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Stenersen MR, Schreier A, Strambler MJ, Marshall T, Bracey J, Kaufman JS. Needs of Youth Enrolled in a Statewide System of Care: A Latent Class Analysis. Child Youth Serv Rev 2023; 154:107126. [PMID: 37744024 PMCID: PMC10512660 DOI: 10.1016/j.childyouth.2023.107126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Objective Access to wraparound care coordination within systems of care (SOC) is increasing nationwide for youth with emotional and behavioral disorders and their families. Though wraparound care coordination serves a broad population of youth who experience a variety of complex needs, less is known about the impact of wraparound services based on these specified needs. Using latent class analysis, the current study aimed to first identify classes of youth based on their presenting needs and then examine the impact of class membership on treatment experiences and outcomes at baseline and six-month follow-up. Method Caregiver-reported data from 1,243 youth enrolled in wraparound care coordination services within a statewide SOC were used. Latent class analysis was used to determine classes of youth needs and regression results examined whether baseline characteristics, child and family team meeting characteristics, mental health outcomes, and perceptions of care differed based on identified classes. Results Results revealed five distinct classes of youth needs: Behavioral Needs, ADHD-related Behavior Needs, Educational Needs, Mental Health Needs, and Multi-Needs. Overall participants saw improvement in all follow-up outcomes. Significant between-class differences were also found in all outcome categories measured. Conclusion The current results further solidify the benefits of comprehensive wraparound care within a SOC. Additionally, understanding youth's needs and their impact on treatment services allows for more targeted care for youth and their families.
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Affiliation(s)
- Madeline R Stenersen
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
| | - Alayna Schreier
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
| | - Michael J Strambler
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
| | - Tim Marshall
- Office of Community Based Mental Health Services, Connecticut Department of Children and Families
| | - Jeana Bracey
- Child Health and Development Institute of Connecticut, Inc
| | - Joy S Kaufman
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
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2
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Schreier A, Stenersen MR, Strambler MJ, Marshall T, Bracey J, Kaufman JS. Needs of Caregivers of Youth Enrolled in a Statewide System of Care: A Latent Class Analysis. Child Youth Serv Rev 2023; 147:106838. [PMID: 37719138 PMCID: PMC10501261 DOI: 10.1016/j.childyouth.2023.106838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Objective Systems of care (SOC) provide a coordinated array of services to youth with serious emotional and behavioral problems and their families. Little is known about what caregiver-specific needs at presentation to care may contribute to use of and engagement with care coordination and subsequent youth and family outcomes. This study aimed to determine latent classes of youth enrolled in wraparound care coordination within a statewide SOC based on caregiver needs impacting youth functioning and identify the relationship between class membership and characteristics of participation in Child and Family Team meetings (CFTs) and mental health outcomes at six-month follow-up. Method Participants were 703 youth (Mage = 11.21, SD = 3.67) and their caregivers that had information about caregiver needs and received a six-month follow-up assessment. Latent class analysis determined latent classes of families based on caregiver service needs at presentation to care, and differences in participation in care coordination and youth outcomes at 6-month follow up based on class membership was examined. Results Results indicated four classes of caregivers: Physical Health Needs, No Needs, Basic Needs, and Mental Health/Trauma Needs. Class membership was associated with size of the CFT, number of CFTs attended by the youth, percentage of CFTs with a natural support present, and percentage of CFTs that occurred in the family's home. Class membership was associated with caregiver ratings of objective strain at 6-month follow-up. Conclusion Assessing caregiver needs at presentation to care can provide direction for care coordinators to more directly target areas of family need through wraparound and individualize services.
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Affiliation(s)
- Alayna Schreier
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
| | - Madeline R Stenersen
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
| | - Michael J Strambler
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
| | - Tim Marshall
- Office of Community Based Mental Health Services, Connecticut Department of Children and Families
| | - Jeana Bracey
- Child Health and Development Institute of Connecticut, Inc
| | - Joy S Kaufman
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
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3
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Raddi R, Marshall T, Voelz V. BICePs repx: Force field validation by a Bayesian/maximum entropy approach. Biophys J 2023; 122:281a. [PMID: 36783398 DOI: 10.1016/j.bpj.2022.11.1597] [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: 02/12/2023] Open
Affiliation(s)
- Robert Raddi
- Chemistry, Temple University, Philadelphia, PA, USA
| | - Tim Marshall
- Chemistry, Temple University, Philadelphia, PA, USA
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4
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Marshall T, Raddi R, Voelz V. An evaluation of force field accuracy for the mini-protein chignolin using Markov state models. Biophys J 2023; 122:420a. [PMID: 36784151 DOI: 10.1016/j.bpj.2022.11.2275] [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: 02/12/2023] Open
Affiliation(s)
- Tim Marshall
- Chemistry, Temple University, Philadelphia, PA, USA
| | - Robert Raddi
- Chemistry, Temple University, Philadelphia, PA, USA
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5
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Cleasby C, Marshall T, Gordon AC, Antcliffe DB. The effect of vasopressin and hydrocortisone on cytokine trajectories. Intensive Care Med 2023; 49:241-243. [PMID: 36629879 PMCID: PMC9944736 DOI: 10.1007/s00134-022-06905-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Charlotte Cleasby
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Tim Marshall
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Anthony C Gordon
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - David B Antcliffe
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
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Holland B, Marshall T, Goldman A, Miyashita T. Initial Investigation into the Key Differences for Achieving Patient-Reported Measure Outcome Goals in Concussion Rehabilitation. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.08.654] [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: 12/04/2022]
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Percy MC, Redemann J, Babu D, Marshall T. An Unusual Extramedullary Presentation of an NPM1-Mutated Acute Myeloid Leukemia (AML) in a Young Adult. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.238] [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: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
Pleural effusion presentation of AML, particularly without leukemic disease, has been rarely described in the literature. This case serves to investigate the value of an identified NPM1 mutation.
Methods/Case Report
A 25-year-old male with Down syndrome presented with dyspnea. Computerized tomography scan identified a moderate pleural effusion and pelvic lytic bone lesions. A complete blood count was normal. Pleural fluid cytologic evaluation showed a spectrum of immature myeloid precursors, and flow cytometry identified a 23% CD117 positive myeloblast population expressing CD33, CD13, and dim CD45 but lacking CD34 and HLA-DR. Fluorescence in-situ hybridization testing was negative for a PML-RARA fusion. Given the phenotype, molecular testing was initiated and confirmed an NPM1 mutation. Testing revealed additional pathogenic variants in DNMT3A and IDH1 with no FLT3 mutations. Peripheral blood smear and bone marrow evaluations yielded no clear leukemic involvement, and cytogenetics from bone marrow showed 47,XY,+21c[20]. The significance of this myeloid infiltrate was initially not entirely clear with no established leukemic involvement or tumor-forming mass as required for the World Health Organization diagnosis of myeloid sarcoma. However, the finding of the NPM1 mutation lent high confidence for a diagnosis of an extramedullary presentation of acute myeloid leukemia, though the lytic bone lesions were not biopsied to possibly demonstrate a myeloid sarcoma.
Results (if a Case Study enter NA)
N/A.
Conclusion
The identified NPM1 mutation was instrumental in diagnosing an unusual presentation of AML where material was limited. Subsequent to this presentation the patient developed more overt leukemic disease at an outside institution, additionally supporting this diagnosis.
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Affiliation(s)
- M C Percy
- Pathology , University of New Mexico , Albuquerque, New Mexico , United States
| | - J Redemann
- Pathology , University of New Mexico , Albuquerque, New Mexico , United States
| | - D Babu
- Pathology , University of New Mexico , Albuquerque, New Mexico , United States
| | - T Marshall
- Pathology, St. Mary's Hospital , Grand Junction, Colorado , United States
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Stenersen MR, Kelly A, Bracey J, Marshall T, Cummins M, Clark K, Kaufman JS. Understanding Racial-Ethnic Disparities in Wraparound Care for Youths With Emotional and Behavioral Disorders. Psychiatr Serv 2022; 73:526-532. [PMID: 34470504 PMCID: PMC8888774 DOI: 10.1176/appi.ps.202100086] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Systems of care (SOCs) were developed to increase access to and quality of care for children with emotional and behavioral difficulties and their families through the provision of coordinated, community-based, culturally competent, family-driven services. SOCs focus on wraparound care that is individualized to meet each family's needs. Previous research has illustrated significant disparities in outcomes of nonwraparound care on the basis of youths' race-ethnicity. This study aimed to fill a research gap by examining disparities in outcomes for families receiving wraparound care coordination within an SOC. METHODS This exploratory study examined racial-ethnic disparities in outcomes observed at intake, during service provision, and at 6-month follow-up among 1,138 youths and their caregivers who participated in wraparound care coordination as part of a statewide SOC between 2016 and 2020. Analyses of variance and regression analyses were executed to investigate whether receiving services and/or the youths' racial-ethnic identity predicted differences in behavioral health outcomes and characteristics of or satisfaction with care. Caregiver-reported outcomes were assessed with the Ohio Scales for Youth, the Child Trauma Screen, and the Caregiver Strain Questionnaire. RESULTS Results revealed few racial-ethnic disparities in the characteristics and outcomes of care coordination among participants at intake or in family involvement in the wraparound process. Participants across groups reported similar and significant improvement in outcomes. However, the results indicated some disparities in satisfaction with care. CONCLUSIONS Results revealed the positive impact of care coordination on the health and well-being of youths and caregivers across racial-ethnic groups.
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Affiliation(s)
- Madeline R Stenersen
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
| | - Aleece Kelly
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
| | - Jeana Bracey
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
| | - Tim Marshall
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
| | - Mary Cummins
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
| | - Kathryn Clark
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
| | - Joy S Kaufman
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
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9
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Davis E, Martinez G, Blostein F, Marshall T, Jones A, Jansen E, McNeil D, Neiswanger K, Marazita M, Foxman B. Dietary Patterns and Risk of a New Carious Lesion Postpartum: A Cohort Study. J Dent Res 2022; 101:295-303. [PMID: 34609222 PMCID: PMC8982010 DOI: 10.1177/00220345211039478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 12/28/2022] Open
Abstract
Dental caries (cavities), one of the most common infectious diseases, is caused by a number of factors. Oral microbes, dietary practices, sociodemographic factors, and dental hygiene all inform caries risk. Assessing the impact of diet is complicated as individuals eat foods in combinations, and the interactions among the foods may alter caries risk. Our study aimed to prospectively assess the association between dietary patterns and caries risk in the postpartum period, a potentially sensitive period for caries development. We analyzed in-person dental assessments and telephone food frequency questionnaires (FFQs) from 879 Caucasian women participating in the Center for Oral Health Research in Appalachia Cohort 2 (COHRA2) that were collected biannually for up to 6 y. One-week recall of food intake frequency was assessed using a Likert scale. We used principal component analysis to summarize the FFQ data; the top 2 components described 15% and 12% of the variance in FFQ data. The first component was characterized by high consumption of fruits and vegetables, while the second component was heavily influenced by desserts and crackers. We used a modified Poisson model to predict the risk of an increase in the number of decayed, missing, and filled teeth in the postpartum period by 1) dietary patterns and 2) individual foods and beverages at the previous study visit, after controlling for other known risk factors, including history of carious lesions. Eating a dietary pattern high in desserts and crackers was associated with a 20% increase in the number of decayed, missing, and filled teeth in the postpartum period (95% confidence interval, 1.03-1.39). However, this effect was attenuated among those who also consumed a dietary pattern high in fruits and vegetables. Dietary patterns should be considered when devising interventions aimed at preventing dental caries.
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Affiliation(s)
- E. Davis
- Center for Molecular and Clinical
Epidemiology of Infectious Diseases, Department of Epidemiology, University of
Michigan School of Public Health, Ann Arbor, MI, USA
| | - G. Martinez
- Center for Molecular and Clinical
Epidemiology of Infectious Diseases, Department of Epidemiology, University of
Michigan School of Public Health, Ann Arbor, MI, USA
| | - F. Blostein
- Center for Molecular and Clinical
Epidemiology of Infectious Diseases, Department of Epidemiology, University of
Michigan School of Public Health, Ann Arbor, MI, USA
| | - T. Marshall
- Department of Preventive and Community
Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - A.D. Jones
- Department of Nutritional Sciences,
University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - E. Jansen
- Department of Nutritional Sciences,
University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - D.W. McNeil
- Center for Oral Health Research in
Appalachia (COHRA) University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychology, West Virginia
University, Department of Dental Practice & Rural Health, West Virginia
University School of Dentistry, Morgantown, WV Morgantown, WV, USA
| | - K. Neiswanger
- Center for Oral Health Research in
Appalachia (COHRA) University of Pittsburgh, Pittsburgh, PA, USA
- Center for Craniofacial and Dental
Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine,
University of Pittsburgh, Pittsburgh, PA, USA
| | - M.L. Marazita
- Center for Oral Health Research in
Appalachia (COHRA) University of Pittsburgh, Pittsburgh, PA, USA
- Center for Craniofacial and Dental
Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine,
University of Pittsburgh, Pittsburgh, PA, USA
- Department of Human Genetics, Graduate
School of Public Health, Clinical and Translational Sciences, School of Medicine,
University of Pittsburgh, Pittsburgh, PA, USA
| | - B. Foxman
- Center for Molecular and Clinical
Epidemiology of Infectious Diseases, Department of Epidemiology, University of
Michigan School of Public Health, Ann Arbor, MI, USA
- B. Foxman, Center for Molecular and
Clinical Epidemiology of Infectious Diseases, Department of Epidemiology,
University of Michigan School of Public Health, 1415 Washington Heights, Ann
Arbor, MI 48109, USA.
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10
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Alimohammadi F, Yasini P, Marshall T, Attanayake NH, Borguet E, Strongin DR. Layer by Layer Deposition of 1T′‐MoS
2
for the Hydrogen Evolution Reaction. ChemistrySelect 2022. [DOI: 10.1002/slct.202103386] [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: 11/07/2022]
Affiliation(s)
- Farbod Alimohammadi
- Department of Chemistry Temple University Philadelphia Pennsylvania 19122 USA
- Center for Complex Materials from First Principles (CCM) Temple University Philadelphia Pennsylvania 19122 USA
| | - Parisa Yasini
- Department of Chemistry Temple University Philadelphia Pennsylvania 19122 USA
- Center for Complex Materials from First Principles (CCM) Temple University Philadelphia Pennsylvania 19122 USA
| | - Tim Marshall
- Department of Chemistry Temple University Philadelphia Pennsylvania 19122 USA
- Center for Complex Materials from First Principles (CCM) Temple University Philadelphia Pennsylvania 19122 USA
| | - Nuwan H. Attanayake
- Department of Chemistry Temple University Philadelphia Pennsylvania 19122 USA
- Center for Complex Materials from First Principles (CCM) Temple University Philadelphia Pennsylvania 19122 USA
| | - Eric Borguet
- Department of Chemistry Temple University Philadelphia Pennsylvania 19122 USA
- Center for Complex Materials from First Principles (CCM) Temple University Philadelphia Pennsylvania 19122 USA
| | - Daniel R. Strongin
- Department of Chemistry Temple University Philadelphia Pennsylvania 19122 USA
- Center for Complex Materials from First Principles (CCM) Temple University Philadelphia Pennsylvania 19122 USA
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11
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Schreier A, Horwitz M, Marshall T, Bracey J, Cummins M, Kaufman JS. Trauma Symptoms and Relationship With Child and Family Team Meeting Characteristics and Outcomes in a Statewide System of Care. J Emot Behav Disord 2021; 29:175-186. [PMID: 34712039 PMCID: PMC8547490 DOI: 10.1177/1063426620980695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Systems of care (SOCs) are comprehensive, community-based services for youth with emotional and behavioral disorders. For these youth, little is known about how trauma symptoms influence participation in SOC care coordination through the Child and Family Team (CFT) meeting. The current study assessed the extent to which exposure to potentially traumatic events (PTEs) and trauma symptoms were associated with participation in CFTs and youth and family outcomes. Participants were 464 youth (M age = 11.02, SD = 3.72) and their caregivers. Families completed measures of youth and caregiver functioning, PTEs, and trauma symptoms at enrollment and 6-month follow-up. Care coordinators completed surveys assessing CFT characteristics following each meeting and assessments of youth functioning. Moderated multiple regression analyses tested the conditional effects of youth trauma symptoms on the relationships between CFT characteristics and youth and caregiver outcomes. Trauma symptoms moderated the relationship between the number of days to the first CFT meeting and youth impairment and the relationship between CFT meeting duration and youth impairment. Results suggest the presence of trauma and other contextual factors contributed to difficulty in initiating services and to changes in youth impairment. Implications for the provision of trauma-informed SOC services are discussed.
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Affiliation(s)
| | | | - Tim Marshall
- Connecticut Department of Children and Families, Hartford, USA
| | - Jeana Bracey
- Child Health and Development Institute of Connecticut, Inc., Farmington, USA
| | - Mary Cummins
- Connecticut Department of Children and Families, Hartford, USA
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12
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Söreskog E, Borgström F, Shepstone L, Clarke S, Cooper C, Harvey I, Harvey NC, Howe A, Johansson H, Marshall T, O'Neill TW, Peters TJ, Redmond NM, Turner D, Holland R, McCloskey E, Kanis JA. Long-term cost-effectiveness of screening for fracture risk in a UK primary care setting: the SCOOP study. Osteoporos Int 2020; 31:1499-1506. [PMID: 32239237 PMCID: PMC7115896 DOI: 10.1007/s00198-020-05372-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/28/2020] [Indexed: 12/30/2022]
Abstract
UNLABELLED Community-based screening and treatment of women aged 70-85 years at high fracture risk reduced fractures; moreover, the screening programme was cost-saving. The results support a case for a screening programme of fracture risk in older women in the UK. INTRODUCTION The SCOOP (screening for prevention of fractures in older women) randomized controlled trial investigated whether community-based screening could reduce fractures in women aged 70-85 years. The objective of this study was to estimate the long-term cost-effectiveness of screening for fracture risk in a UK primary care setting compared with usual management, based on the SCOOP study. METHODS A health economic Markov model was used to predict the life-time consequences in terms of costs and quality of life of the screening programme compared with the control arm. The model was populated with costs related to drugs, administration and screening intervention derived from the SCOOP study. Fracture risk reduction in the screening arm compared with the usual management arm was derived from SCOOP. Modelled fracture risk corresponded to the risk observed in SCOOP. RESULTS Screening of 1000 patients saved 9 hip fractures and 20 non-hip fractures over the remaining lifetime (mean 14 years) compared with usual management. In total, the screening arm saved costs (£286) and gained 0.015 QALYs/patient in comparison with usual management arm. CONCLUSIONS This analysis suggests that a screening programme of fracture risk in older women in the UK would gain quality of life and life years, and reduce fracture costs to more than offset the cost of running the programme.
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Affiliation(s)
| | - F Borgström
- Quantify Research, Stockholm, Sweden
- LIME/MMC, Karolinska Institutet, Stockholm, Sweden
| | - L Shepstone
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - S Clarke
- Department of Rheumatology, University Hospitals Bristol, Bristol, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Oxford Biomedical Research Unit, University of Oxford, Oxford, UK
| | - I Harvey
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Howe
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - H Johansson
- Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
- Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - T Marshall
- Norfolk and Norwich University Hospital, Norwich, UK
| | - T W O'Neill
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - T J Peters
- Bristol Medical School, University of Bristol, Bristol, UK
| | - N M Redmond
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation, Bristol, UK
| | - D Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - R Holland
- Leicester Medical School, Centre for Medicine, University of Leicester, Leicester, UK
| | - E McCloskey
- Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
- Centre for Integrated research into Musculoskeletal Ageing, University of Sheffield Medical School, Sheffield, UK
- Academic Unit of Bone Metabolism, Department of Oncology and Metabolism, The Mellanby Centre For Bone Research, University of Sheffield, Sheffield, UK
| | - J A Kanis
- Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
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Piontek SM, DelloStritto M, Mandal B, Marshall T, Klein ML, Borguet E. Probing Heterogeneous Charge Distributions at the α-Al2O3(0001)/H2O Interface. J Am Chem Soc 2020; 142:12096-12105. [DOI: 10.1021/jacs.0c01366] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Harrison JAK, Thomson R, Banda HT, Mbera GB, Gregorius S, Stenberg B, Marshall T. Access to health care for people with disabilities in rural Malawi: what are the barriers? BMC Public Health 2020; 20:833. [PMID: 32487088 PMCID: PMC7268500 DOI: 10.1186/s12889-020-08691-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 04/13/2020] [Indexed: 02/06/2023] Open
Abstract
Background People with disabilities experience significant health inequalities. In Malawi, where most individuals live in low-income rural settings, many of these inequalities are exacerbated by restricted access to health care services. This qualitative study explores the barriers to health care access experienced by individuals with a mobility or sensory impairment, or both, living in rural villages in Dowa district, central Malawi. In addition, the impact of a chronic lung condition, alongside a mobility or sensory impairment, on health care accessibility is explored. Methods Using data from survey responses obtained through the Research for Equity And Community Health (REACH) Trust’s randomised control trial in Malawi, 12 adult participants, with scores of either 3 or 4 in the Washington Group Short Set (WGSS) questions, were recruited. The WGSS questions concern a person’s ability in core functional domains (including seeing, hearing and moving), and a score of 3 indicates ‘a lot of difficulty’ whilst 4 means ‘cannot do at all’. People with cognitive impairments were not included in this study. All who were selected for the study participated in an individual in-depth interview and full recordings of these were then transcribed and translated. Results Through thematic analysis of the transcripts, three main barriers to timely and adequate health care were identified: 1) Cost of transport, drugs and services, 2) Insufficient health care resources, and 3) Dependence on others. Attitudinal factors were explored and, whilst unfavourable health seeking behaviour was found to act as an access barrier for some participants, community and health care workers’ attitudes towards disability were not reported to influence health care accessibility in this study. Conclusions This study finds that health care access for people with disabilities in rural Malawi is hindered by closely interconnected financial, practical and social barriers. There is a clear requirement for policy makers to consider the challenges identified here, and in similar studies, and to address them through improved social security systems and health system infrastructure, including outreach services, in a drive for equitable health care access and provision.
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Affiliation(s)
| | - Rachael Thomson
- Collaboration for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Hastings T Banda
- Research for Equity And Community Health (REACH) Trust, Lilongwe, Malawi
| | - Grace B Mbera
- Research for Equity And Community Health (REACH) Trust, Lilongwe, Malawi
| | - Stefanie Gregorius
- Collaboration for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Tim Marshall
- School for Policy Studies, University of Bristol, Bristol, UK
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15
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Condurache CI, Chiu S, Chotiyarnwong P, Johansson H, Shepstone L, Lenaghan E, Cooper C, Clarke S, Khioe RFS, Fordham R, Gittoes N, Harvey I, Harvey NC, Heawood A, Holland R, Howe A, Kanis JA, Marshall T, O'Neill TW, Peters TJ, Redmond NM, Torgerson D, Turner D, McCloskey E. Screening for high hip fracture risk does not impact on falls risk: a post hoc analysis from the SCOOP study. Osteoporos Int 2020; 31:457-464. [PMID: 31960099 DOI: 10.1007/s00198-019-05270-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/17/2019] [Indexed: 12/30/2022]
Abstract
UNLABELLED A reduction in hip fracture incidence following population screening might reflect the effectiveness of anti-osteoporosis therapy, behaviour change to reduce falls, or both. This post hoc analysis demonstrates that identifying high hip fracture risk by FRAX was not associated with any alteration in falls risk. INTRODUCTION To investigate whether effectiveness of an osteoporosis screening programme to reduce hip fractures was mediated by modification of falls risk in the screening arm. METHODS The SCOOP study recruited 12,483 women aged 70-85 years, individually randomised to a control (n = 6250) or screening (n = 6233) arm; in the latter, osteoporosis treatment was recommended to women at high risk of hip fracture, while the control arm received usual care. Falls were captured by self-reported questionnaire. We determined the influence of baseline risk factors on future falls, and then examined for differences in falls risk between the randomisation groups, particularly in those at high fracture risk. RESULTS Women sustaining one or more falls were slightly older at baseline than those remaining falls free during follow-up (mean difference 0.70 years, 95%CI 0.55-0.85, p < 0.001). A higher FRAX 10-year probability of hip fracture was associated with increased likelihood of falling, with fall risk increasing by 1-2% for every 1% increase in hip fracture probability. However, falls risk factors were well balanced between the study arms and, importantly, there was no evidence of a difference in falls occurrence. In particular, there was no evidence of interaction (p = 0.18) between baseline FRAX hip fracture probabilities and falls risk in the two arms, consistent with no impact of screening on falls in women informed to be at high risk of hip fracture. CONCLUSION Effectiveness of screening for high FRAX hip fracture probability to reduce hip fracture risk was not mediated by a reduction in falls.
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Affiliation(s)
- C I Condurache
- Centre for Integrated Research in Musculoskeletal Aging, University of Sheffield Medical School, Sheffield, UK
- Department of Oncology and Metabolism, Academic Unit of Bone Metabolism, The Mellanby Centre For Bone Research, University of Sheffield, Sheffield, UK
| | - S Chiu
- Centre for Integrated Research in Musculoskeletal Aging, University of Sheffield Medical School, Sheffield, UK
- Department of Oncology and Metabolism, Academic Unit of Bone Metabolism, The Mellanby Centre For Bone Research, University of Sheffield, Sheffield, UK
| | - P Chotiyarnwong
- Department of Oncology and Metabolism, Academic Unit of Bone Metabolism, The Mellanby Centre For Bone Research, University of Sheffield, Sheffield, UK
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - H Johansson
- Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
- Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - L Shepstone
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - E Lenaghan
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Oxford Biomedical Research Unit, University of Oxford, Oxford, UK
| | - S Clarke
- Department of Rheumatology, University Hospitals Bristol, Bristol, UK
| | - R F S Khioe
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - R Fordham
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - N Gittoes
- Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, Birmingham, UK
| | - I Harvey
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Heawood
- Bristol Medical School, University of Bristol, Bristol, UK
| | - R Holland
- Leicester Medical School, Centre for Medicine, University of Leicester, Leicester, UK
| | - A Howe
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - J A Kanis
- Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - T Marshall
- Norfolk and Norwich University Hospital, Norwich, UK
| | - T W O'Neill
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - T J Peters
- Bristol Medical School, University of Bristol, Bristol, UK
| | - N M Redmond
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation, Bristol, UK
| | - D Torgerson
- Department of Health Sciences, University of York, York, UK
| | - D Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - E McCloskey
- Centre for Integrated Research in Musculoskeletal Aging, University of Sheffield Medical School, Sheffield, UK.
- Department of Oncology and Metabolism, Academic Unit of Bone Metabolism, The Mellanby Centre For Bone Research, University of Sheffield, Sheffield, UK.
- Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
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16
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Lawrence JG, Andrew L, Bracken J, Voskoboynik A, Oakley E, South M, Middleton K, Scanlan B, Marshall T, Hiscock H. Bronchiolitis at a specialist paediatric centre: The electronic medical record helps to evaluate low-value care. J Paediatr Child Health 2020; 56:304-308. [PMID: 31448456 DOI: 10.1111/jpc.14602] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 12/01/2022]
Abstract
AIM Low-value care (LVC) is common. We aimed, using infants presenting to a major tertiary paediatric hospital with bronchiolitis between April 2016 and July 2018, to: (i) assess rates of chest X-ray (CXR) and medication use; (ii) identify associated factors; and (iii) measure the harm of not performing these practices. METHODS We extracted data from the electronic medical record for all children aged 1-12 months given a diagnosis of bronchiolitis in the emergency department. Factors potentially associated with LVC practices were extracted, including patient demographics, ordering physician characteristics, order indication, medications prescribed and admission ward. To assess for harm, a radiologist, blinded to CXR indication, reviewed all CXRs ordered over the winter of 2017 for infants with bronchiolitis. RESULTS A CXR was ordered for 439 (11.2%) infants, most commonly to rule out consolidation and collapse (65%). CXRs were more likely to be ordered for admitted infants (40.9% admitted to the general medical ward), and 62% were ordered by emergency department staff. Salbutamol was prescribed for 9.3% (n = 199). Amongst those who had a CXR, 28% were prescribed an antibiotic compared to 2.1% for those who did not. In an audit of 98 CXRs ordered over the winter of 2017, there were no CXR findings that meaningfully affected patient outcomes. CONCLUSION Using electronic medical record data, we found that CXR and medication use in bronchiolitis were higher than expected given our hospital guideline advice. Future research needs to understand why and develop interventions to reduce LVC.
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Affiliation(s)
- Joanna G Lawrence
- Informatics and Training, The Royal Children's Hospital, Melbourne, Victoria, Australia.,General Medicine, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Lauren Andrew
- Informatics and Training, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jenny Bracken
- Medical Imaging Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Alice Voskoboynik
- Informatics and Training, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ed Oakley
- General Medicine, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Mike South
- Informatics and Training, The Royal Children's Hospital, Melbourne, Victoria, Australia.,General Medicine, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Katherine Middleton
- Informatics and Training, The Royal Children's Hospital, Melbourne, Victoria, Australia.,General Medicine, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Barry Scanlan
- Informatics and Training, The Royal Children's Hospital, Melbourne, Victoria, Australia.,General Medicine, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Tim Marshall
- Strategy and Improvement, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- General Medicine, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Health Services Research Unit, Royal Children's Hospital, Melbourne, Victoria, Australia
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17
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Parsons CM, Harvey N, Shepstone L, Kanis JA, Lenaghan E, Clarke S, Fordham R, Gittoes N, Harvey I, Holland R, Redmond NM, Howe A, Marshall T, Peters TJ, Torgerson D, O'Neill TW, McCloskey E, Cooper C. Systematic screening using FRAX ® leads to increased use of, and adherence to, anti-osteoporosis medications: an analysis of the UK SCOOP trial. Osteoporos Int 2020; 31:67-75. [PMID: 31606826 PMCID: PMC6952271 DOI: 10.1007/s00198-019-05142-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/20/2019] [Indexed: 12/01/2022]
Abstract
UNLABELLED In the large community-based SCOOP trial, systematic fracture risk screening using FRAX® led to greater use of AOM and greater adherence, in women at high fracture risk, compared with usual care. INTRODUCTION In the SCreening of Older wOmen for Prevention of fracture (SCOOP) trial, we investigated the effect of the screening intervention on subsequent long-term self-reported adherence to anti-osteoporosis medications (AOM). METHODS SCOOP was a primary care-based UK multicentre trial of screening for fracture risk. A total of 12,483 women (70-85 years) were randomised to either usual NHS care, or assessment using the FRAX® tool ± dual-energy X-ray absorptiometry (DXA), with medication recommended for those found to be at high risk of hip fracture. Self-reported AOM use was obtained by postal questionnaires at 6, 12, 24, 36, 48 and 60 months. Analysis was limited to those who initiated AOM during follow-up. Logistic regression was used to explore baseline determinants of adherence (good ≥ 80%; poor < 80%). RESULTS The mean (SD) age of participants was 75.6 (4.2) years, with 6233 randomised to screening and 6250 to the control group. Of those participants identified at high fracture risk in the screening group, 38.2% of those on treatment at 6 months were still treated at 60 months, whereas the corresponding figure for the control group was 21.6%. Older age was associated with poorer adherence (OR per year increase in age 0.96 [95% CI 0.93, 0.99], p = 0.01), whereas history of parental hip fracture was associated with greater rate adherence (OR 1.67 [95% CI 1.23, 2.26], p < 0.01). CONCLUSIONS Systematic fracture risk screening using FRAX® leads to greater use of AOM and greater adherence, in women at high fracture risk, compared with usual care.
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Affiliation(s)
- C M Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
| | - N Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Institute for Health and Ageing, Catholic University of Australia, Melbourne, Australia
| | | | - S Clarke
- Bristol Medical School, University of Bristol, Bristol, UK
| | - R Fordham
- University of East Anglia, Norwich, UK
| | - N Gittoes
- Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, Birmingham, UK
| | - I Harvey
- University of East Anglia, Norwich, UK
| | - R Holland
- University of East Anglia, Norwich, UK
| | - N M Redmond
- Bristol Medical School, University of Bristol, Bristol, UK
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - A Howe
- University of East Anglia, Norwich, UK
| | | | - T J Peters
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - T W O'Neill
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospitals Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - E McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Mellanby Centre for Bone Research, Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
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18
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Schreier A, Horwitz M, Marshall T, Bracey J, Cummins M, Kaufman JS. Child and Family Team Meeting Characteristics and Outcomes in a Statewide System of Care. Am J Community Psychol 2019; 63:487-498. [PMID: 30848833 PMCID: PMC6597283 DOI: 10.1002/ajcp.12323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Systems of care (SOC) have relied on the wraparound care process to individualize community-based services for children and youth with serious emotional and behavioral difficulties. A core element of wraparound care is Child and Family Team meetings (CFTs), which are designed to give youth and families a leadership role in developing and guiding their plan of care. The National Wraparound Initiative (NWI) has identified Practice Standards regarding CFT implementation. This study examined CFT characteristics and the association between those characteristics and youth and family outcomes in a statewide SOC. Participants were 363 youth (Mage = 10.89, SD = 3.72) and their caregivers. Families completed measures of youth and caregiver functioning and symptoms at enrollment and 6-month follow-up. Care coordinators completed a survey assessing CFT implementation and characteristics following each meeting. Multiple regression analyses were used to examine the relationship between CFT characteristics and youth and caregiver outcomes. Results indicated that a higher number of CFTs was associated with poorer outcomes, while a higher percentage of natural supports at meetings was associated with better youth outcomes. Number of days to the first CFT was associated with greater caregiver strain. Implications for CFT implementation within wraparound are discussed.
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Affiliation(s)
| | | | - Tim Marshall
- Connecticut Department of Children and Families, Hartford, CT, USA
| | - Jeana Bracey
- Child Health and Development Institute of Connecticut, Inc., Farmington, CT, USA
| | - Mary Cummins
- Connecticut Department of Children and Families, Hartford, CT, USA
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19
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Reinhardt JP, Cimarolli V, Burack O, Marshall T, Weiner AS, Minahan J. PERSON DIRECTED CARE: A COMPARISON OF THE SMALL HOUSE AND TRADITIONAL NURSING HOME MODEL. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.761] [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
Affiliation(s)
- J P Reinhardt
- The New Jewish Home, New York, New York, United States
| | | | - O Burack
- The New Jewish Home, New York, NY, USA
| | | | | | - J Minahan
- Psychology Department, Fordham University, Bronx, NY, USA
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20
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Taylor-Rowan M, Quinn T, Smith P, Ellis G, Keir R, McAlpine C, Marsh G, Murtagh J, McElroy M, Mitchell L, Waddell G, Williams A, Duffy L, Oswald S, Myles A, Bann A, Rodger K, Reid J, Kellichan L, Docharty D, Marshall T, McGurn B, Ritchie C, Wells A, Talbot A, McInnes C, Reynish E, Coleman D, Flynn B, Scott A, Coull A, Dingwall L. 53ASSESSING THE PSYCHOMETRIC PROPERTIES OF THE HIS “THINK FRAILTY” TOOL. Age Ageing 2018. [DOI: 10.1093/ageing/afy127.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - T Quinn
- New Lister Building, Glasgow Royal Infirmary
| | - P Smith
- New Lister Building, Glasgow Royal Infirmary
| | - G Ellis
- New Lister Building, Glasgow Royal Infirmary
| | - R Keir
- New Lister Building, Glasgow Royal Infirmary
| | - C McAlpine
- New Lister Building, Glasgow Royal Infirmary
| | - G Marsh
- New Lister Building, Glasgow Royal Infirmary
| | - J Murtagh
- New Lister Building, Glasgow Royal Infirmary
| | - M McElroy
- New Lister Building, Glasgow Royal Infirmary
| | - L Mitchell
- New Lister Building, Glasgow Royal Infirmary
| | - G Waddell
- New Lister Building, Glasgow Royal Infirmary
| | - A Williams
- New Lister Building, Glasgow Royal Infirmary
| | - L Duffy
- New Lister Building, Glasgow Royal Infirmary
| | - S Oswald
- New Lister Building, Glasgow Royal Infirmary
| | - A Myles
- New Lister Building, Glasgow Royal Infirmary
| | - A Bann
- New Lister Building, Glasgow Royal Infirmary
| | - K Rodger
- New Lister Building, Glasgow Royal Infirmary
| | - J Reid
- New Lister Building, Glasgow Royal Infirmary
| | - L Kellichan
- New Lister Building, Glasgow Royal Infirmary
| | - D Docharty
- New Lister Building, Glasgow Royal Infirmary
| | - T Marshall
- New Lister Building, Glasgow Royal Infirmary
| | - B McGurn
- New Lister Building, Glasgow Royal Infirmary
| | - C Ritchie
- New Lister Building, Glasgow Royal Infirmary
| | - A Wells
- New Lister Building, Glasgow Royal Infirmary
| | - A Talbot
- New Lister Building, Glasgow Royal Infirmary
| | - C McInnes
- New Lister Building, Glasgow Royal Infirmary
| | - E Reynish
- New Lister Building, Glasgow Royal Infirmary
| | - D Coleman
- New Lister Building, Glasgow Royal Infirmary
| | - B Flynn
- New Lister Building, Glasgow Royal Infirmary
| | - A Scott
- New Lister Building, Glasgow Royal Infirmary
| | - A Coull
- New Lister Building, Glasgow Royal Infirmary
| | - L Dingwall
- New Lister Building, Glasgow Royal Infirmary
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21
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Dewar HA, Marshall T, Weightman D, Prakash V, Boon PJ. β-Thromboglobulin in Antecubital Vein Blood - The Influence of Age, Sex and Blood Group. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1657011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummarySamples of blood for estimation of beta-thromboglobulin (B. T. G.) in normal subjects have been obtained both from blood donors at the end of their donation and from other volunteers by standard venepuncture. The former was a satisfactory method in males only.By standard venepuncture females have on average lower values than males and in the pre-menopausal age groups the difference is statistically significant.Mean values vary little up to 59 years after which they rise slowly but steadily. There is no significant difference in the mean B. T. G. values between the ABO blood groups.
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Affiliation(s)
- H A Dewar
- The Royal Victoria Infirmary and University Department of Medical Statistics, Newcastle upon Tyne, England
| | - T Marshall
- The Royal Victoria Infirmary and University Department of Medical Statistics, Newcastle upon Tyne, England
| | - D Weightman
- The Royal Victoria Infirmary and University Department of Medical Statistics, Newcastle upon Tyne, England
| | - V Prakash
- The Royal Victoria Infirmary and University Department of Medical Statistics, Newcastle upon Tyne, England
| | - P J Boon
- The Royal Victoria Infirmary and University Department of Medical Statistics, Newcastle upon Tyne, England
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22
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Adderley NJ, Mallett S, Marshall T, Ghosh S, Rayman G, Bellary S, Coleman J, Akiboye F, Toulis KA, Nirantharakumar K. Temporal and external validation of a prediction model for adverse outcomes among inpatients with diabetes. Diabet Med 2018; 35:798-806. [PMID: 29485723 DOI: 10.1111/dme.13612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2018] [Indexed: 02/06/2023]
Abstract
AIM To temporally and externally validate our previously developed prediction model, which used data from University Hospitals Birmingham to identify inpatients with diabetes at high risk of adverse outcome (mortality or excessive length of stay), in order to demonstrate its applicability to other hospital populations within the UK. METHODS Temporal validation was performed using data from University Hospitals Birmingham and external validation was performed using data from both the Heart of England NHS Foundation Trust and Ipswich Hospital. All adult inpatients with diabetes were included. Variables included in the model were age, gender, ethnicity, admission type, intensive therapy unit admission, insulin therapy, albumin, sodium, potassium, haemoglobin, C-reactive protein, estimated GFR and neutrophil count. Adverse outcome was defined as excessive length of stay or death. RESULTS Model discrimination in the temporal and external validation datasets was good. In temporal validation using data from University Hospitals Birmingham, the area under the curve was 0.797 (95% CI 0.785-0.810), sensitivity was 70% (95% CI 67-72) and specificity was 75% (95% CI 74-76). In external validation using data from Heart of England NHS Foundation Trust, the area under the curve was 0.758 (95% CI 0.747-0.768), sensitivity was 73% (95% CI 71-74) and specificity was 66% (95% CI 65-67). In external validation using data from Ipswich, the area under the curve was 0.736 (95% CI 0.711-0.761), sensitivity was 63% (95% CI 59-68) and specificity was 69% (95% CI 67-72). These results were similar to those for the internally validated model derived from University Hospitals Birmingham. CONCLUSIONS The prediction model to identify patients with diabetes at high risk of developing an adverse event while in hospital performed well in temporal and external validation. The externally validated prediction model is a novel tool that can be used to improve care pathways for inpatients with diabetes. Further research to assess clinical utility is needed.
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Affiliation(s)
- N J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - S Mallett
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - T Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - S Ghosh
- Diabetes Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - G Rayman
- Ipswich Hospital NHS Trust, Ipswich
| | - S Bellary
- Heart of England Foundation Trust, Birmingham, UK
| | - J Coleman
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | | | - K A Toulis
- Institute of Applied Health Research, University of Birmingham, Birmingham
- 424 General Military Hospital, Thessaloniki, Greece
| | - K Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham
- Diabetes Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham
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23
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Chandan JS, Thomas T, Lee S, Marshall T, Willis B, Nirantharakumar K, Gill P. The association between idiopathic thrombocytopenic purpura and cardiovascular disease: a retrospective cohort study. J Thromb Haemost 2018; 16:474-480. [PMID: 29297977 DOI: 10.1111/jth.13940] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 06/07/2017] [Indexed: 01/01/2023]
Abstract
Essentials We estimated the cardiovascular risk of patients with idiopathic thrombocytopenic purpura (ITP). The risk of cardiovascular disease was 38% higher in ITP patients compared with controls. Among the ITP patients, splenectomy was associated with higher cardiovascular disease. Clinicians should consider cardiovascular risk when managing ITP patients. SUMMARY Background Idiopathic thrombocytopenic purpura (ITP) is classically characterized by a transient or persistent decrease of platelet count. Mortality is higher in the ITP population than the general population, with a possible association with increased cardiovascular disease (CVD). Objectives The objective was to assess the strength of the association between ITP and CVD, with a secondary aim to assess the impact of splenectomy on CVD. Methods A population-based retrospective, open cohort study using clinical codes was performed using data from 6591 patients with ITP and 24 275 randomly matched controls (up to 1:4 ratio matched by age, sex, body mass index and smoking status). The main outcome was the risk of CVD, which included ischemic heart disease, stroke, trans-ischemic attack and heart failure. Adjusted incidence rate ratios were calculated using Poisson regression. Results During a median 6-year observation period there was a CVD diagnosis recorded in 392 (5.9%) ITP patients and 1114 (4.5%) control patients. There was an increased risk of developing CVD in the ITP cohort (incidence rate ratio [IRR], 1.38; 95% confidence interval [CI], 1.23-1.55), which remained robust even after a sensitivity analysis only including incident cases of ITP. Findings suggested that patients who had undergone splenectomy were at even further increased risk of developing CVD when compared with the ITP population who had not undergone splenectomy (adjusted IRR, 1.69; 95% CI, 1.22-2.34). Conclusion There is an increased risk of developing CVD in patients with ITP and even further increased risk for those patients with ITP who underwent splenectomy.
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Affiliation(s)
| | - T Thomas
- Queen Elizabeth Hospital, Birmingham, UK
| | - S Lee
- New Cross Hospital, Heath Town, Wolverhampton, UK
| | - T Marshall
- Primary Care Clinical Sciences, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - B Willis
- Primary Care Clinical Sciences, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - K Nirantharakumar
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - P Gill
- WMS - Social Science and Systems in Health, University of Warwick, Coventry, UK
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Touma F, Clifford L, Guider A, Nicholas N, Howden N, Marshall T, Rogers J, Forsyth C. The Incidence of Iron Deficiency in Hospitalised Cardiac Patients and its Relationship to Anticoagulant and Antiplatelet Therapy. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Stuart K, Adderley NJ, Marshall T, Rayman G, Sitch A, Manley S, Ghosh S, Toulis KA, Nirantharakumar K. Predicting inpatient hypoglycaemia in hospitalized patients with diabetes: a retrospective analysis of 9584 admissions with diabetes. Diabet Med 2017. [PMID: 28632918 DOI: 10.1111/dme.13409] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 01/14/2023]
Abstract
AIMS To explore whether a quantitative approach to identifying hospitalized patients with diabetes at risk of hypoglycaemia would be feasible through incorporation of routine biochemical, haematological and prescription data. METHODS A retrospective cross-sectional analysis of all diabetic admissions (n=9584) from 1 January 2014 to 31 December 2014 was performed. Hypoglycaemia was defined as a blood glucose level of <4 mmol/l. The prediction model was constructed using multivariable logistic regression, populated by clinically important variables and routine laboratory data. RESULTS Using a prespecified variable selection strategy, it was shown that the occurrence of inpatient hypoglycaemia could be predicted by a combined model taking into account background medication (type of insulin, use of sulfonylureas), ethnicity (black and Asian), age (≥75 years), type of admission (emergency) and laboratory measurements (estimated GFR, C-reactive protein, sodium and albumin). Receiver-operating curve analysis showed that the area under the curve was 0.733 (95% CI 0.719 to 0.747). The threshold chosen to maximize both sensitivity and specificity was 0.15. The area under the curve obtained from internal validation did not differ from the primary model [0.731 (95% CI 0.717 to 0.746)]. CONCLUSIONS The inclusion of routine biochemical data, available at the time of admission, can add prognostic value to demographic and medication history. The predictive performance of the constructed model indicates potential clinical utility for the identification of patients at risk of hypoglycaemia during their inpatient stay.
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Affiliation(s)
- K Stuart
- Institute of Applied Health Research, University of Birmingham, Birmingham
- West Hertfordshire NHS Trust, Hertfordshire
| | - N J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - T Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - G Rayman
- Ipswich Hospital NHS Trust, Ipswich
| | - A Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - S Manley
- Diabetes Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Ghosh
- Diabetes Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - K A Toulis
- Institute of Applied Health Research, University of Birmingham, Birmingham
- 424 General Military Hospital, Thessaloniki, Greece
| | - K Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham
- Diabetes Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Jeddian A, Lindenmeyer A, Marshall T, Howard A, Sayadi L, Rashidian A, Jafari N. Implementation of a critical care outreach service: a qualitative study. Int Nurs Rev 2017; 64:353-362. [DOI: 10.1111/inr.12377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A. Jeddian
- Digestive Disease Research Institute; Tehran University of Medical Sciences; Tehran Iran
| | - A. Lindenmeyer
- Qualitative Methods; Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - T. Marshall
- Public Health & Primary Care; Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - A.F. Howard
- School of Nursing; The University of British Columbia; Vancouver BC Canada
| | - L. Sayadi
- School of Nursing and Midwifery; Nursing & Midwifery Care Research Center Tehran University of Medical Sciences; Tehran Iran
| | - A. Rashidian
- School of Public Health; Tehran University of Medical Sciences; Tehran Iran
| | - N. Jafari
- Digestive Disease Research Institute; Tehran University of Medical Sciences; Tehran Iran
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Clegg A, Bates C, Young J, Ryan R, Nichols L, Teale E, Mohammed M, Parry J, Marshall T. 129Development, Internal Validation And Independent External Validation Of An Electronic Frailty Index Using Routine Primary Care Electronic Health Record Data. Age Ageing 2017. [DOI: 10.1093/ageing/afx068.129] [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: 11/14/2022] Open
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Tackett S, Gaglani S, Slinn K, Marshall T, Desai R, Haynes M. Open Osmosis: Promoting the Global Diffusion of Open Education
Resources. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.318] [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: 11/16/2022] Open
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Abstract
OBJECTIVES To explore 2 key points in the heart failure diagnostic pathway-symptom onset and diagnostic meaning-from the patient perspective. DESIGN Qualitative interview study. SETTING Participants were recruited from a secondary care clinic in central England following referral from primary care. PARTICIPANTS Over age 55 years with a recent (<1 year) diagnosis of heart failure confirmed by a cardiologist following initial presentation to primary care. METHODS Semistructured interviews were carried out with 16 participants (11 men and 5 women, median age 78.5 years) in their own homes. Data were audio-recorded and transcribed. Participants were asked to describe their diagnostic journey from when they first noticed something wrong up to and including the point of diagnosis. Data were analysed using the framework method. RESULTS Participants initially normalised symptoms and only sought medical help when daily activities were affected. Failure to realise that anything was wrong led to a delay in help-seeking. Participants' understanding of the term 'heart failure' was variable and 1 participant did not know he had the condition. The term itself caused great anxiety initially but participants learnt to cope with and accept their diagnosis over time. CONCLUSIONS Greater public awareness of symptoms and adequate explanation of 'heart failure' as a diagnostic label, or reconsideration of its use, are potential areas of service improvement.
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Affiliation(s)
- C J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - F D R Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - T Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - F Leyva-Leon
- Aston Medical Research Insitutue, Aston Medical School, Birmingham, UK
| | - N Gale
- Health Services Management Centre, University of Birmingham, Birmingham, UK
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Turner G, Calvert M, Feltham M, Ryan R, Marshall T. Response to Professor Kawada. Eur J Neurol 2016; 24:e1. [PMID: 28000347 DOI: 10.1111/ene.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/16/2016] [Indexed: 10/20/2022]
Affiliation(s)
- G Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - M Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - M Feltham
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R Ryan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - T Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Natarajan M, Alnajjar HM, Woodward CI, Tshuma M, Marshall T, Rochester M. Abdominal wall ectopic testis torsion mimicking a Spigelian hernia in an adult. Ann R Coll Surg Engl 2016; 99:e65-e68. [PMID: 27917664 DOI: 10.1308/rcsann.2016.0335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report an unusual case of an ectopic testis identified in a 37-year-old man presenting with acute severe right iliac fossa pain and an irreducible mass. Initially diagnosed as a Spigelian hernia, computed tomography and ultrasonography identified the presence of an ectopic testis in the abdominal wall. Interparietal testicular ectopia is an extremely rare condition. We present and discuss the first case in the literature of an ectopic testis located between the internal and external oblique muscle layers of the anterior abdominal wall in an adult.
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Affiliation(s)
- M Natarajan
- Norfolk and Norwich University Hospitals NHS Foundation Trust , UK
| | - H M Alnajjar
- Norfolk and Norwich University Hospitals NHS Foundation Trust , UK
| | - C I Woodward
- Norfolk and Norwich University Hospitals NHS Foundation Trust , UK
| | - M Tshuma
- Norfolk and Norwich University Hospitals NHS Foundation Trust , UK
| | - T Marshall
- Norfolk and Norwich University Hospitals NHS Foundation Trust , UK
| | - M Rochester
- Norfolk and Norwich University Hospitals NHS Foundation Trust , UK
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Marshall T. Book Review: Practical Paediatric Problems: A Textbook for the MRCPCH. Scott Med J 2016. [DOI: 10.1258/rsmsmj.51.3.51a] [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: 11/18/2022]
Affiliation(s)
- T Marshall
- Consultant Paediatrician, Edinburgh Royal Hospital for Sick Children
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Furniss G, Opel A, Hussein A, Pearman C, Grace A, Connelly D, Orlowski A, Banerjee A, McNicholas T, Providencia R, Montañes M, Providencia R, Panagopoulos D, Tomlinson D, Dalrymple-Hay M, Haywood G, Butler A, Ang R, Ullah W, Schwartz R, Fannon M, Finlay M, Hunter R, Schilling R, Das M, Asfour I, Morgan M, Ronayne C, Shaw M, Snowdon R, Gupta D, Todd D, King R, Hall M, Modi S, Mediratta N, Gupta D, Reddy V, Neuzil P, Willems S, Verma A, Heck P, Schilling R, Lambiase P, Hall M, Nicholl B, McQueenie R, Jani BD, McKeag N, Gallacher K, Mair F, Heaton D, Macdonald J, Burnell J, Ryan R, Marshall T, Sutton C, O'Callaghan S, Kenny R, Karim N, Srinivasan N, Ferreira M, Goncalves L, Lambiase P, Toledano M, Field E, Walsh H, Maguire K, Cervi E, Kaski J, Perez Tome M, Pantazis A, Elliott P, Lambiase P, Segal O. ORAL ABSTRACTS (3)EP & Ablation31LEFT ATRIAL POSTERIOR WALL ISOLATION (THE “BOX LESION PATTERN”) IN THE TREATMENT OF ATRIAL FIBRILLATION: A SINGLE CENTRE EXPERIENCE32DAY CASE CRYOBLATION (CRYO) FOR PAROXYSMAL ATRIAL FIBRILLATION (pAF) IN THE DISTRICT GENERAL HOSPITAL IS SAFE AND EFFECTIVE IF DONE IN HIGH VOLUME WITH EXPERIENCED OPERATORS33ABLATION INDEX-GUIDED PULMONARY VEIN ISOLATION FOR ATRIAL FIBRILLATION MAY IMPROVE CLINICAL OUTCOMES IN COMPARISON TO CONTACT FORCE-GUIDED ABLATION34THE PROCEDURAL COMPLICATION RATES AND SHORT-TERM SUCCESS RATES OF THORACOSCOPIC AF ABLATION DURING THE INSTITUTIONAL LEARNING CURVE35INITIAL PROCEDURAL RESULTS FROM DDRAMATIC-SVT STUDY: DD MECHANISM IDENTIFICATION AND LOCALISATION USING DIPOLE DENSITY MAPPING TO GUIDE ABLATION STRATEGY36MORBIDITY AND MORTALITY IN MIDDLE-AGED INDIVIDUALS WITH ATRIAL FIBRILLATION: UK BIOBANK DATAClinical EP37THE GM AHSN AF LANDSCAPE TOOL: A SHARED PUBLIC DATA PLATFORM TO PROMOTE QUALITY IMPROVEMENTS AND IDENTIFY OPPORTUNITIES TO PREVENT AF-RELATED STROKE IN THE DEVOLVED GREATER MANCHESTER HEALTH SYSTEM38REAL WORLD PERSISTENCE, ADHERENCE AND SWITCH-OVER ACROSS ANTICOAGULANTS IN ATRIAL FIBRILLATION-A NATIONAL POPULATION-BASED STUDY39ORTHOSTATIC HYPOTENSION AND ATRIAL FIBRILLATION40PREVALENCE OF SHORT QT AND CRITERIA OF SEVERITY IN A YOUNG ASYMPTOMATIC COHORT41SURFACE ELECTROCARDIOGRAPHIC FEATURES AND PREVALENCE OF ARRHYTHMIAS IN PAEDIATRIC FRIEDREICH'S ATAXIA42RISK STRATIFICATION OF TYPE 1 MYOTONIC DYSTROPHY: IS THE ECG ACCURATE ENOUGH TO SELECT PATIENTS AT RISK OF BRADYARRHYTHMIC EVENTS? Europace 2016. [DOI: 10.1093/europace/euw272] [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: 11/12/2022] Open
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Marshall T, VanBuren J, Cavanaugh J, Warren J, Curtis A, Levy S. Beverage Clusters Have Limited Associations with Dental Caries During Adolescence. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.026] [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: 11/30/2022]
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Jones E, Pike J, Marshall T, Ye X. Quantifying the relationship between increased disability and health care resource utilization, quality of life, work productivity, health care costs in patients with multiple sclerosis in the US. BMC Health Serv Res 2016; 16:294. [PMID: 27443278 PMCID: PMC4957342 DOI: 10.1186/s12913-016-1532-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 07/07/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic progressive condition affecting the central nervous system. Progression of MS results in increased level of disability and most patients will eventually experience some degree of functional impairment and impaired mobility. Costs and burdens escalate as MS disability increases. However, there is a lack of recent data on the impact of MS disability on the cost and burden among patients in the US. METHODS Data for this study were drawn from a real world, cross-sectional survey undertaken between 2013 and 2014. Neurologists completed detailed patient report forms (PRF) for the most recent consulting patients with MS (age >18 years). Patient's perceptions of their diagnosis and health-related quality of life (HRQoL) were collected through a patient self-completion questionnaire (PSC). Regression analysis was used to evaluate the relationship between disability (determined by latest Expanded Disability Status Scale [EDSS] score) and current relapse and health care resource utilization, health care costs, HRQoL and work productivity. RESULTS PRF data were collected for 715 patients (335 also completed a PSC). Patients with higher disability scores (EDSS 3-5 and >5 vs <3 points) and current relapse (vs no current relapse) reported significantly greater health resource utilization for physician visits (p < 0.05) and hospitalizations (p < 0.05) in the preceding 12 months. In addition, they had poorer HRQoL (p < 0.05), were significantly more likely to be unemployed (p < 0.05) and to have had to stop working due to MS (p < 0.05). They also incurred significantly higher health care related costs, including costs for physician consultations, hospitalizations and therapy (p < 0.05). The total costs of care were $51,825, $57,889 and $67,116 for EDSS < 3, EDSS 3-5 and EDSS > 5 groups, respectively; $51,692 and $58,648 for non-relapse and relapse groups, respectively. CONCLUSIONS For MS patients in the US, health resource utilization and healthcare care costs increase with progression of disability. As the disability worsens, patients also exhibit diminished HRQoL and lower work productivity. There is a need for treatments that slow down or delay disability progression among MS patients.
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Affiliation(s)
- E Jones
- Adelphi Real World, Adelphi Mill, Bollington, Macclesfield, Cheshire, SK10 5JB, UK.
| | - J Pike
- Adelphi Real World, Adelphi Mill, Bollington, Macclesfield, Cheshire, SK10 5JB, UK
| | - T Marshall
- Abbvie Inc., 26525 Riverwoods Blvd., Mettawa, IL, 60060, USA
| | - X Ye
- Abbvie Inc., 26525 Riverwoods Blvd., Mettawa, IL, 60060, USA
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Turner GM, Calvert M, Feltham MG, Ryan R, Marshall T. Ongoing impairments following transient ischaemic attack: retrospective cohort study. Eur J Neurol 2016; 23:1642-1650. [DOI: 10.1111/ene.13088] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
- G. M. Turner
- Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - M. Calvert
- Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - M. G. Feltham
- Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - R. Ryan
- Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - T. Marshall
- Institute of Applied Health Research; University of Birmingham; Birmingham UK
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Humphreys JH, Warner A, Chipping J, Marshall T, Lunt M, Symmons DPM, Verstappen SMM. Mortality trends in patients with early rheumatoid arthritis over 20 years: results from the Norfolk Arthritis Register. Arthritis Care Res (Hoboken) 2014; 66:1296-301. [PMID: 24497371 PMCID: PMC4226330 DOI: 10.1002/acr.22296] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [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: 07/26/2013] [Accepted: 01/28/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To examine mortality rates in UK patients with early rheumatoid arthritis (RA) from 1990-2011 and compare with population trends. METHODS The Norfolk Arthritis Register (NOAR) recruited adults with ≥2 swollen joints for ≥4 weeks: cohort 1 (1990-1994), cohort 2 (1995-1999), and cohort 3 (2000-2004). At baseline, serum rheumatoid factor and anti-citrullinated protein antibody were measured and the 2010 American College of Rheumatology/European League Against Rheumatism RA classification criteria were applied. Patients were followed for 7 years, until emigration or death. The UK Office for National Statistics notified the NOAR of the date and cause of deaths, and provided mortality rates for the Norfolk population. All-cause and cardiovascular-specific standardized mortality ratios (SMRs) were calculated. Poisson regression was used to compare mortality rate ratios (MRRs) between cohorts and then, with cubic splines, to model rates by calendar year. Analyses were performed in patients 1) with early inflammatory arthritis, 2) classified as having RA, and 3) autoantibody positive. RESULTS A total of 2,517 patients were included, with 1,639 women (65%) and median age 55 years, and 1,419 (56%) fulfilled the 2010 RA criteria. All-cause and cardiovascular-specific SMRs were significantly elevated in the antibody-positive groups. There was no change in mortality rates over time after accounting for changes in the population rates. In RA patients, all-cause MRRs, compared to cohort 1, were 1.13 (95% confidence interval [95% CI] 0.84-1.52) and 1.00 (95% CI 0.70-1.43) in cohorts 2 and 3, respectively. CONCLUSION Mortality rates were increased in patients with RA and SMRs were particularly elevated in those who were autoantibody positive. Compared to the general population, mortality rates have not improved over the past 20 years.
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Affiliation(s)
- J H Humphreys
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Bluett J, Chipping J, Marshall T, Symmons D, Verstappen S. OP0150 Long-Term Persistence with Oral Methotrexate in Patients with Early Inflammatory Arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1866] [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]
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Ramanujam S, Symmons D, Marshall T, Chipping J, Bruce I, Verstappen S. FRI0089 Respiratory Morbidity and Mortality in Early Rheumatoid Arthritis: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Humphreys J, van Nies J, Chipping J, Marshall T, van der Helm-van Mil A, Symmons D, Verstappen S. OP0033 Rheumatoid Factor and Anti-Citrullinated Protein Antibody Positivity, but not Their Concentration, Are Associated with Increased Mortality in Patients with Rheumatoid Arthritis: Results from Two Large Independent Cohorts: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Moran GM, Fletcher B, Feltham MG, Calvert M, Sackley C, Marshall T. Fatigue, psychological and cognitive impairment following transient ischaemic attack and minor stroke: a systematic review. Eur J Neurol 2014; 21:1258-67. [PMID: 24861479 DOI: 10.1111/ene.12469] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [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: 01/13/2014] [Accepted: 04/07/2014] [Indexed: 11/28/2022]
Abstract
Transient ischaemic attack (TIA) and minor stroke are characterized by short-lasting symptoms; however, anecdotal and empirical evidence suggests that these patients experience ongoing cognitive/psychological impairment for which they are not routinely treated. The aims were (i) to investigate the prevalence and time course of fatigue, anxiety, depression, post-traumatic stress disorder(PTSD) and cognitive impairment following TIA/minor stroke; (ii) to explore the impact on quality of life (QoL), change in emotions and return to work; and (iii) to identify where further research is required and potentially inform an intervention study. A systematic review of MEDLINE, EMBASE, PSYCINFO, CINAHL, the Cochrane libraries and the grey literature between January 1993 and April 2013 was undertaken. Literature was screened and data were extracted by two independent reviewers. Studies were included of adult TIA/minor stroke participants with any of the outcomes of interest: fatigue, anxiety, depression, PTSD, cognitive impairment, QoL, change in emotions and return to work. Random-effects meta-analysis pooled outcomes by measurement tool. Searches identified 5976 records, 289 were assessed for eligibility and 31 studies were included. Results suggest high levels of cognitive impairment and depression post-TIA/minor stroke which decreased over time. However, frequencies varied between studies. Limited information was available on anxiety, PTSD and fatigue. Meta-analysis revealed that the measurement tool administered influenced the prevalence of cognitive impairment: Mini-Mental State Examination 17% [95% confidence interval (CI) 7, 26]; neuropsychological test battery 39% (95% CI 28, 50); Montreal Cognitive Assessment 54% (95% CI 43, 66). There is evidence to suggest that TIA/minor stroke patients may experience residual impairments; however, results should be interpreted with caution because of the few high quality studies. Notwithstanding, it is important to raise awareness of potential subtle but meaningful residual impairments.
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Affiliation(s)
- G M Moran
- Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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Roberts YH, Snyder FJ, Kaufman JS, Finley MK, Griffin A, Anderson J, Marshall T, Radway S, Stack V, Crusto CA. Children exposed to the arrest of a family member: Associations with mental health. J Child Fam Stud 2014; 23:214-244. [PMID: 24829537 PMCID: PMC4016966 DOI: 10.1007/s10826-013-9717-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The arrest of a parent or other family member can be detrimental to children's health. To study the impact of exposure to the arrest of a family member on children's mental health and how said association may change across developmental periods, we examined baseline data for children (birth through 11 years) entering family-based systems of care (SOC). Children exposed to the arrest of a family member had experienced significantly more 5.38 (SD = 2.59) different types of potentially traumatic events (PTE) than children not exposed to arrest 2.84 (SD = 2.56). Multiple regression model results showed that arrest exposure was significantly associated with greater behavioral and emotional challenges after controlling for children's age, gender, race/ethnicity, household income, caregiver's education, parenting factors, and other PTE exposure. Further analyses revealed differences in internalizing and externalizing behaviors associated with arrest exposure across developmental levels. This study highlights some of the mental health challenges for children exposed to the arrest of a family member, while adding to our knowledge of how such an event affects children across different developmental periods. More trauma-informed, developmentally appropriate systems need to be in place at all levels to assist children and families experiencing arrest.
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Affiliation(s)
| | - Frank J. Snyder
- Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT
| | - Joy S. Kaufman
- Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT
| | | | | | - Janet Anderson
- Rhode Island Department of Children and Families, Providence, RI
| | - Tim Marshall
- Connecticut Department of Children and Families, Hartford, CT
| | | | - Virginia Stack
- Paul V. Sherlock Center on Disabilities, Rhode Island College, Providence, RI
| | - Cindy A. Crusto
- Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT
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Talaei M, Sadeghi M, Marshall T, Thomas G, Iranipour R, Nazarat N, Sarrafzadegan N. Anthropometric indices predicting incident type 2 diabetes in an Iranian population: The Isfahan Cohort Study. Diabetes & Metabolism 2013; 39:424-31. [PMID: 23867722 DOI: 10.1016/j.diabet.2013.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 03/11/2013] [Accepted: 04/07/2013] [Indexed: 12/20/2022]
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Diffin J, Marshall T, Chipping J, Symmons D, Verstappen S. OP0089 Disease Severity in Patients with Inflammatory Arthritis who Persistently, Intermittently, or Never Achieve Remission. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Diffin J, Lunt M, Marshall T, Chipping J, Symmons D, Verstappen S. OP0088 Changes in Baseline Severity of Inflammatory Polyarthritis Over Time. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Humphreys J, Verstappen S, Lunt M, Hyrich K, Marshall T, Symmons D. OP0131 Incidence of rheumatoid arthritis in the UK using the 2010 ACR/EULAR classification criteria for RA; and comparison with estimates using the 1987 ACR criteria:. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1814] [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]
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Alhusain A, Verstappen S, Lunt M, Mirjafari H, Bunn D, Marshall T, Charlton-menys V, Durrington P, Symmons D, Bruce I. OP0118 Predictors of overall/cardiovascular mortality in patients with early inflammatory polyarthritis; the lipid-paradox? Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1801] [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]
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Skeoch S, Verstappen S, Chipping J, Marshall T, Symmons D, Bruce I. SAT0081 Seropositivity is Associated with Increased Arterial Stiffness in Rheumatoid Arthritis Patients: Results from the Norfolk Arthritis Register. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1807] [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]
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Nirantharakumar K, Toulis KA, Wijesinghe H, Mastan MS, Srikantharajah M, Bhatta S, Marshall T, Coleman JJ. Impact of diabetes on inpatient mortality and length of stay for elderly patients presenting with fracture of the proximal femur. J Diabetes Complications 2013; 27:208-10. [PMID: 23312217 DOI: 10.1016/j.jdiacomp.2012.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 11/02/2012] [Accepted: 11/28/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Osteoporosis-related fractures of the proximal femur cause significant morbidity and result in an economic burden on societies. It remains debatable whether diabetic patients with proximal fracture of the femur demonstrate poorer outcomes in terms of hospital stay and mortality compared to non-diabetic controls. METHODS All patients over 65years old admitted to the University Hospital Birmingham during 2007-2010 with a diagnosis of a fracture of the proximal femur (total 1468 including 197 patients with diabetes) were analysed. Eligibility and case definitions were ascertained using electronic records. Multivariate analyses were conducted to control for the confounding effect of covariates, which may be associated with the outcomes of interest on the basis of biological plausibility and known risks. RESULTS In-patient mortality was estimated at 14.2% and 12% for the diabetic and non-diabetic patients respectively. Diabetes was not found to be a significant predictor of in-patient mortality, before and after adjustment for the covariates [Adjusted odds ratio 1.01 (95% CI 0.62-1.65)], in contrast to advancing age, male gender, co-morbidity score, low albumin and high creatinine concentrations. Similarly, median length of stay was greater in the diabetes patients, yet only by a day (20 versus 19 days). This was not statistically significant in either the unadjusted (p=0.17) or in the multivariate analysis (p=0.06). CONCLUSIONS Diabetic patients admitted with fracture of the proximal femur did not demonstrate significantly poorer outcomes in terms of in-patient mortality and length of stay compared to non-diabetic patients.
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Affiliation(s)
- K Nirantharakumar
- Public Health, Epidemiology and Biostatistics, University of Birmingham, UK.
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