1
|
Pruthi V, Abbasi N, Thakur V, Shinar S, O'Connor A, Silver R, Simpson T, Van Mieghem T. Performance of comprehensive first trimester fetal anatomy assessment. Prenat Diagn 2023. [PMID: 37113105 DOI: 10.1002/pd.6360] [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: 03/08/2023] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE Ultrasound assessment of the fetal anatomy and fetal echocardiography are feasible in the first trimester of pregnancy. This study was designed to assess the performance of a comprehensive fetal anatomy assessment in a high-risk population at a tertiary fetal medicine unit. METHODS Retrospective review of high-risk patients undergoing comprehensive fetal anatomy ultrasound assessment between 11 weeks and 13+6 weeks gestation was conducted. Findings of the early anatomy ultrasound scan were compared with the second trimester anatomy scan, and birth outcomes or post-mortem results. RESULTS Early anatomy ultrasounds were performed in 765 patients. Sensitivity of the scan for detecting fetal anomalies compared to the birth outcome was 80.5% (95% CI 73.5 -86.3) and specificity was 93.1% (95%CI 90.6 - 95.2). Positive and negative predictive values were 78.5% (95% CI 71.4 - 84.6) and 93.9 % (95% CI 91.4 - 95.8), respectively. The most missed and the most overdiagnosed abnormalities were ventricular septal defects. The second trimester ultrasound had sensitivity of 69.0% (95% CI 55.5 - 80.5) and specificity of 87.5% (95% CI 84.3 - 90.2). CONCLUSION In a high-risk population, early assessments had similar performance metrics as the second trimester anatomy ultrasound. We advocate for a comprehensive fetal assessment in the care of high-risk pregnancies. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Vagisha Pruthi
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
| | - Nimrah Abbasi
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
| | - Varsha Thakur
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
- Department of Cardiology, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Shiri Shinar
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
| | - Anne O'Connor
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
| | - Rachel Silver
- Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Tasha Simpson
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
| | - Tim Van Mieghem
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
| |
Collapse
|
2
|
Grealish L, Todd J, Teodorczuk A, Krug M, Simpson T, Jenkinson K, Soltau D, Stockwell-Smith G. Erratum to ’Feasibility of a two-part person-centred care initiative for people living with dementia in acute hospitals: A mixed method study’ International Journal of Nursing Studies Advances, 3 (2021) Article Number: 100040. International Journal of Nursing Studies Advances 2022. [DOI: 10.1016/j.ijnsa.2022.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
3
|
Billy H, Simpson T. IBC-Ox24 Routine Oversewing of Staple Lines to Prevent Leaks is Unnecessary in Patients with Normal Iintraoperative Indocyanine Green (ICG) Perfusion Studies Uundergoing Sleeve Gastrectomy. Br J Surg 2022. [DOI: 10.1093/bjs/znac402.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Abstract
Anastomotic staple line leaks following laparoscopic sleeve gastrectomy is a devastating complication. Gastric ischemia and poor tissue perfusion has been hypothesized to be a contributing factor. Various interventions including oversewing of staple lines are commonly used hoping to decrease staple line leaks. Indocyanine green (ICG) can be used to assess bowel perfusion and anastomotic viability following laparoscopic surgery. 50 consecutive patients underwent laparoscopic sleeve gastrectomy utilizing intravenous administration of ICG to assess tissue perfusion and the need for staple line oversewing.
Methods
50 consecutive patients undergoing laparoscopic sleeve gastrectomy were studied intraoperatively after completion of sleeve gastrectomy using intravenous administration of ICG. 7.5 mg of ICG was administered intravenously. Arterial perfusion and end stage tissue perfusion of the completed sleeve gastrectomy was then evaluated. Vascular arterial inflow of the gastric cardia, body and antrum was carefully evaluated both anteriorly and posteriorly for evidence of delayed tissue perfusion or tissue ischemia.
Results
In all cases the staple line was examined for staple line formation and evidence of poor tissue perfusion using ICG. Both anterior and posterior evaluation was performed of the distal esophagus, gastric cardia, gastric body and antrum. Absence of tissue perfusion in the resected gastric body was used as a comparison control in all cases. ICG perfusion of the gastric cardia, body and antrum was found to be excellent and brisk in all patients. There were no areas of decreased perfusion or tissue ischemia. Oversewing of the staple line was avoided in all cases. Hemostatic clips were deployed as needed for staple line bleeding until there was no evidence of bleeding on visual inspection and final ICG administration. Patients were followed for evidence of leakage or obstruction for 30 days following completion of the sleeve gastrectomy. There were no leaks, there were no deaths. There were no obstructions and no readmissions. There were no complications related to administration of ICG. Average operative time was 48.7 minutes.
Conclusions
Our series of 50 consecutive sleeve gastrectomies utilizing ICG to assess for tissue perfusion demonstrated no evidence of tissue perfusion deficiencies along the staple line or at the angle of His. Staple line oversewing was not used in any patients. Staple line oversewing in cases without evidence of tissue perfusion deficits on ICG evaluation following sleeve gastrectomy is unnecessary. Further multicenter studies and prospective randomized series are necessary to confirm these initial findings.
Collapse
|
4
|
Simpson T, Billy H. IBC-Ox22 Greater Adherence to Mediterranean Diet leads to longer term weight loss. Br J Surg 2022. [DOI: 10.1093/bjs/znac402.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Abstract
We were able to obtain dietary data of 134 weight loss surgery patients with an average follow up of five years with annual scoring of the 9 point Mediterranean Diet. The closer adherence to the MD showed more weight loss than those who had not.
Background
The Mediterranean Diet has been associated with decreased all cause mortality for those who adhere strongly to it, as well as decreased risk of heart disease, and cancer. The diet is rich in polyphenols with fruits, vegetables, legumes, fish, mono-unsaturated fats, whole grains, while minimizing dairy, meat and poultry, and some moderate alcohol consumption.
Methods
Pre operatively all bariatric patients patients were counseled about the Mediterranean diet, how to score the diet, and adherence to the diet was reemphasized at their follow ups. Annually they were asked to fill out their scores. We looked at other diet plans that some of the patients reported (low carbohydrate, weight watchers) and the results were not significant.
Results
Of the 134 patients there were 65 which had scores of 5 points or more and showed an absolute reduction in weight of 54% total weight loss on average, vs those of 1-3 who had 32% total weight loss (total of 60 patients). The remaining 9 patients who escorted 4 points had a wide spread of weight loss that could not be calculated (these patients predominantly followed a self-described low-carbohydrate diet). There was no difference in weight loss regarding the type of surgery that the patient had (Lap-Band (N=74) vs Gastric Sleeve (N=50) vs Gastric bypass (N=10). Nor was there any difference in weight loss when measuring physical activity.
Using the 9 point scale of the Mediterranean Diet those who had greater than 5 of the 9 points on the MD had greater weight loss over five years than those who were 0-3. Those who scored 4 points were indeterminate.
Conclusions
The Mediterranean Diet scale provides a quick and easy guide, providing targets for patients (example, less than 4 ounces per day of poultry or meat is a point, more is 0 points). The emphasis on a post operative diet for health, as opposed to weight loss, inadvertently provided a good model for post operative weight loss.
Collapse
|
5
|
Hill SV, Pratt MC, Elopre L, Smith TV, Simpson T, Lanzi R, Matthews LT. "Let's take that [stop sign] down." Provider perspectives on barriers to and opportunities for PrEP prescription to African American girls and young women in Alabama. AIDS Care 2022; 34:1473-1480. [PMID: 35914114 PMCID: PMC9889573 DOI: 10.1080/09540121.2022.2105799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/18/2021] [Accepted: 07/20/2022] [Indexed: 02/03/2023]
Abstract
HIV disproportionately impacts many groups, including Black adolescent girls and young women (AGYW) aged 13-24 living in the Deep South. Current prevention efforts have the potential to further exacerbate disparities within this population as HIV pre-exposure prophylaxis (PrEP) remains underutilized by Black AGYW in the South. We conducted in-depth interviews (IDIs) grounded in Andersen's Model of Healthcare Utilization exploring providers' PrEP prescribing practices to Black AGYW in Alabama. Eleven providers completed IDIs exploring providers' PrEP prescription knowledge and experiences. Cross-cutting themes included: (1) Community and provider-level stigmas (including those propagated by legislation) relating to HIV and sexuality limit sexual health discussions with Black AGYW clients; (2) Low PrEP knowledge and comfort with guidelines limits PrEP conversations and reinforces low uptake and prescriptions; (3) Healthcare systems and structural barriers impede PrEP access for youth. Multi-level (structural, community, and provider) barriers to PrEP prescription demands high activation energy for providers to prescribe PrEP. We present recommendations in training in sexual health assessment, updates to PrEP guidelines to accommodate risk assessment appropriate for AGYW, and increased implementation science focused on PrEP prescription for Black AGYW in order to reduce HIV incidence for this population.
Collapse
Affiliation(s)
- Samantha V. Hill
- Department of Pediatrics, University of Alabama at Birmingham (UAB), School of Medicine, Birmingham, AL, USA
| | - M. C. Pratt
- Division of Infectious Diseases, University of Alabama at Birmingham (UAB), School of Medicine, Birmingham, AL, USA
| | - L. Elopre
- Division of Infectious Diseases, University of Alabama at Birmingham (UAB), School of Medicine, Birmingham, AL, USA
| | - T. V. Smith
- Department of Pediatrics, University of Alabama at Birmingham (UAB), School of Medicine, Birmingham, AL, USA
| | - T. Simpson
- Department of Pediatrics, University of Alabama at Birmingham (UAB), School of Medicine, Birmingham, AL, USA
| | - R. Lanzi
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - L. T. Matthews
- Division of Infectious Diseases, University of Alabama at Birmingham (UAB), School of Medicine, Birmingham, AL, USA
| |
Collapse
|
6
|
Hughes TP, Kerry JT, Simpson T. Large-scale bleaching of corals on the Great Barrier Reef. Ecology 2017; 99:501. [DOI: 10.1002/ecy.2092] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/20/2017] [Accepted: 08/25/2017] [Indexed: 11/06/2022]
Affiliation(s)
- T. P. Hughes
- Australian Research Council Centre of Excellence for Coral Reef Studies; James Cook University; Townsville Queensland 4811 Australia
| | - J. T. Kerry
- Australian Research Council Centre of Excellence for Coral Reef Studies; James Cook University; Townsville Queensland 4811 Australia
| | - T. Simpson
- Torres Strait Regional Authority; P.O. Box 261 Thursday Island Queensland 4875 Australia
| |
Collapse
|
7
|
Mason D, Crossland M, Simpson T, Peterson R, Kirkwood M. B-60Health-Related Quality of Life Following Youth Soccer-Related Concussion. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.145] [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: 11/14/2022] Open
|
8
|
Came HA, McCreanor T, Doole C, Simpson T. Realising the rhetoric: refreshing public health providers' efforts to honour Te Tiriti o Waitangi in New Zealand. Ethn Health 2017; 22:105-118. [PMID: 27323889 DOI: 10.1080/13557858.2016.1196651] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES New Zealand has a unique tool, Te Tiriti o Waitangi, the Treaty of Waitangi, for addressing health disparities. Indigenous Māori have compromised health status compared to other groups. This paper investigates ways in which public health units (PHUs) and non-governmental organisations (NGOs) use Te Tiriti o Waitangi in service delivery to Māori. DESIGN A nationwide telephone survey of primary health providers (n=162) was conducted in 2014-15. Participants were asked about effectiveness and monitoring of their service delivery to Māori. RESULTS PHUs reported actively working with Māori, and Te Tiriti o Waitangi to reduce health disparities. Direct Māori engagement with development and delivery of programmes was viewed as essential. Strategies included designated PHU staff in positions of responsibility, formal partnerships with Māori, and providing operational and strategic guidance. Some PHUs supported development of cultural competencies. NGO responsiveness to Māori was variable. Some NGOs described prioritising service delivery and programmes for Māori. Others reported the focus of their service was European or other non-Māori ethnicities. Lack of resources or past difficulties engaging with Māori were barriers. CONCLUSION Public health has an ethical commitment to reduce health disparities. Advancing Te Tiriti obligations in everyday practice has the potential to address inequalities.
Collapse
Affiliation(s)
- H A Came
- a Faculty of Health and Environmental Sciences , Auckland University of Technology , Auckland , New Zealand
| | - T McCreanor
- b Te Rōpū Whāriki , Massey University , Auckland , New Zealand
| | - C Doole
- a Faculty of Health and Environmental Sciences , Auckland University of Technology , Auckland , New Zealand
| | - T Simpson
- c Health Promotion Forum , Auckland , New Zealand
| |
Collapse
|
9
|
Affiliation(s)
- H. A. Came
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - T. McCreanor
- Te Rōpū Whāriki, Massey University, Auckland, New Zealand
| | - T. Simpson
- Health Promotion Forum, Auckland, New Zealand
| |
Collapse
|
10
|
Kelly F, Cook T, Boniface N, Hughes J, Seller C, Simpson T. Videolaryngoscopes confer benefits in human factors in addition to technical skills. Br J Anaesth 2015; 115:132-3. [DOI: 10.1093/bja/aev188] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
11
|
Dearnley N, Eyres R, Simpson T, Stephenson E, Belton M, Palchaudhuri P. S76 Tb Infection In The Nepali Population In South-east London Displays Different Characteristics Compared To The Tb Population In Nepal. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
12
|
Simpson T, Ling C, Glover G, Barrett N, Ioannou N, Lams B, Langrish C, Meadows C, Agarwal N, D'Cruz D. P278 Extra-corporeal Membrane Oxygenation And Diffuse Alveolar Haemorrhage - A Single Centre Case Series And Analysis Of The Elso Database. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
13
|
Ling C, Simpson T, Glover G, Nicholas B, D'Cruz D. FRI0451 Extra-Corporeal Membrane Oxygenation and Diffuse Alveolar Haemorrhage - A Single Centre CASE Series and Analysis of the ELSO Database: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
14
|
Acquaye AA, Vera-Bolanos E, Gilbert MR, Armstrong TS, Lin L, Amidei C, Lovely M, Arzbaecher J, Page M, Mogensen K, Lupica K, Maher ME, Armstrong TS, Won M, Wefel JS, Gilbert MR, Pugh S, Wendland MM, Brachman DG, Brown PD, Crocker IR, Robins HI, Lee RJ, Mehta M, Arvold N, Wang Y, Zigler C, Schrag D, Dominici F, Boele F, Douw L, de Groot M, van Thuijl H, Cleijne W, Heimans J, Taphoorn M, Reijneveld J, Klein M, Bunevicius A, Tamasauskas S, Tamasauskas A, Deltuva V, Bunevicius R, Cahill J, Lin L, Armstrong T, Acquaye A, Vera-Bolanos E, Gilbert M, Padhye N, Chan J, Clarke J, Lawton K, Rabbitt J, DeSilva A, Prados M, Rosen M, Cher L, Diamond E, Applebaum A, Corner G, DeRosa A, Breitbart W, DeAngelis L, Hoogendoorn P, Ikuta S, Muragaki Y, Maruyama T, Nitta M, Tamura M, Okamoto S, Iseki H, Okada Y, Lacouture M, Davis ME, Elzinga G, Butowski N, Tran D, Villano J, Wong E, Legge D, Cher L, Legge D, Cher L, Mills K, Lin L, Acquaye A, Vera-Bolanos E, Gilbert M, Armstrong T, Lovely M, Sullivan D, Mueller S, Fullerton H, Stratton K, Leisenring W, Armstrong G, Weathers R, Stovall M, Goldsby R, Sklar C, Robison L, Krull K, Pace A, Villani V, Focarelli S, Benincasa D, Benincasa A, Carapella CM, Pompili A, Peiffer AM, Burke A, Leyer CM, Shing E, Kearns WT, Hinson WH, Case D, Rapp SR, Shaw EG, Chan MD, Porensky E, Cavaliere R, Newton H, Shilds A, Burgess S, Ravelo A, Taylor F, Mazar I, Abrey L, Rooney A, Graham C, McKenzie H, Fraser M, MacKinnon M, McNamara S, Rampling R, Carson A, Grant R, Rooney A, Heimans L, Woltz S, Kerrigan S, McNamara S, Grant R, Seibl-Leven M, Wittenstein K, Rohn G, Goldbrunner R, Timmer M, Kennedy J, Sherman W, Sen-Gupta I, Garic I, Macken M, Gerard E, Raizer J, Schuele S, Grontoft M, Stragliotto G, Taphoorn MJ, Henriksson R, Bottomley A, Cloughesy T, Wick W, Mason W, Saran F, Nishikawa R, Ravelo A, Hilton M, Chinot OL, Trad W, Simpson T, Wright K, Tran T, Choong C, Barton M, Hovey E, Robinson K, Koh ES, Vera-Bolanos E, Acquaye AA, Brown PD, Chung C, Gilbert MR, Vardy J, Armstrong TS, Walbert T, Mendoza T, Vera-Bolanos E, Gilbert M, Acquaye A, Armstrong T, Walbert T, Glantz M, Schultz L, Puduvalli VK, Oudenhoven M, Farin C, Hoffman R, Armstrong T, Ewend M, Wu J. SYMPTOM MANAGEMENT/QUALITY OF LIFE. Neuro Oncol 2013; 15:iii226-iii234. [PMCID: PMC3823907 DOI: 10.1093/neuonc/not192] [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] [Indexed: 01/19/2024] Open
|
15
|
Pennycuick A, Simpson T, Crawley D, Lal R, Santis G, Cane P, Tobal K, Spicer J. Routine EGFR and KRAS Mutation analysis using COLD-PCR in non-small cell lung cancer. Int J Clin Pract 2012; 66:748-752. [PMID: 22805266 DOI: 10.1111/j.1742-1241.2012.02961.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Aims: Epidermal growth factor receptor (EGFR) antagonists are particularly active in non-small cell lung cancer (NSCLC) patients with tumours bearing mutations in the EFGR gene. EGFR mutation prevalence is very low in squamous histology. Response rates using these drugs in patients with KRAS mutations are low, so available KRAS mutation information may aid treatment selection in the second-line setting. Since 2009, patients presenting to this hospital with non-squamous histology have been routinely screened for mutations in both the EGFR and KRAS genes, with results used to inform treatment. We present an analysis of 215 consecutive patients for whom EGFR mutation analysis was informative. Methodology: EGFR and KRAS mutations were identified using a COLD-PCR technique confirmed with sequencing, which makes no prior assumption about location of specific mutations. Results were correlated with clinical and demographic data from hospital records, where available. Results: The prevalence of patients with EGFR mutations was 14% and for KRAS mutations it was 27%. Despite the conventional understanding that EGFR and KRAS mutations are mutually exclusive, we identified two dual mutations. Of 29 patients identified with mutated EGFR, there were 3/8/8/10 mutations in exons 18/19/20/21 respectively. Exon 20 mutations were identified in a proportion exceeding many other series because of the unbiased mutation analysis used, and clinical benefit was seen in some of these. Of 23 different EGFR mutations identified, 11 have not previously been described in the literature. Conclusions: The high prevalence of EGFR, KRAS or both mutations (40%) in this non-squamous population tested in clinical practice supports a policy of routine screening for these mutations in NSCLC.
Collapse
Affiliation(s)
- A Pennycuick
- School of Medicine, King's College London, Guy's Hospital, London, UK Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Huon G, Simpson T, Holzer F, Maini G, Will F, Kopinke FD, Roland U. In Situ Radio-Frequency Heating for Soil Remediation at a Former Service Station: Case Study and General Aspects. Chem Eng Technol 2012. [DOI: 10.1002/ceat.201200027] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
17
|
Whiting DL, Simpson GK, Koh ES, Wright KM, Simpson T, Firth R. A multi-tiered intervention to address behavioural and cognitive changes after diagnosis of primary brain tumour: a feasibility study. Brain Inj 2012; 26:950-61. [PMID: 22630044 DOI: 10.3109/02699052.2012.661912] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Untreated behavioural and cognitive changes after primary brain tumour (PBT) can result in challenging behaviours (CBs), with limited documentation on treatment approaches. This study explored the feasibility of employing a Behavioural Consultancy approach to manage CBs, targeting individuals with PBT, family and treating staff. METHODS Participants were patients and families of two hospitals and health professionals from cancer/neurological services. A single-case experimental design piloted skill-based training and environmental changes in managing socio-behavioural impairments in a person with a low grade astrocytoma. A half-day workshop to train family members (n = 7) in compensatory strategy use to manage CBs after PBT was piloted. Finally, a 1-day workshop was provided to 43 health professionals in managing CBs after PBT. For both workshops, a pre-post impact evaluation was conducted employing a purpose-designed Strategies Use Measure. RESULTS All three interventions demonstrated positive results. The single case showed a 71% decrease in the target behaviour (time spent talking) post-intervention. Some attrition to these gains was observed at two follow-up time points (3 and 5 months). Participants from both workshops demonstrated significant post-intervention increases in perceived knowledge of Strategy Use (family members z = 2.03, p < 0.05; health professionals z = 4.95, p < 0.00; Wilcoxon signed-rank test). CONCLUSIONS These initial studies highlight the potential of employing an integrated multi-tiered intervention based on a Behavioural Consultancy model to manage CBs after PBT.
Collapse
Affiliation(s)
- D L Whiting
- Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, Australia.
| | | | | | | | | | | |
Collapse
|
18
|
Lucas MR, Robinson KM, Koh ES, Hovey EJ, Wright KM, Simpson T, Price MA, Shafiq J, Kaadan N, Barton MB, Armstrong T, Wefel JS, Wang M, Won M, Bottomley A, Mendoza TR, Coens C, Werner-Wasik M, Brachman DG, Choucair AK, Mehta M, Gilbert MR, Spezeski J, de Melo SM, Taylor LP, Otero H, Zuurveld MA, Peerdeman SM, Bouma GJ, Feller RE, Klein M, Aaronson NK, Taphoorn MJB, Heimans JJ, Postma TJ, Gundy CM, Beute GN, Slotman BJ, Klein M, Satoer D, Vincent A, Dirven C, Smits M, Visch-Brink E, Vera-Bolanos E, Armstrong TS, Mendoza T, Fisher A, Kuo CW, Sherwood P, Peters KB, Coan AD, West MJ, Reardon DA, Desjardins A, Vredenburgh JJ, Friedman HS, Jones LW, Acquaye AA, Lin L, Aspenson AS, Cahill J, Vera-Bolanos E, Gilbert MR, Armstrong TS, Lamki T, Ammirati M, Lin L, Acquaye AA, Vera-Bolanos E, Cahill J, Gilbert MR, Armstrong TS, Lin L, Acquaye AA, Vera-Bolanos E, Cahill J, Gilbert MR, Armstrong TS, Lai JS, Acquaye A, Armstrong TS, Acquaye AA, Lin L, Aspenson AC, Cahill J, Vera-Bolanos E, Gilbert MR, Armstrong TS, Stell BV, Jacobs DI, Grimm SA, Rademaker A, Rice L, Schwartz M, Chandler J, Muro K, Helenowki IB, Marymont MH, Wagner LI, Mehta M, Raizer J, Gerard ME, Drappatz J, Muzikansky A, Weiss S, Kesari S, Wong E, Fadul CE, Norden AD, Quant EC, Beroukhim R, Alexander B, Ruland S, Ciampa AS, LaFrankie DC, Sceppa C, Smith KH, Hammond SN, Wen PY, Farace E, Sheehan J, Bonneau R, Glantz M, McDonald KL, Ryu S, Rock J, Jain R, Casas C, Schultz L, Pace M, Aho T, Horio M, Doshi P, Cahill J, Padhye N, Vera-Bolanos E, Gning I, Mendoza T, Gilbert M, Armstrong T, Hoover JM, Mandrekar J, Meyer FB, Parney IF. QUALITY OF LIFE. Neuro Oncol 2011. [DOI: 10.1093/neuonc/nor159] [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: 11/13/2022] Open
|
19
|
Beringer RM, Kelly F, Cook TM, Nolan J, Hardy R, Simpson T, White MC. A cohort evaluation of the paediatric i-gel™ airway during anaesthesia in 120 children*. Anaesthesia 2011; 66:1121-6. [DOI: 10.1111/j.1365-2044.2011.06884.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
20
|
Abstract
Aims: Evaluation of the pediatric appendicitis score (PAS), in all patients who had an appendicectomy over a one-year period. Methods: Retrospective study of 56 patients aged 4–15 years, who underwent an emergency appendicectomy. PAS was applied and patients were divided according to the PAS protocol into high probability and low probability groups. These results were then correlated with histology. Results: The PAS had sensitivity 0.87, specificity 0.59, positive predictive value 0.83, and negative predictive value 0.67. The negative appendicectomy rate would have been reduced to 17%, but five patients with appendicitis would have been denied early surgical treatment and may have been discharged. Conclusions: The PAS cannot be recommended as it would lead to an unacceptable risk of wrongly discharging or delaying necessary surgery in 13% of patients with appendicitis.
Collapse
Affiliation(s)
- F Goulder
- Department of General Surgery, Kent and Sussex Hospital, UK
| | | |
Collapse
|
21
|
Simpson T, Pennycuick A, Crawley D, Tobal K, Santis G. 46 Prevalence of EGFR and K-RAS mutation status in clinical practice - relationship to patient characteristics. Lung Cancer 2011. [DOI: 10.1016/s0169-5002(11)70046-0] [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: 11/17/2022]
|
22
|
Gatward JJ, Cook TM, Seller C, Handel J, Simpson T, Vanek V, Kelly F. Evaluation of the size 4 i-gel™ airway in one hundred non-paralysed patients*. Anaesthesia 2008; 63:1124-30. [DOI: 10.1111/j.1365-2044.2008.05561.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
23
|
|
24
|
Abstract
Ethyl formate (EF) in combination with CO2 was tested for control of arthropods commonly infesting California table grapes. In addition, table grape tolerance to EF exposure was evaluated. LC99 estimates were developed for target pests by using a range of EF concentrations (0.04-4.7% EF). Response to treatments varied greatly between species, as well as life stages within species. Western flower thrips, Frankliniella occidentalis (Pergande), and adult and crawler stages of grape mealybug, Pseudococcus maritimus (Ehrhorn), were most susceptible to EF treatments. Least susceptible were grape mealybug eggs; Pacific spider mite, Tetranychus pacificus McGregor; and omnivorous leafroller, Platynota stultana Walsingham. The LC99 for target pests fell within the range of EF concentrations tolerated by table grapes with the exception of 1-, 3-, and 5-d-old omnivorous leafroller pupae.
Collapse
Affiliation(s)
- T Simpson
- Department of Plant Sciences, University of California, Davis, CA 95616, USA.
| | | | | | | |
Collapse
|
25
|
Khullar D, Molineu A, Followill D, Bosch W, Willcut V, Simpson T, Ju T, Deasy J. SU-FF-T-75: An Open-Source Software Tool to Support Film-Based IMRT Quality Assurance. Med Phys 2007. [DOI: 10.1118/1.2760726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
26
|
Simpson T, Deasy J, Apte A, Ju T. TH-D-M100E-09: Accurate Interpolation of 3D Structures and Doses Using Smoothed Surface Meshes. Med Phys 2007. [DOI: 10.1118/1.2761736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
27
|
Abstract
6099 Background: As the number and complexity of chemotherapy regimens increase, the demands on pharmacy services to reduce chemotherapy preparation and checking times continues to increase. Dose banding, a system whereby doses of intravenous cytotoxic drugs calculated on an individual basis are rounded up or down to predetermined standard doses (the maximum variation of the adjustment between standard dose and doses constituting each band is 5% or less) was identified as a strategy that could be used to address some of the issues around time pressures to help reduce patient waiting times for treatment. Methods: The project consisted of 3 phases; Phase I - literature review to identify dose banding publications; Phase II - selection of drugs to be banded for the pilot. The two drugs selected were 5FU and leukovorin, and Phase III - Time studies pre-, interim and post dose banding implementation to determine drug dispensing time and patients’ wait time for pharmacy related procedures. This occurred for a 2 week period (10 working days) either prior to implementation (pre- 819 patients studied), 4 days after implementation (interim - 854 patients studied) and 4 weeks after implementation (post - 785 patients studied). Results: Drug dispensing time did not decrease with dose banding (pre- 7.9 min, interim - 7.6 min and post - 9.4 min). However, the average patient wait time decreased after piloting the dose banding project (pre - 31.6 min, interim 23.7 min, and post - 27.8 min). The percentage of doses that were banded were 37.8% in the interim time study and 58.2% in the post time study. Conclusions: Although dose banding did not reduce dispensing time in this study, likely because the preparation for dispensing 5FU and leukovorin syringes is normally very simple and quick, patient’s wait time for pharmacy related procedures did decrease. This was probably due to contributions of other factors in the pharmacy process. A reduction in dispensing time could likely be achieved if more complex regimens were considered for dose banding. Dose banding could be used to increase capacity within the chemotherapy suite on the day of administration. It also allows for a better work schedule and increases efficiencies within the chemotherapy preparation and administration areas. (Sponsored by funds from Cancer Care Ontario) No significant financial relationships to disclose.
Collapse
Affiliation(s)
- H. W. Hirte
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - S. Kagoma
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - L. Zhong
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - I. Collins
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - D. Burns
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - C. Rand
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - T. Simpson
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - A. Snider
- Juravinski Cancer Centre, Hamilton, ON, Canada
| |
Collapse
|
28
|
Chalmers R, Begley C, Edrington T, Caffery B, Nelson D, Snyder C, Simpson T. The agreement between self-assessment and clinician assessment of dry eye severity. Am J Ophthalmol 2006. [DOI: 10.1016/j.ajo.2006.01.007] [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: 11/25/2022]
|
29
|
Elliott M, Fandrich H, Simpson T, Fonn D. Analysis of the repeatability of tear break-up time measurement techniques on asymptomatic subjects before, during and after contact lens wear. Cont Lens Anterior Eye 2006; 21:98-103. [PMID: 16303386 DOI: 10.1016/s1367-0484(98)80002-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/1998] [Revised: 05/27/1998] [Indexed: 11/21/2022]
Abstract
This study assessed the repeatability of various methods of measuring tear break-up time (TBUT) with and without soft contact lenses (CLs). TBUT was measured on 22 subjects with the tearscope, videokeratoscope and slit-lamp before and after 30 min of soft CL wear, and immediately after CL removal. Slit-lamp corneal TBUT was measured with fluorescein and without fluorescein while wearing CLs. TBUT was measured three times on the right eye only, using each technique in randomised order. TBUT measurements on CLs were repeated a second day. TBUT measurements were highly variable under all conditions and our results indicated a lack of correlation between techniques. The videokeratoscope was the least repeatable; while the tearscope was the most repeatable technique.
Collapse
Affiliation(s)
- M Elliott
- Centre for Contact Lens Research, School of Optometry, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
| | | | | | | |
Collapse
|
30
|
Simpson T, Spivey C, Vazin T, Chapple B, Oh MK, Gunn K. 259 HEALTH KNOWLEDGE SELF-ASSESSMENT AND PREVENTIVE CARE EXPERIENCES AMONG COLLEGE FRESHMEN. J Investig Med 2005. [DOI: 10.2310/6650.2005.00006.258] [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: 11/18/2022]
|
31
|
Abstract
The purpose of this paper was to investigate the effects of both monocular and dichoptic masking on the frequency doubling (FD) illusion, using both temporal and spatial masks. Monocular spatial tuning effects occurred around the fundamental FD spatial frequency of 0.25 cycles per degree (c/deg), whereas dichoptic spatial frequency tuning effects occurred at the doubled spatial frequency of 0.50 c/deg. Temporal tuning effects were observed at the FD temporal frequency of 25 Hz, in both monocular and dichoptic paradigms. These results suggest that the FD illusion is cortical in origin and is dominated by a flicker component.
Collapse
Affiliation(s)
- P T Quaid
- School of Optometry, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1.
| | | | | |
Collapse
|
32
|
Simpson T, Spivey C, Logan P, Oh MK. 161 ADOLESCENTS' EXPERIENCES WITH PREVENTIVE CARE. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
33
|
Cook TM, Rudd P, McCormick B, Hersch P, Simpson T, Gupta KJ, Nolan JP. An evaluation of the PAxpress pharyngeal airway. Anaesthesia 2003; 58:191; discussion 191-2. [PMID: 12562427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
|
34
|
Abstract
We study experimentally the time dependence, steady state behavior and spectra of a dual fiber-laser compound cavity. Theoretically we confirm the CW and spectral characteristics. This particular cavity is formed with two Er-doped fiber amplifiers, each terminated with a fiber Bragg grating, and coupled through a 50/50 coupler to a common feedback and output coupling element. The experiment and theory show that a low Q, high gain symmetric compound cavity extracts nearly 4 times the power of a component resonator. This extraction is maintained even when there is significant difference in the optical pathlengths of the two component elements. Further, our measurements and theory show that the longitudinal modes of the coupled cavity are distinct from the modes of the component cavities and that the coherence is formed on a mode-by-mode basis using these coupled-cavity modes. The time behavior of the compound cavity shows slow fluctuations, on the order of seconds, consistent with perturbations in the laboratory environment.
Collapse
|
35
|
Jones L, May C, Nazar L, Simpson T. In vitro evaluation of the dehydration characteristics of silicone hydrogel and conventional hydrogel contact lens materials. Cont Lens Anterior Eye 2002; 25:147-56. [PMID: 16303487 DOI: 10.1016/s1367-0484(02)00033-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE This study investigated the in vitro dehydration performance of silicone hydrogel and conventional hydrogel contact lens materials. METHODS In vitro dehydration was assessed using a gravimetric method. The mass loss over time of Focus Night&Day, PureVision, Optima, Acuvue and Proclear Compatibles was measured as the ambient temperature increased from room temperature to 34 degrees C under varying airflow and humidity conditions. RESULTS Dehydration data demonstrated a typical ogival form. The results were best fitted with a double exponential, non-linear regression model, which accounted for at least 99% of the variance. Regardless of material, increased airflow had a greater impact on dehydration rate than increased humidity (P<0.05). Relative dehydration amounts were strongly correlated with initial water content (r(2)=0.92), with higher water content materials dehydrating to a greater extent. CONCLUSIONS In vitro dehydration studies of conventional and novel silicone-containing hydrogel materials indicated that evaporation rates from materials are predominantly water content related, with only subtle differences between materials of similar water contents being seen. Environmental conditions have a significant impact on in vitro dehydration, with increased airflow having a greater impact than reduced humidity on increasing dehydration rates. In vitro dehydration is closely related to bulk water diffusion rates and, as a result of their low water content, silicone-containing hydrogel materials exhibit low levels of dehydration compared with high water content hydrogel contact lens materials. Further, in vivo studies are necessary to see if the in vitro dehydration behaviour of silicone hydrogel materials is predictive of in-eye performance.
Collapse
Affiliation(s)
- L Jones
- Centre For Contact Lens Research, School of Optometry, University of Waterloo, Waterloo, Ont., Canada N2L 3G1.
| | | | | | | |
Collapse
|
36
|
Simpson T, Bond E. Crit Care 2002; 6:P3. [DOI: 10.1186/cc1728] [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: 11/10/2022] Open
|
37
|
Begley CG, Chalmers RL, Mitchell GL, Nichols KK, Caffery B, Simpson T, DuToit R, Portello J, Davis L. Characterization of ocular surface symptoms from optometric practices in North America. Cornea 2001; 20:610-8. [PMID: 11473162 DOI: 10.1097/00003226-200108000-00011] [Citation(s) in RCA: 218] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study characterized ocular symptoms typical of dry eye in an unselected optometric clinical population in the United States and Canada. METHODS Self-administered dry eye questionnaires, one for non-contact lens wearers (dry eye questionnaire) and one for contact lens wearers (contact lens dry eye questionnaire), were completed at six clinical sites in North America. Both questionnaires included categoric scales to measure the prevalence, frequency, diurnal severity, and intrusiveness of nine ocular surface symptoms. The questionnaires also asked how much these ocular symptoms affected daily activities and contained questions about computer use, medications, and allergies. The examining doctors, who were masked to questionnaire responses, recorded a nondirected dry eye diagnosis for each patient, based on their own diagnostic criteria. RESULTS The dry eye questionnaires were completed by 1,054 patients. The most common ocular symptom was discomfort, with 64% of non--contact lens wearers and 79% of contact lens wearers reporting the symptom at least infrequently. There was a diurnal increase in the intensity of many symptoms, with symptoms such as discomfort, dryness, and visual changes reported to be more intense in the evening. The 22% percent of non-contact lens wearers and 15% of contact lens wearers diagnosed with dry eye (most in the mild to moderate categories) reported symptoms at a greater frequency than those not diagnosed with dry eye. CONCLUSIONS Our results show that symptoms of ocular irritation and visual disturbances were relatively common in this unselected clinical population. The intensity of many ocular symptoms increased late in the day, which suggested that environmental factors played a role in the etiology of the symptoms.
Collapse
Affiliation(s)
- C G Begley
- Indiana University School of Optometry, Bloomington, 47405, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
OBJECTIVES Although alcohol is known to play a key part in accidents, no UK study has assessed alcohol concentrations in a comprehensive sample of accident and emergency (A&E) attenders. This study set out to do this, and examine the relation between alcohol concentrations and the severity, type and circumstances of presentation, and the sociodemographic characteristics of patients. METHODS A survey was conducted of all new A&E attenders (aged 10 years or over). Two 24 hour periods for each day of the week were covered in 6, 7 or 11 hour sessions over a two month period. Alcohol concentrations were assessed from saliva samples using a disposable device. Data were collected from 638 attenders, of whom 544 provided saliva samples; the remainder refused or were unable to participate. RESULTS Positive saliva alcohol readings were obtained in 22% of attenders (95%CI 19% to 26%); this increased to 25% if others were included (for example, those who refused to participate but were judged to be intoxicated). Alcohol was associated with 94% of incidents of self harm, 54% of non-specific/multiple complaints, 47% of collapses, 50% of assaults, and 50% of patients admitted to hospital. Higher concentrations of alcohol were found from Friday to Sunday, between midnight and 0900, and in patients aged 41 to 60. Among people with positive alcohol results, those attending with a companion had higher concentrations than those attending alone. There were no significant differences between men and women in alcohol concentrations. DISCUSSION These findings show that alcohol use is an important factor in A&E attendance, but it should not be assumed that there is a causal relation between alcohol use and injury. Several accident related and sociodemographic variables were predictive of alcohol use before attending. The overall level of prediction was too weak to permit accurate identification of drinkers for screening purposes, but routine alcohol concentration assessments may be justified in the high risk groups identified in this study. A&E departments may be convenient and fruitful settings for brief interventions with early problem drinkers.
Collapse
Affiliation(s)
- T Simpson
- Department of Clinical Psychology, Highland Primary Care NHS Trust, Craig Phadrig Hospital, Inverness, Scotland
| | | | | |
Collapse
|
39
|
Abstract
PURPOSE To assess the tear film, ocular surfaces, and symptoms of ocular discomfort in a presbyopic population before and after contact lens wear. METHODS A total of 150 presbyopes (49% were previous soft contact lens wearers) participated in a clinical trial in which they wore either monovision (single vision Acuvue lenses) or Acuvue Bifocal contact lenses. Clinical measurements of tear film, biomicroscopy, and corneal sensitivity as well as subjective ratings using the Dry Eye Questionnaire were collected at the initial visit and repeated after 6 months. Comparisons were made between age groups (40 to 51 years and 52 to 71 years) and genders before and after contact lens wear. Associations between objective and subjective tests were sought. RESULTS After 6 months of contact lens wear, clinical signs had worsened by less than one-half of a grade, and tear break up time (TBUT) worsened by 3 s. Only TBUT was lower for the older age group. Females had less bulbar hyperemia, more sensitive eyes, more lissamine green staining, and lower TBUT and phenol red thread measurements (all p < 0.04). Twenty-eight percent experienced dryness before contact lens wear, but this figure increased to 68% when wearing contact lenses. There were no age differences, but almost twice as many females as males reported dryness. Reporting symptoms of dryness was associated with gender, corneal sensitivity, and type of corneal staining. CONCLUSIONS These results provide a representation of the ocular surface condition and symptoms of ocular discomfort in the middle-aged population and seem similar to reports of younger populations. Wearing contact lenses seems to influence dry eye symptoms more than age or gender. Therefore, presbyopes should not be excluded from consideration for contact lens fitting.
Collapse
Affiliation(s)
- R du Toit
- Centre for Contact Lens Research, University of Waterloo, Ontario, Canada.
| | | | | | | |
Collapse
|
40
|
Abstract
Ocular microtremor (OMT) is a fine high frequency tremor of the eyes caused by extra-ocular muscle activity stimulated by impulses emanating in the brain stem. Several studies have shown that the frequency of this tremor is reduced in patients whose consciousness is reduced by anaesthesia or head injury. Therefore, OMT may possibly be used to determine depth of anaesthesia. Twenty-two unpre-medicated subjects undergoing surgery with general anaesthesia were studied. OMT activity was measured at admission using the open eye piezoelectric strain gauge technique. Anaesthesia was induced with propofol using a target controlled infusion delivery system (Diprifusor). OMT activity was then recorded at predicted plasma propofol concentrations of 1, 2, 3 and 5 microg ml(-1). The patient's level of consciousness (response to command or stimulation) was assessed after each OMT measurement. OMT activity was reduced progressively at predicted plasma concentrations of propofol of I and 2 microg ml(-1) and then plateaued between 3 and 5 microg ml(-1). There was a significant difference between the last awake OMT recording and the first recording at loss of consciousness (P < 0.001). OMT recording holds promise as a practical indicator of the depth of anaesthesia.
Collapse
Affiliation(s)
- S Bojanic
- Department of Neurosurgery, Frenchay Hospital, Bristol, UK
| | | | | |
Collapse
|
41
|
Kuhns WJ, Burger MM, Sarkar M, Fernandez-Busquets X, Simpson T. Enzymatic biosynthesis of N-linked glycan by the marine sponge Microciona prolifera. Biol Bull 2000; 199:192-194. [PMID: 11081730 DOI: 10.2307/1542892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- W J Kuhns
- Marine Biological Laboratory, Woods Hole, Massachusetts 02543, USA
| | | | | | | | | |
Collapse
|
42
|
Abstract
This report describes the new optical imaging technique of optical coherence tomography (OCT). OCT is capable of high-resolution, micrometer-scale, cross-sectional imaging of biological tissue. The OCT for ophthalmic application uses 843-nm, near-infrared light, which produces a longitudinal resolution of 10 to 20 microm and a penetration depth of a few millimeters. The scans are displayed in a false color representation scale on which warm colors represent areas of high optical reflectivity and cool colors represent areas of minimal or no reflectivity. A cross-sectional view similar to a histology section is obtained. The cornea, iris, and lens may be visualized as well as the retina and optic nerve. OCT has been used to investigate several ocular diseases. These include macular disease, genetic retinal disease, retinal detachment and retinoschisis, choroidal tumors, optic nerve disorders, and glaucoma.
Collapse
Affiliation(s)
- P Hrynchak
- School of Optometry, University of Waterloo, Ontario, Canada.
| | | |
Collapse
|
43
|
Abstract
PURPOSE To investigate the repeatability of three anterior segment clinical grading scales: 1) verbal descriptors scale (VDS), 2) photographic matching scale (PS), and 3) continuous matching scale (CS). METHODS Five optometrists graded 30 slides each of 3-9-o'clock staining, bulbar redness, and palpebral conjunctival roughness twice, separated by at least a day. VDS and PS were five-point scales (0-4) with half grades permitted. The CS was a 5-second, 240-frame video movie generated using morphing software. PS and CS grading was done with references presented on a computer screen. RESULTS Averaged across observers, the test-retest intraclass correlation, correlation coefficient of concordance, and Pearson's r ranged from 0.95 to 0.99 (all p < 0.001). Coefficients of repeatability using CS to grade all three ocular conditions ranged between 0.31 and 0.49. The corresponding PS and VDS coefficients of repeatability ranged between 0.37 and 0.49; PS generally had better repeatability than VDS. CONCLUSIONS Each of the clinical grading scales was reliable. The coefficients of repeatability showed that bulbar redness and palpebral conjunctival roughness were graded with higher precision using CS.
Collapse
Affiliation(s)
- E Chong
- Centre for Contact Lens Research, School of Optometry, University of Waterloo, Ontario, Canada
| | | | | |
Collapse
|
44
|
Abstract
The prediction of the outcome from coma is of considerable importance to the patients, their relatives and attendant medical staff, and yet current clinical methods lack sensitivity and specificity. Objective investigations can enhance the accuracy of such predictions and are an important adjuvant when reaching decisions to continue or terminate life support. Of the neurophysiological methods available, electroencephalography and short-latency somatosensory evoked potentials have proved the most useful in the clinical setting. These tests are good predictors of an adverse outcome; however, they tell us only about the ongoing cerebral activity and integrity of the primary somatosensory pathways, respectively. The presence of long-latency event-related potentials has been shown to be a useful predictor of a favourable neurological outcome, and thus their use complements other neurophysiological techniques. Their potential application in clinical practice is reviewed.
Collapse
Affiliation(s)
- N M Kane
- Frenchay Hospital and Burden Neurological Institute, Bristol, UK.
| | | | | |
Collapse
|
45
|
Abstract
PURPOSE The aim of this study was to compare the cardio-respiratory differences between rowing ergometry and treadmill exercise in beta-blocked men participating in exercise rehabilitation soon after myocardial infarction (postMI). METHODS Eleven males all receiving beta-blockade medication were measured for oxygen consumption (VO2), respiratory exchange ratio (RER), and rating of perceived exertion (RPE) at individualized submaximal exercise target heart rates (THR) during 6 min of exercise on each of a motorized treadmill and a rowing ergometer 2-6 wk (4.9 +/- 1.4) postMI. RESULTS The mean THR of the group, predetermined from an exercise ECG stress test, was 107 +/- 16 beats x min(-1). No significant difference was found between rowing versus treadmill VO2 (19.4 +/- 3.2 vs 19.7 +/- 4.2 mL x kg(-1) x min(-1); P = 0.53) or RPE (12.6 +/- 1 vs 12.7 +/- 1; P = 0.72). RER was significantly greater (P = 0.02) during rowing (0.99 +/- 0.07) compared with treadmill exercise (0.94 +/- 0.07). CONCLUSION Exercising at a specified submaximal THR during rowing versus treadmill exercise in beta-blocked men participating in very early cardiac rehabilitation represents the same VO2 and RPE. A significantly greater RER was, however, apparent during rowing compared with treadmill exercise; thus, agreement was shown with previous studies on healthy individuals where rowing ergometry was less metabolically efficient than treadmill exercise. The results suggest that establishing a THR from a standard treadmill stress test soon after MI is not only suitable for walking/treadmill exercise but also in setting exercise intensity for rowing ergometry.
Collapse
Affiliation(s)
- J P Buckley
- Department of Physiotherapy Studies, Keele University, Staffordshire, England.
| | | | | |
Collapse
|
46
|
Abstract
PURPOSE To determine whether lens dehydration correlates with discomfort, dryness, and noninvasive tear break-up time in symptomatic and asymptomatic contact lens wearers and whether dehydration of the two lens types varies. METHOD Twenty hydrogel contact lens wearers with dryness-related symptoms and 20 asymptomatic wearers wore an Etafilcon A lens (Acuvue; Vistakon, Inc., Jacksonville, Florida) in one eye and an Omafilcon A lens (Proclear; Biocompatibles, Norfolk, Virginia) in the contralateral eye for 7 h in a randomized, double-masked study. Lens water content was measured before and after 7 h of lens wear and prelens noninvasive tear film break-up time (NIBUT) was measured immediately after insertion and after 5 h of lens wear. Subjective comfort and dryness were rated at 0, 1, 3, 5, and 7 h of lens wear. RESULTS The symptomatic group had significantly reduced prelens NIBUT, decreased comfort, and increased dryness, but there was no difference between lenses for these variables. The Omafilcon A lenses dehydrated significantly less than the Etafilcon A lenses, but there was no significant difference in lens dehydration between two subject groups. CONCLUSION No correlation was found between lens dehydration and subjective dryness and comfort. Symptomatic hydrogel contact lens wearers with decreased wearing time had measurably decreased comfort, increased dryness ratings, and reduced NIBUT.
Collapse
Affiliation(s)
- D Fonn
- Centre for Contact Lens Research, University of Waterloo, Ontario, Canada.
| | | | | |
Collapse
|
47
|
|
48
|
Barr RD, Simpson T, Whitton A, Rush B, Furlong W, Feeny DH. Health-related quality of life in survivors of tumours of the central nervous system in childhood--a preference-based approach to measurement in a cross-sectional study. Eur J Cancer 1999; 35:248-55. [PMID: 10448267 DOI: 10.1016/s0959-8049(98)00366-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is an evident need to measure the comprehensive burden of morbidity experienced by survivors of brain tumours in childhood. To this end, a questionnaire based on the Health Utilities Index mark 2 (HUI2) and mark 3 (HUI3) systems was completed independently for a cohort of such children by their parents, by a nurse, by physicians and by a selected group of the children themselves. Each of the HUI2 and HUI3 systems consists of a multi-attribute health status classification scheme linked to a preference function which provides utility scores for levels within single attributes (domains of health) and for global health states. All eligible families (n = 44) participated. Even cognitively impaired children of at least 9.5 years of age could complete the questionnaire. The greatest burden of morbidity, occurring in two-thirds of children, was in the attribute of cognition. Surprisingly, almost one-third of children experienced pain. Global health status was lowest in children who underwent radiotherapy before the age of 5 years and the corresponding utility scores were related inversely to the volume irradiated. Children with demonstrable disease had lower scores than those in whom disease was not evident. There was a high level of agreement (intraclass correlation coefficients > 0.5) on formal assessment of inter-rater reliability for global health-related quality of life utility scores. The usefulness of measures of health status and health-related quality of life, in children surviving brain tumours, has been demonstrated by this study.
Collapse
Affiliation(s)
- R D Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
| | | | | | | | | | | |
Collapse
|
49
|
Caffery BE, Richter D, Simpson T, Fonn D, Doughty M, Gordon K. CANDEES. The Canadian Dry Eye Epidemiology Study. Adv Exp Med Biol 1998; 438:805-6. [PMID: 9634970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- B E Caffery
- Centre for Contract Lens Research, School of Optometry, University of Waterloo, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
50
|
Affiliation(s)
- B J Phillips
- Department of Surgery, Maricopa Medical Center, Phoenix, Arizona 85044, USA.
| | | | | | | | | | | |
Collapse
|