qasem E, Khot U, Ather S, Mummigati P, Taylor G, Williamson J, Lim J, Powell A, Nageswaran H, Williams A, Padmanabhan J, Phillips K, Ford T, Edwards J, Varney N, Hicks L, Greenway C, Chesters K, Jones H, Blake P, Brown C, Roche L, Jones D, Feeney M, Shah P, Rutter C, McGrath C, Curtis N, Pippard L, Perry J, Allison J, Ockrim J, Dalton R, Allison A, Rendell J, Howard L, Beesley K, Dennison G, Burton J, Bowen G, Duberley S, Richards L, Giles J, Katebe J, Dalton S, Wood J, Courtney E, Hompes R, Poole A, Ward S, Wilkinson L, Hardstaff L, Bogden M, Al-Rashedy M, Fensom C, Lunt N, McCurrie M, Peacock R, Malik K, Burns H, Townley B, Hill P, Sadat M, Khan U, Wignall C, Murati D, Dhanaratne M, Quaid S, Gurram S, Smith D, Harris P, Pollard J, DiBenedetto G, Chadwick J, Hull R, Bach S, Morton D, Hollier K, Hardy V, Ghods M, Tyrrell D, Ashraf S, Glasbey J, Ashraf M, Garner S, Whitehouse A, Yeung D, Mohamed SN, Wilkin R, Suggett N, Lee C, Bagul A, McNeill C, Eardley N, Mahapatra R, Gabriel C, Datt P, Mahmud S, Daniels I, McDermott F, Nodolsk M, Park L, Scott H, Trickett J, Bearn P, Trivedi P, Frost V, Gray C, Croft M, Beral D, Osborne J, Pugh R, Herdman G, George R, Howell AM, Al-Shahaby S, Narendrakumar B, Mohsen Y, Ijaz S, Nasseri M, Herrod P, Brear T, Reilly JJ, Sohal A, Otieno C, Lai W, Coleman M, Platt E, Patrick A, Pitman C, Balasubramanya S, Dickson E, Warman R, Newton C, Tani S, Simpson J, Banerjee A, Siddika A, Campion D, Humes D, Randhawa N, Saunders J, Bharathan B, Hay O. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [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: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
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Ma C, Dushnicky M, Talaat H, Thomas S, Cellucci T, Garner S, Heale L, Matsos M, Beattie K, Batthish M. Self-Reported Transition Readiness of Adolescent Patients with Rheumatic Disease: Do the Parents Agree? J Pediatr 2022; 247:155-159. [PMID: 35561803 DOI: 10.1016/j.jpeds.2022.05.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/05/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022]
Abstract
Our objective was to compare transition readiness assessment scores from adolescents with rheumatic disease with their parents and analyze their level of agreement. We found that adolescents and parents generally agree on the level of the transition readiness; however, there is occasional disagreement in specific domains.
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Affiliation(s)
- Christina Ma
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Molly Dushnicky
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Habeba Talaat
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Steffy Thomas
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Tania Cellucci
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Garner
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Liane Heale
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Mark Matsos
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Karen Beattie
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michelle Batthish
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
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Alabousi M, Junek M, Garner S, Khalidi N, Rebello R. Value of second opinion subspecialty radiology consultation in suspected abdominal medium vessel vasculitis. Abdom Radiol (NY) 2021; 46:5763-5771. [PMID: 34550415 DOI: 10.1007/s00261-021-03277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To perform a descriptive analysis of individuals with suspected Polyarteritis nodosa (PAN) referred for second opinion imaging consultation. METHODS A retrospective observational cohort study was performed at a single institution. A consecutive sample was performed of individuals who underwent a second opinion CT or MR angiography subspecialty radiologist consultation between January 2008 and September 2019 for suspected abdominal medium vessel vasculitis. Demographic, clinical, and imaging data were collected. Clinical and imaging findings were reported for PAN, small vessel vasculitis, and "non-vasculitis" groups. Agreement and diagnostic accuracy between final clinical and second opinion imaging diagnoses for PAN were determined. Two-tailed t-tests with a significant p-value < 0.05 were utilized. RESULTS Of the 58 participants, 9 were clinically diagnosed with PAN, 11 with small vessel vasculitis (including lupus, IgA, and ANCA-associated vasculitis), and 38 with non-vasculitis diagnoses. The non-vasculitis group included 15 SAM, 3 FMD, and 1 SAM-FMD spectrum diagnoses. Higher C-reactive protein level (51 vs 17, p = 0.04) and superior mesenteric artery involvement (56% vs 21%, p = 0.04) were more common in PAN than non-vasculitis diagnoses, while arterial dissection (40% vs 0%, p = 0.02) and celiac vasculature involvement (53% vs 0%, p = 0.003) were more common in the non-vasculitis group. There was 88% agreement (51/58; Cohen's kappa 0.56); sensitivity was 67% [95%-confidence interval (CI) 30-93%] and specificity was 92% (95%-CI 80-98%). CONCLUSION Isolated celiac artery involvement and arterial dissection were more common in non-inflammatory vasculopathies than PAN. Our findings highlight the need for multidisciplinary collaboration and awareness of the diverse findings of abdominal vasculopathies.
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Junek M, Hu A, Garner S, Rebello R, Legault K, Beattie K, Khalidi N. Contextualizing temporal arterial magnetic resonance angiography in the diagnosis of giant cell arteritis: a retrospective cohort study. Rheumatology (Oxford) 2021; 60:4229-4237. [PMID: 33404650 DOI: 10.1093/rheumatology/keaa916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/08/2020] [Revised: 12/12/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Imaging modalities have become common in evaluating patients for a possible diagnosis of GCA. This study seeks to contextualize how temporal arterial magnetic resonance angiography (TA-MRA) can be used in facilitating the diagnosis of GCA. METHODS A retrospective cohort study was performed on patients who had been previously referred to a rheumatologist for evaluation of possible GCA in Hamilton, Ontario, Canada. Data including clinical features, inflammatory markers, imaging, and biopsy results were extracted. Multivariable logistic regression model to predict the diagnosis of GCA. Using these models, the utility of TA-MRA in series with or in parallel to clinical evaluation was demonstrated across the cohort as well as in subgroups defined by biopsy and imaging status. RESULTS In total 268 patients had complete data. Those diagnosed with biopsy- and/or imaging-positive GCA were more likely to demonstrate classic features including jaw claudication and vision loss. Clinical multivariable modelling allowed for fair discriminability [receiver operating characteristic (ROC) 0.759, 95% CI: 0.703, 0.815] for diagnosing GCA; there was excellent discriminability in facilitating the diagnosis of biopsy-positive GCA (ROC 0.949, 0.898-1.000). When used in those with a pre-test probability of 50% or higher, TA-MRA had a positive predictive value of 93.0%; in those with a pre-test probability of 25% or less TA-MRA had a negative predictive value of 89.5%. CONCLUSION In those with high disease probability, TA-MRA can effectively rule in disease (and replace temporal artery biopsy). In those with low to medium probability, TA-MRA can help rule out the disease, but this continues to be a challenging diagnostic population.
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Affiliation(s)
- Mats Junek
- Department of Medicine, Division of Rheumatology, McMaster University, Hamilton
| | - Angela Hu
- Department of Medicine, University of Toronto, Toronto
| | - Stephanie Garner
- Department of Medicine, Division of Rheumatology, McMaster University, Hamilton
| | - Ryan Rebello
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Kim Legault
- Department of Medicine, Division of Rheumatology, McMaster University, Hamilton
| | - Karen Beattie
- Department of Medicine, Division of Rheumatology, McMaster University, Hamilton
| | - Nader Khalidi
- Department of Medicine, Division of Rheumatology, McMaster University, Hamilton
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Semalulu T, McColl J, Alam A, Thomas S, Herrington J, Gorter JW, Cellucci T, Garner S, Heale L, Matsos M, Beattie KA, Batthish M. The transition from pediatric to adult rheumatology care through creating positive and productive patient-provider relationships: an opportunity often forgotten. Journal of Transition Medicine 2021. [DOI: 10.1515/jtm-2021-0001] [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] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The transition of patients with a chronic rheumatic disease from pediatric to adult care has been characterized by poor medical and patient-centered outcomes due to the lack of comprehensive transition programs and the paucity of evidence to guide practitioners. We describe a multidisciplinary transition program, data assessing patients’ preparedness for transition and perception of care providers, and the association between these outcomes.
Content
Patients aged 14–19 with childhood-onset systemic lupus erythematosus (cSLE) or juvenile idiopathic arthritis (JIA) were recruited from Rheumatology Transition Clinics and Young Adult Clinics at a single institution. Participants completed the TRANSITION-Q, which assesses healthcare self-management skills as a proxy for transition readiness, and the Consultation and Relational Empathy Scale (CARE) questionnaire, which measures patients’ perception of their providers’ care and empathy.
Summary
Among 63 participants, 87% had JIA (mean age 16.5 years). Age was the only patient characteristic positively associated with TRANSITION-Q scores. CARE scores revealed overwhelmingly positive interactions between patients and healthcare team members. TRANSITION-Q and CARE scores were positively correlated.
Outlook
The transition from pediatric to adult rheumatology care should be recognized as an opportunity to impact the trajectories of patients entering adult care where the patient-provider relationship may play an important role.
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Affiliation(s)
- Teresa Semalulu
- Division of Rheumatology, Department of Medicine , McMaster University , Hamilton , Canada
| | - Jeanine McColl
- Department of Pediatrics , McMaster University , Hamilton , Canada
| | | | | | - Julie Herrington
- Division of Rheumatology , Department of Pediatrics , McMaster University , Hamilton , Canada
| | - Jan Willem Gorter
- Department of Pediatrics and Director of CanChild Centre for Childhood Disability Research, Division of Physical Medicine and Rehabilitation, McMaster University , Hamilton , Canada
| | - Tania Cellucci
- Division of Rheumatology , Department of Pediatrics , McMaster University , Hamilton , Canada
| | - Stephanie Garner
- Division of Rheumatology, Department of Medicine , McMaster University , Hamilton , Canada
| | - Liane Heale
- Division of Rheumatology , Department of Pediatrics , McMaster University , Hamilton , Canada
| | - Mark Matsos
- Division of Rheumatology, Department of Medicine , McMaster University , Hamilton , Canada
| | - Karen A. Beattie
- Division of Rheumatology, Department of Medicine , McMaster University , Hamilton , Canada
| | - Michelle Batthish
- Division of Rheumatology , Department of Pediatrics , McMaster University , Hamilton , Canada
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McColl J, Semalulu T, Beattie KA, Alam A, Thomas S, Herrington J, Gorter JW, Cellucci T, Garner S, Heale L, Matsos M, Batthish M. Transition Readiness in Adolescents With Juvenile Idiopathic Arthritis and Childhood-Onset Systemic Lupus Erythematosus. ACR Open Rheumatol 2021; 3:260-265. [PMID: 33711192 PMCID: PMC8063142 DOI: 10.1002/acr2.11237] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Received: 11/25/2020] [Revised: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 11/25/2022] Open
Abstract
Objective The transition from pediatric to adult rheumatology care represents a particularly vulnerable time for patients with juvenile idiopathic arthritis (JIA) and childhood‐onset systemic lupus erythematosus (cSLE). Improving self‐management skills is important in optimizing health care transition. The study’s objectives were to 1) examine variability in transition readiness of adolescents and young adults within and between different ages, sexes, and disease types; 2) determine the association between age and transition readiness; and 3) identify specific challenges to transition readiness for adolescents. Methods Over 1 year, patients 14 to 20 years of age with JIA or cSLE were recruited from pediatric transition and young adult clinics at a single academic institution. Participants completed the 14‐item Transition‐Q at a single time point. Total scores range from 0 to 100; higher scores indicate greater health care self‐management skills as a proxy for transition readiness. Descriptive statistics summarized patient characteristics and Transition‐Q scores for the population. Regression analyses determined the association between age, sex, and disease type and Transition‐Q score. Results Among 70 participants, 61 had JIA and 9 cSLE (mean disease duration 4.6 years). The mean (SD) total Transition‐Q score was 59.8 (14.9). Age was significantly associated with Transition‐Q score (standardized β = 0.372l P = 0.002). The most commonly reported challenges were seeing the physician alone (without parents), making one’s own appointments, picking up prescriptions, and independent transportation for appointments. Conclusion Transition readiness appears to increase with patient age. There is significant variability in Transition‐Q scores between patients of the same age, suggesting that an individualized approach to improving self‐management skills is necessary.
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Affiliation(s)
| | | | | | - Arzoo Alam
- McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | | | - Liane Heale
- McMaster University, Hamilton, Ontario, Canada
| | - Mark Matsos
- McMaster University, Hamilton, Ontario, Canada
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Mendel A, Ennis D, Go E, Bakowsky V, Baldwin C, Benseler SM, Cabral DA, Carette S, Clements-Baker M, Clifford AH, Cohen Tervaert JW, Cox G, Dehghan N, Dipchand C, Dhindsa N, Famorca L, Fifi-Mah A, Garner S, Girard LP, Lessard C, Liang P, Noone D, Makhzoum JP, Milman N, Pineau CA, Reich HN, Rhéaume M, Robinson DB, Rumsey DG, Towheed TE, Trudeau J, Twilt M, Yacyshyn E, Yeung RSM, Barra LB, Khalidi N, Pagnoux C. CanVasc Consensus Recommendations for the Management of Antineutrophil Cytoplasm Antibody-associated Vasculitis: 2020 Update. J Rheumatol 2020; 48:555-566. [PMID: 32934123 DOI: 10.3899/jrheum.200721] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 09/05/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE In 2015, the Canadian Vasculitis Research Network (CanVasc) created recommendations for the management of antineutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV) in Canada. The current update aims to revise existing recommendations and create additional recommendations, as needed, based on a review of new available evidence. METHODS A needs assessment survey of CanVasc members informed questions for an updated systematic literature review (publications spanning May 2014 to September 2019) using Medline, Embase, and Cochrane. New and revised recommendations were developed and categorized according to the level of evidence and strength of each recommendation. The CanVasc working group used a 2-step modified Delphi procedure to reach > 80% consensus on the inclusion, wording, and grading of each new and revised recommendation. RESULTS Eleven new and 16 revised recommendations were created and 12 original (2015) recommendations were retained. New and revised recommendations are discussed in detail within this document. Five original recommendations were removed, of which 4 were incorporated into the explanatory text. The supplementary material for practical use was revised to reflect the updated recommendations. CONCLUSION The 2020 updated recommendations provide rheumatologists, nephrologists, and other specialists caring for patients with AAV in Canada with new management guidance, based on current evidence and consensus from Canadian experts.
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Affiliation(s)
- Arielle Mendel
- A. Mendel, MD, MSc, C.A. Pineau, MD, Division of Rheumatology, Lupus and Vasculitis Clinic, McGill University, Montréal, Québec;
| | - Daniel Ennis
- D. Ennis, MD, C. Baldwin, MD, N. Dehghan, MD, N. Dhindsa, MD, Division of Rheumatology, University of British Columbia, Vancouver, British Columbia
| | - Ellen Go
- E. Go, MD, R.S. Yeung, MD, PhD, Division of Rheumatology, Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Volodko Bakowsky
- V. Bakowsky, MD, Division of Rheumatology, QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia
| | - Corisande Baldwin
- D. Ennis, MD, C. Baldwin, MD, N. Dehghan, MD, N. Dhindsa, MD, Division of Rheumatology, University of British Columbia, Vancouver, British Columbia
| | - Susanne M Benseler
- S.M. Benseler, MD, PhD, M. Twilt, MD, PhD, Division of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta
| | - David A Cabral
- D.A. Cabral, MBBS, Division of Pediatric Rheumatology, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia
| | - Simon Carette
- S. Carette, MD, MPhil, C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario
| | - Marie Clements-Baker
- M. Clements-Baker, MD, T.E. Towheed, MD, MS, Division of Rheumatology, Queen's University, Kingston, Ontario
| | - Alison H Clifford
- A.H. Clifford, MD, J.W. Cohen Tervaert, MD, PhD, E. Yacyshyn, MD, Division of Rheumatology, University of Alberta, Edmonton, Alberta
| | - Jan Willem Cohen Tervaert
- A.H. Clifford, MD, J.W. Cohen Tervaert, MD, PhD, E. Yacyshyn, MD, Division of Rheumatology, University of Alberta, Edmonton, Alberta
| | - Gerard Cox
- G. Cox, MB, Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario
| | - Natasha Dehghan
- D. Ennis, MD, C. Baldwin, MD, N. Dehghan, MD, N. Dhindsa, MD, Division of Rheumatology, University of British Columbia, Vancouver, British Columbia
| | - Christine Dipchand
- C. Dipchand, MD, MSc, Division of Nephrology, QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia
| | - Navjot Dhindsa
- D. Ennis, MD, C. Baldwin, MD, N. Dehghan, MD, N. Dhindsa, MD, Division of Rheumatology, University of British Columbia, Vancouver, British Columbia
| | - Leilani Famorca
- L. Famorca, MD, S. Garner, MD, MSc, N. Khalidi, MD, Division of Rheumatology, McMaster University, Hamilton, Ontario
| | - Aurore Fifi-Mah
- A. Fifi-Mah, MD, Division of Rheumatology, University of Calgary, Calgary, Alberta
| | - Stephanie Garner
- L. Famorca, MD, S. Garner, MD, MSc, N. Khalidi, MD, Division of Rheumatology, McMaster University, Hamilton, Ontario
| | - Louis-Philippe Girard
- L.P. Girard, MD, MSc, Division of Nephrology, University of Calgary, Calgary, Alberta
| | - Clode Lessard
- C. Lessard, MD, Centre de Recherche Musculo-Squelettique, Trois-Rivières, Québec
| | - Patrick Liang
- P. Liang, MD, Division of Rheumatology, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec
| | - Damien Noone
- D. Noone, MB, BCh, BAO, MSc, Division of Nephrology, Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Jean-Paul Makhzoum
- J.P. Makhzoum, MD, M. Rhéaume, MD, Division of Internal Medicine, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec
| | - Nataliya Milman
- N. Milman, MD, MSc, Division of Rheumatology, The Ottawa Hospital, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario
| | - Christian A Pineau
- A. Mendel, MD, MSc, C.A. Pineau, MD, Division of Rheumatology, Lupus and Vasculitis Clinic, McGill University, Montréal, Québec
| | - Heather N Reich
- H.N. Reich, MD, PhD, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario
| | - Maxime Rhéaume
- J.P. Makhzoum, MD, M. Rhéaume, MD, Division of Internal Medicine, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec
| | - David B Robinson
- D.B. Robinson, MD, MSc, Section of Rheumatology, University of Manitoba, Winnipeg, Manitoba
| | - Dax G Rumsey
- D.G. Rumsey, MD, MSc, Division of Pediatric Rheumatology, University of Alberta, Edmonton, Alberta
| | - Tanveer E Towheed
- M. Clements-Baker, MD, T.E. Towheed, MD, MS, Division of Rheumatology, Queen's University, Kingston, Ontario
| | - Judith Trudeau
- J. Trudeau, MD, Division of Rheumatology, CISSS Chaudière-Appalaches, Université Laval, Québec City, Québec
| | - Marinka Twilt
- S.M. Benseler, MD, PhD, M. Twilt, MD, PhD, Division of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta
| | - Elaine Yacyshyn
- A.H. Clifford, MD, J.W. Cohen Tervaert, MD, PhD, E. Yacyshyn, MD, Division of Rheumatology, University of Alberta, Edmonton, Alberta
| | - Rae S M Yeung
- E. Go, MD, R.S. Yeung, MD, PhD, Division of Rheumatology, Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Lillian B Barra
- L.B. Barra, MD, Division of Rheumatology, Department of Medicine, Western University, London, Ontario, Canada
| | - Nader Khalidi
- L. Famorca, MD, S. Garner, MD, MSc, N. Khalidi, MD, Division of Rheumatology, McMaster University, Hamilton, Ontario
| | - Christian Pagnoux
- S. Carette, MD, MPhil, C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario
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Garner S. From value-based pricing to fair pricing: the role of HTA for UHC. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.157] [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
The UHC key concepts and relevant UN resolutions recommending transparency, including in relation to HTA and pricing. The role of innovation and intellectual property frameworks will be discussed, including financing and co-ordination of R&D for health technologies. Examples on the importance information exchange can play to improve negotiations will also be discussed, along with key considerations, commonalities and differences for for developed and developing countries.
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Affiliation(s)
- S Garner
- Health Technologies and Pharmaceuticals Programme, Division, WHO/Europe, Copenhagen, Denmark
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Abstract
There have been great advances in the management of ANCA associated vasculitis over the past decades. We have gone from an era where the disease was almost universally fatal to trying to prevent long-term side effects of treatment regimens. With the ability to use pulse cyclophosphamide or rituximab as alternates to oral cyclophosphamide for induction of remission, side effects of therapy have been greatly reduced. New approaches have drastically changed our approach to maintenance and we now favor much longer durations of maintenance therapy, as they are more successful in preventing relapse. Steroids have long been the bane of treatment as they are associated with a significant risk of infection and metabolic consequences. We are now in a steroid-sparing and looking ahead to a steroid-free era with new data being published showing lower doses of steroids being equally effective and several ongoing seminal trials looking at agents that could completely replace steroids very early on.
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Keshri S, Marín-Sáez J, Naydenova I, Murphy K, Atencia J, Chemisana D, Garner S, Collados MV, Martin S. Stacked volume holographic gratings for extending the operational wavelength range in LED and solar applications. Appl Opt 2020; 59:2569-2579. [PMID: 32225798 DOI: 10.1364/ao.383577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/09/2020] [Indexed: 06/10/2023]
Abstract
A novel stacking procedure is presented for volume phase holographic gratings (VPHGs) recorded in photopolymer material using Corning Willow Glass as a flexible substrate in order to achieve broader angular and spectral selectivity in a diffractive device with high efficiency for solar and LED applications. For the first time to our knowledge, we have shown a device designed for use with a white LED that has the same input and output angles and high efficiency when illuminated by different wavelengths. In this paper, two VPHGs were designed, experimentally recorded, and tested when illuminated at normal incidence. The experimental approach is based on stacking two individual gratings in which the spatial frequency and slant have been tailored to the target wavelength and using real-time on-Bragg monitoring of the gratings in order to control the recorded refractive index modulation, thereby optimizing each grating efficiency for its design wavelength. Lamination of the two gratings together was enabled by using a flexible glass substrate (Corning Willow Glass). Recording conditions were studied in order to minimize the change in diffraction efficiency and peak diffraction angle during lamination and bleaching. The final fabricated stacked device was illuminated by a white light source, and its output was spectrally analyzed. Compared to a single grating, the stacked device demonstrated a twofold increase in angular and wavelength range. The angular and wavelength selectivity curves are in good agreement with the theoretical prediction for this design. This approach could be used to fabricate stacked lenses for white light LED or solar applications.
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Garner S, Massicotte-Azarnio D, Molnar A, Khalidi N, Walsh M. 139. UTILIZATION OF CANADIAN HEALTHCARE ADMINISTRATIVE DATABASES TO ACCURATELY IDENTIFY CASES OF ANCA-ASSOCIATED VASCULITIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez059.016] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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18
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Garner S, Rawn S, Cox G, Pagnoux C, Cuthbertson D, Carette S, Koening C, Langford C, McAlear C, Monach P, Moreland L, Seo P, Specks U, Sreih A, Ytterberg S, Merkel P, Khalidi N. 138. DIFFUSE ALVEOLAR HEMORRHAGE, PULMONARY NODULES AND INFILTRATES IN GRANULOMATOSIS POLYANGIITIS AND MICROSCOPIC POLYANGIITIS. A COHORT STUDY OF 736 PATIENTS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez059.015] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - Gerald Cox
- St Joseph’s Healthcare Hamilton, ON Canada
| | | | | | | | | | | | | | - Paul Monach
- Boston University and VA Boston Health Boston, MA USA
| | | | - Philip Seo
- Johns Hopkins University Baltimore, MD USA
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19
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Garner S, Fenton T, Martin L, Creaser C, Johns C, Barnabe C. Personalized diet and exercise recommendations in early rheumatoid arthritis: A feasibility trial. Musculoskeletal Care 2017; 16:167-172. [PMID: 28967710 DOI: 10.1002/msc.1214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physical activity and diet have a positive influence on disease activity and cardiovascular risk in patients with rheumatoid arthritis (RA). OBJECTIVE We tested the feasibility and effect of a brief individualized counselling intervention on physical activity levels and fitness, and dietary intake, compared with standard of care. METHODS Thirty patients with inflammatory arthritis (<1 year duration) were assigned to standard of care or the intervention, which consisted of individualized visits with a dietetic intern and physiotherapist at two time points, to review age-specific strategies on diet and exercise. Primary outcomes included anthropometric measurements (height, weight, waist and hip circumference), nutritional intake, physical activity (pedometer steps) and physical fitness. Disease activity measures and biochemical testing (blood pressure measurement, inflammatory markers, cholesterol profile and random glucose) were collected. The changes in these outcomes from baseline to 6 months were assessed using paired t-tests between groups. RESULTS Thirteen patients in the intervention group and 10 in the control group completed the study. There were non-significant trends in improvements in physical activity, low-density lipoprotein cholesterol level and nutritional intake (vitamin C, iron, fibre, vitamin A and folate) in the intervention group. CONCLUSIONS Poor enrolment and high dropout rates in this short-term study highlighted the difficulty of behavioural change. Those continuing in the study and who received the intervention demonstrated a non-significantly improved activity level and nutritional intake that may benefit long-term outcomes.
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Affiliation(s)
- Stephanie Garner
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tanis Fenton
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Nutrition Services, Alberta Health Services, Calgary, AB, Canada
| | - Liam Martin
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Caitlin Creaser
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Carolyn Johns
- Community Accessible Rheumatology Rehabilitation, Alberta Health Services, Calgary, AB, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Barbolla L, Nieto S, llamas P, Moreno C, Contreras M, Lubenko A, Garner S. Severe Immune Haemolytic Anaemia Caused by Intravenous Immunoglobulin Anti-D in the Treatment of Autoimmune Thrombocytopenia. Vox Sang 2017. [DOI: 10.1159/000462340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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21
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Hirsch G, Trusheim M, Cobbs E, Bala M, Garner S, Hartman D, Isaacs K, Lumpkin M, Lim R, Oye K, Pezalla E, Saltonstall P, Selker H. Corrigendum: Adaptive biomedical innovation: Evolving our global system to sustainably and safely bring new medicines to patients in need. Clin Pharmacol Ther 2017; 101:542. [DOI: 10.1002/cpt.643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2017] [Indexed: 11/09/2022]
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22
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Garner S, Lopatina E, Rankin JA, Marshall DA. Nurse-led Care for Patients with Rheumatoid Arthritis: A Systematic Review of the Effect on Quality of Care. J Rheumatol 2017; 44:757-765. [DOI: 10.3899/jrheum.160535] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
Objective.In the nurse-led care (NLC) model, nurses take on the primary responsibility for patient management. We systematically assessed the effect of NLC for patients with rheumatoid arthritis (RA) on multiple dimensions of quality of care from the Alberta Quality of Care Matrix for Health.Methods.We searched MEDLINE, EMBASE, and CINAHL from 1950 to January 2015. English-language studies were included if they reported on NLC for patients with RA and assessed 1 or more dimensions of quality (effectiveness, acceptability, efficiency, accessibility, appropriateness, and safety). Data were synthesized using narrative analysis.Results.We included 10 studies. The NLC models varied in terms of nurses’ professional designation (clinical nurse specialists or nurse practitioners); however, their role in the clinic was fairly consistent. Disease activity was the most common measure of effectiveness, with NLC being equal (n = 2) or superior (n = 3) to the comparator. NLC was equal (n = 1) or superior (n = 5) versus the comparator in terms of patient satisfaction (i.e., acceptability of care). NLC was equally safe as other models (n = 2). Regarding efficiency, results varied across studies (n = 6) and did not allow for conclusions about models’ cost-effectiveness. In qualitative studies, patients found NLC to be superior in terms of accessibility [i.e., continuity of care (n = 3) and appropriateness measured with education and support (n = 4)]; however, no quantitative measures were found.Conclusion.NLC for patients with RA is effective, acceptable, and safe as compared with other models. However, current evidence is insufficient to draw conclusions about its efficiency, accessibility, and appropriateness.
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Hirsch G, Trusheim M, Cobbs E, Bala M, Garner S, Hartman D, Isaacs K, Lumpkin M, Lim R, Oye K, Pezalla E, Saltonstall P, Selker H. Adaptive Biomedical Innovation: Evolving Our Global System to Sustainably and Safely Bring New Medicines to Patients in Need. Clin Pharmacol Ther 2016; 100:685-698. [PMID: 27626610 PMCID: PMC5129677 DOI: 10.1002/cpt.509] [Citation(s) in RCA: 8] [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] [Received: 07/20/2016] [Revised: 08/24/2016] [Accepted: 08/31/2016] [Indexed: 01/10/2023]
Abstract
The current system of biomedical innovation is unable to keep pace with scientific advancements. We propose to address this gap by reengineering innovation processes to accelerate reliable delivery of products that address unmet medical needs. Adaptive biomedical innovation (ABI) provides an integrative, strategic approach for process innovation. Although the term "ABI" is new, it encompasses fragmented "tools" that have been developed across the global pharmaceutical industry, and could accelerate the evolution of the system through more coordinated application. ABI involves bringing stakeholders together to set shared objectives, foster trust, structure decision-making, and manage expectations through rapid-cycle feedback loops that maximize product knowledge and reduce uncertainty in a continuous, adaptive, and sustainable learning healthcare system. Adaptive decision-making, a core element of ABI, provides a framework for structuring decision-making designed to manage two types of uncertainty - the maturity of scientific and clinical knowledge, and the behaviors of other critical stakeholders.
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Affiliation(s)
- G Hirsch
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - M Trusheim
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - E Cobbs
- Merck, Kenilworth, New Jersey, USA
| | - M Bala
- Sanofi, Seattle, Washington, USA
| | - S Garner
- National Institute for Health and Clinical Excellence (NICE), London, UK
| | - D Hartman
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - K Isaacs
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - M Lumpkin
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - R Lim
- Health Canada, Ottawa, Ontario, Canada
| | - K Oye
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | - P Saltonstall
- National Organization for Rare Disorders (NORD), Danbury, Connecticut, USA
| | - H Selker
- Tufts University, Boston, Massachusetts, USA
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Schneeweiss S, Eichler HG, Garcia-Altes A, Chinn C, Eggimann AV, Garner S, Goettsch W, Lim R, Löbker W, Martin D, Müller T, Park BJ, Platt R, Priddy S, Ruhl M, Spooner A, Vannieuwenhuyse B, Willke RJ. Real World Data in Adaptive Biomedical Innovation: A Framework for Generating Evidence Fit for Decision-Making. Clin Pharmacol Ther 2016; 100:633-646. [DOI: 10.1002/cpt.512] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 12/24/2022]
Affiliation(s)
- S Schneeweiss
- Division of Pharmacoepidemiology (DoPE), Department of Medicine; Brigham & Women's Hospital; Boston Massachusetts USA
| | - H-G Eichler
- European Medicines Agency (EMA); London United Kingdom
| | - A Garcia-Altes
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS); Barcelona Spain
| | | | | | - S Garner
- National Institute for Health and Care Excellence (NICE); London United Kingdom
| | - W Goettsch
- National Health Care Institute, Diemen and Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences; Utrecht The Netherlands
| | - R Lim
- Health Products and Food Branch; Health Canada; Ottawa Ontario Canada
| | - W Löbker
- Gemeinsamer Bundesausschuss (GBA); Abteilung Arzneimittel; Berlin Germany
| | - D Martin
- Center for Drug Evaluation and Research; U.S. Food and Drug Administration; Silver Spring Maryland USA
| | - T Müller
- Gemeinsamer Bundesausschuss (GBA); Abteilung Arzneimittel; Berlin Germany
| | - BJ Park
- Seoul National University, College of Medicine, Department of Preventive Medicine; Seoul South Korea
| | - R Platt
- Department of Population Medicine; Harvard Medical School and Harvard Pilgrim Healthcare Institute; Boston Massachusetts USA
| | - S Priddy
- Comprehensive Health Insights (CHI), Humana; Louisville Kentucky USA
| | - M Ruhl
- Aetion Inc.; New York NY USA
| | - A Spooner
- Health Products Regulatory Authority (HPRA); Dublin Ireland
| | - B Vannieuwenhuyse
- Innovative Medicine Initiative - European Medical Information Framework, Janssen Pharmaceutica Research and Development; Beerse Belgium
| | - RJ Willke
- International Society for Pharmacoeconomics and Outcomes Research; Lawrenceville New Jersey USA
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Bouvy JC, Jonsson P, Longson C, Crabb N, Garner S. Health Technology Assessment in the Context of Adaptive Pathways for Medicines in Europe: Challenges and Opportunities. Clin Pharmacol Ther 2016; 100:594-597. [DOI: 10.1002/cpt.448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 01/13/2023]
Affiliation(s)
- JC Bouvy
- National Institute for Health and Care Excellence (NICE); London England United Kingdom
| | - P Jonsson
- National Institute for Health and Care Excellence (NICE); London England United Kingdom
| | - C Longson
- National Institute for Health and Care Excellence (NICE); London England United Kingdom
| | - N Crabb
- National Institute for Health and Care Excellence (NICE); London England United Kingdom
| | - S Garner
- National Institute for Health and Care Excellence (NICE); London England United Kingdom
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Garner S, Barbour ME. Nanoparticles for controlled delivery and sustained release of chlorhexidine in the oral environment. Oral Dis 2015; 21:641-4. [DOI: 10.1111/odi.12328] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/04/2015] [Accepted: 02/09/2015] [Indexed: 11/29/2022]
Affiliation(s)
- S Garner
- Oral Nanoscience; School of Oral and Dental Sciences; University of Bristol; Bristol UK
| | - ME Barbour
- Oral Nanoscience; School of Oral and Dental Sciences; University of Bristol; Bristol UK
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Eichler HG, Baird LG, Barker R, Bloechl-Daum B, Børlum-Kristensen F, Brown J, Chua R, Del Signore S, Dugan U, Ferguson J, Garner S, Goettsch W, Haigh J, Honig P, Hoos A, Huckle P, Kondo T, Le Cam Y, Leufkens H, Lim R, Longson C, Lumpkin M, Maraganore J, O'Rourke B, Oye K, Pezalla E, Pignatti F, Raine J, Rasi G, Salmonson T, Samaha D, Schneeweiss S, Siviero PD, Skinner M, Teagarden JR, Tominaga T, Trusheim MR, Tunis S, Unger TF, Vamvakas S, Hirsch G. From adaptive licensing to adaptive pathways: delivering a flexible life-span approach to bring new drugs to patients. Clin Pharmacol Ther 2015; 97:234-46. [PMID: 25669457 PMCID: PMC6706805 DOI: 10.1002/cpt.59] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [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] [Received: 12/01/2014] [Accepted: 12/04/2014] [Indexed: 12/15/2022]
Abstract
The concept of adaptive licensing (AL) has met with considerable interest. Yet some remain skeptical about its feasibility. Others argue that the focus and name of AL should be broadened. Against this background of ongoing debate, we examine the environmental changes that will likely make adaptive pathways the preferred approach in the future. The key drivers include: growing patient demand for timely access to promising therapies, emerging science leading to fragmentation of treatment populations, rising payer influence on product accessibility, and pressure on pharma/investors to ensure sustainability of drug development. We also discuss a number of environmental changes that will enable an adaptive paradigm. A life‐span approach to bringing innovation to patients is expected to help address the perceived access vs. evidence trade‐off, help de‐risk drug development, and lead to better outcomes for patients.
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Conrad JR, Wyneken J, Garner JA, Garner S. Experimental study of dune vegetation impact and control on leatherback sea turtle Dermochelys coriacea nests. ENDANGER SPECIES RES 2011. [DOI: 10.3354/esr00361] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Wise R, Blaser M, Carrs O, Cassell G, Fishman N, Guidos R, Levy S, Powers J, Norrby R, Tillotson G, Davies R, Projan S, Dawson M, Monnet D, Keogh-Brown M, Hand K, Garner S, Findlay D, Morel C, Wise R, Bax R, Burke F, Chopra I, Czaplewski L, Finch R, Livermore D, Piddock LJV, White T. The urgent need for new antibacterial agents. J Antimicrob Chemother 2011; 66:1939-40. [DOI: 10.1093/jac/dkr261] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Finch R, Blaser M, Carrs O, Cassell G, Fishman N, Guidos R, Levy S, Powers J, Norrby R, Tillotson G, Davies R, Projan S, Dawson M, Monnet D, Keogh-Brown M, Hand K, Garner S, Findlay D, Morel C, Wise R, Bax R, Burke F, Chopra I, Czaplewski L, Finch R, Livermore D, Piddock LJV, White T. Regulatory opportunities to encourage technology solutions to antibacterial drug resistance. J Antimicrob Chemother 2011; 66:1945-7. [DOI: 10.1093/jac/dkr259] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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White AR, Blaser M, Carrs O, Cassell G, Fishman N, Guidos R, Levy S, Powers J, Norrby R, Tillotson G, Davies R, Projan S, Dawson M, Monnet D, Keogh-Brown M, Hand K, Garner S, Findlay D, Morel C, Wise R, Bax R, Burke F, Chopra I, Czaplewski L, Finch R, Livermore D, Piddock LJV, White T. Effective antibacterials: at what cost? The economics of antibacterial resistance and its control. J Antimicrob Chemother 2011; 66:1948-53. [DOI: 10.1093/jac/dkr260] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Livermore DM, Blaser M, Carrs O, Cassell G, Fishman N, Guidos R, Levy S, Powers J, Norrby R, Tillotson G, Davies R, Projan S, Dawson M, Monnet D, Keogh-Brown M, Hand K, Garner S, Findlay D, Morel C, Wise R, Bax R, Burke F, Chopra I, Czaplewski L, Finch R, Livermore D, Piddock LJV, White T. Discovery research: the scientific challenge of finding new antibiotics. J Antimicrob Chemother 2011; 66:1941-4. [DOI: 10.1093/jac/dkr262] [Citation(s) in RCA: 194] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Edworthy S, Zummer M, Garner S, Boire G, Leclercq S, Bykerk V, Kraag G, Markland J, Thomas D, Thomson J, Henderson J. Smoldering rheumatoid arthritis: is the Canadian healthcare system neglecting a significant disease population? J Rheumatol 2008; 35:1506-1512. [PMID: 18597407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To investigate rheumatology practice in Canada with regard to evaluating disease activity status and treatment regimens in patients with rheumatoid arthritis (RA). It was hypothesized that patients with "smoldering" disease activity were not being adequately treated. METHODS Rheumatologists were invited to participate by the Canadian Rheumatology Association in an audit entitled the Assessment in Rheumatology (AIR) program. From across Canada, 65 rheumatologists participated. One thousand five hundred ninety-six consecutive patients with RA seen in regular clinics were classified according to 4 states of disease activity: remission, controlled adequately, smoldering, and uncontrolled. Demographics (age, sex, geographic region), therapy (nonsteroidal antiinflammatory drugs, disease modifying antirheumatic drugs, biologicals, steroids), joint counts (tender/swollen), comorbidity, and treatment decisions at the time of the visit were recorded. Data were collected at the time of the visit with personal digital assistants (PDA) and aggregated, without personal identifiers, for analysis in SPSS. RESULTS The majority of patients had "smoldering" (29%) or "uncontrolled" disease (23%), with the remainder in "remission" (15%) or "controlled adequately" (33%) at the time of their visit. Following the appointment, the uncontrolled group had a 100% increase (from 10.4% to 23.4%) in the addition of biological agents; however, there was no significant increase in the rates for those with smoldering disease (19.4% to 20.5%). CONCLUSION Despite Canada's universal healthcare system, current treatment regimens may not be optimized on the basis of disease activity. A large proportion of patients with RA (29%) seen in Canadian rheumatology practices may be experiencing unnecessary disease for a variety of reasons.
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Tandon L, Hastings E, Banar J, Barnes J, Beddingfield D, Decker D, Dyke J, Farr D, FitzPatrick J, Gallimore D, Garner S, Gritzo R, Hahn T, Havrilla G, Johnson B, Kuhn K, LaMont S, Langner D, Lewis C, Majidi V, Martinez P, McCabe R, Mecklenburg S, Mercer D, Meyers S, Montoya V, Patterson B, Pereyra RA, Porterfield D, Poths J, Rademacher D, Ruggiero C, Schwartz D, Scott M, Spencer K, Steiner R, Villarreal R, Volz H, Walker L, Wong A, Worley C. Nuclear, chemical, and physical characterization of nuclear materials. J Radioanal Nucl Chem 2008. [DOI: 10.1007/s10967-008-0528-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
BACKGROUND Rheumatoid arthritis (RA) is a systemic auto-immune disorder, in which the synovial lining of many joints and tendon sheaths are persistently inflamed. OBJECTIVES To assess the efficacy and toxicity of rofecoxib for treating RA. SEARCH STRATEGY We searched the following databases up to December 2000: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, National Research Register, NHS Economic Evaluation Database, Health Technology Assessment database. The bibliographies of retrieved papers were scanned for additional references. The manufacturers of rofecoxib, MSD, were also approached by the UK National Institue for Clincal Excellence to submit additional evidence to inform it's appraisal on the use of cyclo-oxygenase inibitors for arthritis. SELECTION CRITERIA Relevant studies were randomised controlled trials of parallel group design evaluating the efficacy and/or toxicity of rofecoxib in RA, both placebo based and comparative trials were eligible. Relevant outcome criteria had to be available to evaluate efficacy and/or toxicity, such as the OMERACT outcomes. DATA COLLECTION AND ANALYSIS Data were abstracted independently by two reviewers and the results were compared for the degree of agreement. A validated tool (Jadad 1995) was used to score the quality of the randomised controlled trials. The planned analysis was to pool, where appropriate, continuous outcome measures using mean or standardized mean differences, and dichotomous outcome measures using relative risk ratios. MAIN RESULTS Two randomised controlled trials evaluating the efficacy and toxicity of rofecoxib in RA were identified and met the criteria. One compared rofecoxib to placebo and the other compared rofecoxib to naproxen. The overall number of ACR 20 responders who had received 25mg (82/ 171 = 48%) or 50mg (86/161 = 53%) was statistically significantly more than those receiving placebo (58/168 = 35% ) (RR 1.39 CI: 1.07, 1.80 and RR 1.55 CI: 1.20, 1.99 respectively) with no statistically significant differences between the 25 and 50 mg doses. The safety profile of rofecoxib was similar to that of placebo. In the comparative trial, rofecoxib at a dosage of 50 mg/day demonstrated similar efficacy to naproxen at a dosage of 500 mg twice daily. However, the combined rate of clinically significant complicated gastro-intestinal events (GI) (perforations, ulcers, bleeds, or obstructions) was lower with rofecoxib than with naproxen (RR 0.46, 95% CI, 0.34 to 0.63) due to a reduction in the number of ulcers and bleeds. Patients taking rofecoxib had a greater risk of having a myocardial infarction (MI) than patients taking naproxen (RR 4.03, 95% CI, 2.86 to 5.68). REVIEWER'S CONCLUSIONS In patients with RA, rofecoxib demonstrates a greater degree of efficacy than placebo, while having a comparable safety profile. Rofecoxib demonstrates a similar degree of efficacy as naproxen, but with a significantly lower rate of ulceration and gastrointestinal bleeding. Rofecoxib was associated with a greater risk for MI, but the exact significance and pathophysiology of this possible relationship is unclear.
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Affiliation(s)
- S Garner
- National Institute for Clinical Excellence, 11 Strand, London, UK, WC1N 5HR.
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Abstract
BACKGROUND Rheumatoid arthritis (RA) is a systemic auto-immune disorder, involving persistent joint inflammation. NSAIDs are used to control the symptoms of RA, but are associated with significant gastro-intestinal toxicity, including a risk of potentially life threatening gastroduodenal perforations, ulcers and bleeds. The NSAIDs known as the selective Cox II inhibitors, of which celecoxib is a member, were developed in order to reduce the GI toxicity, but are more expensive. OBJECTIVES To establish the efficacy and safety of celecoxib in the management of RA by systematic review of available evidence. SEARCH STRATEGY We searched the following databases up to August 2002: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, National Research Register, NHS Economic Evaluation Database, Health Technology Assessment Database. The bibliographies of retrieved papers and content experts were consulted for additional references. SELECTION CRITERIA All eligible randomised controlled trials (RCTs) were included. No unpublished RCTs were included in this edition of the review. DATA COLLECTION AND ANALYSIS Data were abstracted independently by two reviewers. Data was analysed using a fixed effects model. A validated checklist was used to score the quality of the RCTs. The planned analysis was to pool, where appropriate continuous outcomes using mean differences and dichotomous outcomes using relative risk ratios. This was not however possible due to the lack of data. MAIN RESULTS Five RCTs were included (4465 participants); three of the studies also enrolled individuals with OA. The comparators were placebo, naproxen, diclofenac and ibuprofen. The evidence reviewed suggests that celecoxib controls the symptoms of RA to a similar degree to that of the active comparators examined (naproxen, diclofenac and ibuprofen). When compared to placebo, the percentage of patients showing improvement according to ACR 20 criteria at week 4 were 42/82 (51%) in the twice daily celecoxib 200mg group and 43/82 (52%) in the twice daily celecoxib 400mg group; these were significantly different from the placebo group in which 25/85 (29%) improved. The six month data reviewed support a reduced rate of UGI complications with celecoxib but there is also evidence to suggest that these benefits may not be evident in the long-term and that celecoxib offers no additional benefit in patients who are also receiving cardio-prophylactic low dose aspirin. REVIEWER'S CONCLUSIONS For an individual with RA the potential benefits of celecoxib need to be balanced against the uncertainty that the short-term reduced incidence of upper GI complications are maintained in the long-term and its increased cost in comparison to traditional NSAIDs.
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Affiliation(s)
- S Garner
- Department of Public Health, St. George's Hospital Medical School, Cranmer Terrace, London, UK, SW17 0RE.
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Abstract
This article presents a brief history of windsurfing, a relatively new recreational and competitive sport activity also known as sailboarding; a brief summary of physiologic studies of windsurfers; and a review of windsurfing injuries with a focus on the neurological complications of windsurfing.
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Affiliation(s)
- C K Jablecki
- Department of Neurosciences, University of California San Diego Medical School, USA
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Hughes D, Jackson D, Kumpel B, Garner S, Ouwehand WH. Induction of a secondary human HPA-5B alloimmune response in SCID mice engrafted with human lymphocytes and antigen-pulsed autologous dendritic cells. Transfus Med 2000. [DOI: 10.1046/j.1365-3148.2000.00261-20.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Barnett D, Storie I, Granger V, Whitby L, Reilly JT, Brough S, Garner S, Lawry J, Richards S, Bell AE, Shenton BK. Standardization of lymphocyte antibody binding capacity - a multi-centre study. Clin Lab Haematol 2000; 22:89-96. [PMID: 10792398 DOI: 10.1046/j.1365-2257.2000.00286.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
As quantitative flow cytometry is being increasingly used to characterize non-malignant and malignant disorders, interlaboratory standardization becomes an important issue. However, the lack of standardized methods and process controls with predefined antibody binding capacity values, limits direct interlaboratory comparison. The present study has addressed these issues using a stable whole blood product and a standardized antigen quantification protocol. It was demonstrated that: (i) a standard technical protocol can result in a high degree of interlaboratory concordance; (ii) interlaboratory variation of less than 12% can be achieved for CD4 antibody binding capacity values; and (iii) stable whole blood can be used as a process control with predefined antibody binding capacity values. Furthermore, using such an approach, a normal range was established for CD3, CD4 CD8 and CD19. These antigens appear to be expressed in a hierarchical manner, a factor that could be used as a procedural quality control measure.
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Affiliation(s)
- D Barnett
- UK NEQAS for Leucocyte Immunophenotyping, Royal Hallamshire Hospital (co-ordinating centre), Sheffield, UK.
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Seager JM, Cullen DJ, Pearson G, Holmes S, Doherty M, Wilson JV, Garrud P, Garner S, Maynard A, Logan RF, Hawkey CJ. Ibuprofen versus other non-steroidal anti-inflammatory drugs: use in general practice and patient perception. Aliment Pharmacol Ther 2000; 14:187-91. [PMID: 10651659 DOI: 10.1046/j.1365-2036.2000.00699.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
OBJECTIVE To investigate whether ibuprofen was as well-regarded by patients as other non-steroidal anti-inflammatory drugs (NSAIDs). DESIGN Questionnaire sent to 1137 consecutive recipients of an NSAID prescription from 21 doctors in six general practices with computerized records. Patient responses were subsequently linked to data held on the practice records. SETTING General practices in and around Nottingham, selected to reflect local variations in number of partners, list size, geographical location, deprivation, prescribing burden and prescribing rate. SUBJECTS Unselected patients receiving NSAIDs prescribed for all indications for use. MAIN OUTCOME MEASURES Effectiveness of ibuprofen and other NSAIDs, possible drug related adverse events, patients' overall satisfaction with ibuprofen and other NSAIDs, factors associated with choice of ibuprofen, drug costs of ibuprofen and other NSAIDs. RESULTS The main NSAIDs used were ibuprofen, diclofenac and naproxen. Ibuprofen use ranged from 1.0% of prescriptions in one practice to 69.1% in another. Although ibuprofen was generally prescribed in low doses, it was perceived by patients as being as effective as the other NSAIDs used, even after allowing for severity of the pre-treatment condition. Overall, 50.5% of patients rated their NSAID the best treatment they had received for their condition with no differences between individual drugs. CONCLUSIONS Ibuprofen is as highly regarded as other NSAIDs when used in similar circumstances. Switching patients to ibuprofen may be a realistic way of reducing financial and medical costs associated with NSAIDs.
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Affiliation(s)
- J M Seager
- Division of Gastroenterology, University Hospital, Nottingham, UK.
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Cullen DJ, Seager JM, Holmes S, Doherty M, Wilson JV, Garrud P, Garner S, Maynard A, Logan RF, Hawkey CJ. Pharmacoepidemiology of non-steroidal anti-inflammatory drug use in Nottingham general practices. Aliment Pharmacol Ther 2000; 14:177-85. [PMID: 10651658 DOI: 10.1046/j.1365-2036.2000.00700.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
AIM To investigate the pharmacoepidemiology of NSAID usage in Nottingham general practices. DESIGN Questionnaire sent to 1137 consecutive recipients of an NSAID prescription from 21 doctors in six general practices with computerized records. Patient responses were subsequently linked to data held on the practice records. SETTING General practices in and around Nottingham, selected to reflect local variations in number of partners, list size, geographical location, deprivation, prescribing burden and prescribing rate. SUBJECTS Unselected patients receiving NSAIDs prescribed for all indications. MAIN OUTCOME MEASURES Indication for treatment, differences in prescribing to different age groups, compliance and overall scheme drug exposure, drug effectiveness and tolerability, possible drug-related adverse events, patients' overall satisfaction with treatment and estimated costs of care. RESULTS NSAIDs were used for a wide range of conditions and only a small number of patients had rheumatoid arthritis. The main drugs used were ibuprofen, diclofenac and naproxen. Patients making short-term use of NSAIDs had low compliance if they experienced adverse drug effects, whilst conversely in long-term users, those with high compliance reported more adverse drug effects. Calculated compliance did not vary with age although older patients (over 65 years) claimed in their questionnaires to be more compliant than younger patients. Half the patients reported good or complete symptom relief. Half of those questions (and two thirds of those with good or complete symptom relief) rated their NSAID as the best treatment they had received for their current condition. The frequency of gastrointestinal adverse events was higher in the young and the old, which correlated with the use of anti-ulcer drugs, and increased with the total number of medications used. CONCLUSIONS NSAIDs are used for a wide-range of conditions. They give symptom relief to, and are perceived as effective by, most patients taking them.
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Affiliation(s)
- D J Cullen
- Division of Gastroenterology, University Hospital, Nottingham, UK.
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Robinson B, Dalton L, Harper A, Ren A, Wang F, Zhang C, Todorova G, Lee M, Aniszfeld R, Garner S, Chen A, Steier W, Houbrecht S, Persoons A, Ledoux I, Zyss J, Jen A. The molecular and supramolecular engineering of polymeric electro-optic materials. Chem Phys 1999. [DOI: 10.1016/s0301-0104(99)00079-8] [Citation(s) in RCA: 216] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Biopsies (biceps) were examined in 8 bodybuilders across a typical arm-curl training session (80% 1-RM). [PCr] and [glycogen] decreased 62 and 12% after 1 set (n = 4), and 50 and 24% after 3 sets (n = 4). [Lactate] was 91 and 118 mmol × kg-1, respectively, after 1 and 3 sets. Fatigue was probably partially caused by decreased [PCr] and increased [H+] (first set) and by decreased [H+] in subsequent sets.
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Affiliation(s)
- J D MacDougall
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1 Canada
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Abstract
Studies were conducted with rats to investigate whether exposure to CO at concentrations frequently found in the environment caused nitric oxide (NO)-mediated vessel wall changes. Exposure to CO at concentrations of 50 parts per million or higher for 1 h increased the concentration of nitrotyrosine in the aorta. Immunologically reactive nitrotyrosine was localized in a discrete fashion along the endothelial lining, and this was inhibited by pretreatment with the NO synthase (NOS) inhibitor Nomega-nitro-L-arginine methyl ester (L-NAME). The CO-induced elevations of aortic nitrotyrosine were not altered by neutropenia or thrombocytopenia, and CO caused no change in the concentration of endothelial NOS. Consequences from NO-derived stress on the vasculature included an enhanced transcapillary efflux of albumin within the first 3 h after CO exposure and leukocyte sequestration that became apparent 18 h after CO exposure. Oxidized plasma low-density lipoprotein was found immediately after CO exposure, but this was not inhibited by L-NAME pretreatment. We conclude that exposure to relatively low CO concentrations can alter vascular status by several mechanisms and that many changes are linked to NO-derived oxidants.
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Affiliation(s)
- S R Thom
- Institute for Environmental Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104-6068, USA
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Lee SS, Garner S, Steier WH, Shin SY. Integrated optical polarization splitter based on photobleaching-induced birefringence in azo dye polymers. Appl Opt 1999; 38:530-533. [PMID: 18305642 DOI: 10.1364/ao.38.000530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
An integrated optical polarization splitter has been fabricated by utilizing the photobleaching-induced birefringence in an azo dye polymer. It consists of a Y-branch waveguide formed by the reactive ion etching with one of the two arms photobleached. The refractive index of the photobleached arm is decreased for the TE mode and increased for the TM mode. The performance of the splitter was measured as a function of the energy of the photobleaching beam and compared to a wave propagation simulation of the device. The measured cross talks are less than -28 dB for the TM mode and -24 dB for the TE mode at a wavelength of 1310 nm. The measured excess losses for the TE and TM modes, which measure the effect of the Y branch and the photobleaching, are 0.3 and 0.4 dB, respectively. The insertion loss was 5 dB, which includes the input fiber to waveguide coupling loss.
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Affiliation(s)
- S S Lee
- Department of Electrical Engineering and Electrophysics, University of Southern California, Los Angeles, California 90089-0483, USA
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Chen A, Chuyanov V, Garner S, Zhang H, Steier WH, Chen J, Zhu J, Wang F, He M, Mao SS, Dalton LR. Low-V(pi) electro-optic modulator with a high-microbeta chromophore and a constant-bias field. Opt Lett 1998; 23:478-480. [PMID: 18084550 DOI: 10.1364/ol.23.000478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A low half-wave voltage V(pi) of 1.57 V was obtained with a 2-cm-long birefringent polymer waveguide modulator at a wavelength of 1.3 microm by use of a modulator design with a constant-bias electric field and a high-microbeta chromophore. The design allows the maximum achievable electro-optic coefficient of the material to be utilized. This electro-optic coefficient can be more than twice as high as the residue value that is used by conventional modulator designs, after fast partial relaxation following poling.
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Abstract
OBJECTIVES To study the circumstances of death in sudden death in epilepsy. METHODS Self referred bereaved relatives of patients with epilepsy who had died suddenly were interviewed with information obtained substantiated through other sources-namely, coroners' officers' reports, postmortem reports, previous medical records, and EEG reports. RESULTS Of 34 cases, 26 were classified as sudden unexpected deaths in epilepsy (SUDEP). Twenty four of 26 cases of SUDEP were unwitnessed. Evidence indicative or suggestive of a seizure was found in most. In 11 of 26 the position of the head was such that breathing could have been compromised. Cases included both localisation related and idiopathic primary generalised epilepsy. Only three were in remission at the time of death. Most relatives expressed the view that they would have preferred to have known that epilepsy could be fatal. CONCLUSIONS Although the deaths in question were largely unwitnessed, the available evidence suggested that most cases of SUDEP represented ictal or postictal seizure deaths, occurring in people with a history of generalised tonic clonic seizures, and in both primary generalised and localisation related epilepsy. These interviews highlight the needs of bereaved relatives and their sense of isolation in the face of an entirely unexpected and apparently unexplained loss.
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Affiliation(s)
- L Nashef
- Epilepsy Research Group and the Department of Neurophysiology, National Hospital for Neurology and Neurosurgery, London, UK
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Regan F, Teesdale P, Garner S, Callaghan T, Brennan M, Contreras M. Comparison of in vivo red cell survival of donations collected by Haemonetics MCS versus conventional collection. Transfus Med 1997; 7:25-8. [PMID: 9089981 DOI: 10.1046/j.1365-3148.1997.d01-78.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The Haemonetics Multicomponents System (MCS) cell separator allows concurrent donation of red cells in addition to platelets and/or plasma, thus increasing the versatility of apheresis donations. In vivo survival of autologous red cells obtained by MCS was compared with red cells collected conventionally. In this cross-over controlled study, five male volunteers donated one unit of red cells by MCS and one unit of whole blood by the conventional manual method, 3 months apart. After storing donations in SAG-M for 35 days under standard conditions, radioactive (51Cr)-labelled autologous red cells were injected into each donor. The post-transfusion recovery (PTR) of red cells at 24 and 48 h did not show any significant difference between red cells obtained manually and by MCS, indicating that processing differences have no detrimental effects on red cell survival.
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Affiliation(s)
- F Regan
- North London Blood Centre, Colindale, UK
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Shenton BK, Bell AE, Harmer AW, Boyce M, Briggs D, Cavanagh G, Culkin J, van Dam MG, Evans PR, Haynes P, Henderson N, Horsburgh T, Martin S, Preece K, Reynolds W, Robson A, Sutton M, Waters D, Younie M, Garner S. Importance of methodology in the flow cytometric crossmatch: a multicentre study. Transplant Proc 1997; 29:1454-5. [PMID: 9123378 DOI: 10.1016/s0041-1345(96)00563-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- B K Shenton
- Department of Surgery, University of Newcastle Upon Tyne, Medical School, United Kingdom
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Abstract
Substantial psychological and neurobehavioural evidence is available to support the hypothesis that traumatic brain injury (TBI) is a risk factor for subsequent psychiatric disorders. However, studies utilizing established psychiatric diagnostic schemes to study these outcomes after TBI are scarce, and no studies have included an assessment of personality disorders in addition to the major psychiatric disorders. This study utilizes structured psychiatric interviews to measure the prevalence of DSM-III(R) disorders in a sample of 18 subjects derived from a TBI rehabilitation programme. Results revealed high rates for major depression, bipolar affective disorder, generalized anxiety disorder, borderline and avoidant personality disorders. Co-morbidity was also high. A preliminary study of postulated predictive factors revealed possible roles for sex and for initial severity of injury. The study supports the association between TBI and psychiatric disorder, and suggests the need for monitoring, for prevention, and for treatment of psychiatric disorders after TBI.
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Affiliation(s)
- R van Reekum
- Department of Psychiatry, University of Toronto, Canada
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