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Uy GL, Rettig MP, Stone RM, Konopleva MY, Andreeff M, McFarland K, Shannon W, Fletcher TR, Reineck T, Eades W, Stockerl-Goldstein K, Abboud CN, Jacoby MA, Westervelt P, DiPersio JF. A phase 1/2 study of chemosensitization with plerixafor plus G-CSF in relapsed or refractory acute myeloid leukemia. Blood Cancer J 2017; 7:e542. [PMID: 28282031 PMCID: PMC5380905 DOI: 10.1038/bcj.2017.21] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- G L Uy
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - M P Rettig
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - R M Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - M Y Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Andreeff
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K McFarland
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - W Shannon
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - T R Fletcher
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - T Reineck
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - W Eades
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - K Stockerl-Goldstein
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - C N Abboud
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - M A Jacoby
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - P Westervelt
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - J F DiPersio
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
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Dale AM, Rohn A, Burwell A, Shannon W, Standeven J, Patton A, Evanoff B. Evaluation of anti-vibration interventions for the hand during sheet metal assembly work. Work 2011; 39:169-76. [PMID: 21673444 DOI: 10.3233/wor-2011-1163] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ann Marie Dale
- Washington University School of Medicine, Saint Louis, MO, USA
| | - A.E. Rohn
- Washington University School of Medicine, Saint Louis, MO, USA
| | - A. Burwell
- Washington University School of Medicine, Saint Louis, MO, USA
| | - W. Shannon
- Washington University School of Medicine, Saint Louis, MO, USA
| | - J. Standeven
- Washington University School of Medicine, Saint Louis, MO, USA
| | - A. Patton
- Washington University School of Medicine, Saint Louis, MO, USA
| | - B. Evanoff
- Washington University School of Medicine, Saint Louis, MO, USA
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Symanzik J, Wallett B, Zheng J, El Naqa I, Yang D, Deasy J, Shannon W. SU-FF-J-120: The ‘Image Tour’ as An Aid to Managing and Reviewing Multi-Modality Image Data Sets. Med Phys 2007. [DOI: 10.1118/1.2760625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
BACKGROUND A new diabetes shared care service was introduced in North Dublin. It was designed as a randomized controlled trial with a complex intervention comprising education of participating practitioners, the introduction of a community-based diabetes nurse specialist, local agreement on clinical protocols and structured communication across the primary-secondary care interface. OBJECTIVES Our aim was to assess the feasibility and effectiveness of a structured diabetes shared care service in a mixed health care system and to analyse the impact on total patient care. METHODS A Cluster randomized controlled trial lasting 18 months was carried out in 183 patients with type 2 diabetes from 30 general practices in North Dublin. Biophysical outcomes (HbA1c, blood pressure, body mass index), psychosocial measures (smoking status and Diabetes Clinic Treatment Satisfaction and Diabetes Well-being scores) and process outcomes were collected. RESULTS There were significant improvements in diabetes care delivery and in psychosocial outcomes, but no significant improvements in biomedical outcomes. Process data collection revealed a significant increase in diabetes care-related activity for participating patients with an increase in structured annual reviews and fewer patients defaulting from care. There were also significant improvements in information exchange between primary and secondary care. CONCLUSION Structured diabetes shared care, in a mixed health care system, can produce significant improvements in diabetes care delivery and in psychosocial outcomes for patients, with improved information exchange across the primary-secondary care interface.
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Affiliation(s)
- S Smith
- Department of General Practice, UCD, Beaumont Hospital, Dublin, Ireland.
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Smith SM, O'Leary M, Bury G, Shannon W, Tynan A, Staines A, Thompson C. A qualitative investigation of the views and health beliefs of patients with Type 2 diabetes following the introduction of a diabetes shared care service. Diabet Med 2003; 20:853-7. [PMID: 14510868 DOI: 10.1046/j.1464-5491.2003.01071.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS A qualitative research approach was adopted in order to explore the views and health beliefs of patients with Type 2 diabetes who had experienced a new structured diabetes shared care service. METHODS Patients from 15 general practices were randomly selected and invited to attend three focus groups. Two independent researchers adopted the "Framework" technique to analyse the transcribed data and identify key themes expressed by patients. RESULTS Themes relating to diabetes included frustration, victimization and powerlessness in relation to living with diabetes, controlling blood sugar, medication and economic barriers to care. Differences in emphases between patients and healthcare providers emerged. Patients were generally positive about shared care and largely identified it with the nurses involved. CONCLUSION This research highlights the importance of an in-depth exploration of patients' views during changes in diabetes care delivery to identify service delivery failures and gaps in patient knowledge such as lack of awareness of the extent of macrovascular risk.
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Affiliation(s)
- S M Smith
- Department of General Practice, UCD, Dublin, Ireland.
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Ahrens T, Schallom L, Bettorf K, Ellner S, Hurt G, O'Mara V, Ludwig J, George W, Marino T, Shannon W. End-tidal carbon dioxide measurements as a prognostic indicator of outcome in cardiac arrest. Am J Crit Care 2001; 10:391-8. [PMID: 11688606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
PURPOSE To evaluate the use of end-tidal carbon dioxide values in predicting survival in cardiopulmonary arrest. BACKGROUND The decision about when to terminate resuscitative efforts for patients with cardiopulmonary arrest is often subjective. End-tidal carbon dioxide values have been suggested as potential objective criteriafor making this decision. METHODS This study was a cooperative effort of the St Louis chapter of the American Association of Critical-Care Nurses and its members and involved 6 hospitals and an air evacuation service. All adult patients who had a cardiopulmonary arrest were eligiblefor the study. Once a patient with cardiac arrest was intubated, end-tidal carbon dioxide and cardiac rhythms were measured and recorded every 5 minutes for 20 minutes or until resuscitation efforts were terminated. Patients' survival at the time of the arrest, survival 24 hours after the arrest, and discharge status were followed up. RESULTS A total of 127 patients were enrolled in the study. All but 1 patient with end-tidal carbon dioxide values less than 10 mm Hg died before discharge. End-tidal carbon dioxide values greater than 10 mm Hg were associated with various degrees of survival. Overall survival to discharge was less than 14%, regardless of the end-tidal carbon dioxide value. CONCLUSION Measurements of end-tidal carbon dioxide can be used to accurately predict nonsurvival of patients with cardiopulmonary arrest. End-tidal carbon dioxide levels should be monitored during cardiopulmonary arrest and should be considered a useful prognostic value for determining the outcome of resuscitative efforts.
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Affiliation(s)
- T Ahrens
- Barnes-Jewish Hospital, St. Louis, MO, USA
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7
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Ahrens T, Schallom L, Bettorf K, Ellner S, Hurt G, O'Mara V, Ludwig J, George W, Marino T, Shannon W. End-tidal carbon dioxide measurements as a prognostic indicator of outcome in cardiac arrest. Am J Crit Care 2001. [DOI: 10.4037/ajcc2001.10.6.391] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE: To evaluate the use of end-tidal carbon dioxide values in predicting survival in cardiopulmonary arrest. BACKGROUND: The decision about when to terminate resuscitative efforts for patients with cardiopulmonary arrest is often subjective. End-tidal carbon dioxide values have been suggested as potential objective criteriafor making this decision. METHODS: This study was a cooperative effort of the St Louis chapter of the American Association of Critical-Care Nurses and its members and involved 6 hospitals and an air evacuation service. All adult patients who had a cardiopulmonary arrest were eligiblefor the study. Once a patient with cardiac arrest was intubated, end-tidal carbon dioxide and cardiac rhythms were measured and recorded every 5 minutes for 20 minutes or until resuscitation efforts were terminated. Patients' survival at the time of the arrest, survival 24 hours after the arrest, and discharge status were followed up. RESULTS: A total of 127 patients were enrolled in the study. All but 1 patient with end-tidal carbon dioxide values less than 10 mm Hg died before discharge. End-tidal carbon dioxide values greater than 10 mm Hg were associated with various degrees of survival. Overall survival to discharge was less than 14%, regardless of the end-tidal carbon dioxide value. CONCLUSION: Measurements of end-tidal carbon dioxide can be used to accurately predict nonsurvival of patients with cardiopulmonary arrest. End-tidal carbon dioxide levels should be monitored during cardiopulmonary arrest and should be considered a useful prognostic value for determining the outcome of resuscitative efforts.
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Smith S, Bury G, O'Leary M, Shannon W, Tynan A, Staines A, Thompson C. The North Dublin Diabetes Shared Care (DiSC) Project: a profile of current diabetes care in Ireland. Ir Med J 2001; 94:240-3. [PMID: 11758626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The DiSC Project aims to assess the feasibility, effectiveness and costs of diabetes shared care in Ireland. Baseline results provide a profile of diabetes care in Ireland. Thirty general practices are participating in this randomised controlled trial. Outcomes include biophysical and psychosocial measures. The majority of patients agreed to participate in diabetes shared care. Data was collected from 183 patients with type 2 diabetes. The mean age of the patients is 65 years, 56% are male and 63% are GMS eligible. The mean HBA1c was 6.8% though 21% of patients had a HBA1c>8%. The majority of patients had a blood pressure, total cholesterol and body mass index above recommended guidelines. Only half the patients are attending a dietician or a chiropodist. The majority of patients have good glycaemic control but poor blood pressure and cholesterol control. The full trial results will determine if a shared care approach can improve clinical and psychosocial outcomes for patients.
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Affiliation(s)
- S Smith
- Department of General Practice, UCD, Beaumont Hospital, Dublin
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Mondy KE, Shannon W, Mundy LM. Evaluation of zinc bacitracin capsules versus placebo for enteric eradication of vancomycin-resistant Enterococcus faecium. Clin Infect Dis 2001; 33:473-6. [PMID: 11462182 DOI: 10.1086/321895] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2000] [Revised: 12/26/2000] [Indexed: 11/03/2022] Open
Abstract
Patients who are colonized with enteric vancomycin-resistant Enterococcus faecium (VREF) are a major reservoir for transmission of and infection with this organism. In a randomized, controlled study to assess the effectiveness of high-dose bacitracin in the eradication of enteric VREF, 12 patients who were colonized with VREF were randomized to receive placebo (n=6) or orally administered zinc bacitracin (n=6) for 10 days. Posttreatment perirectal or stool cultures indicated that after 3 weeks, VREF had been eradicated from the stool of only 2 (33%) of 6 patients in each group. Of the 8 remaining patients who were still VREF-positive at 3 weeks after treatment, 5 (62%) had later evidence of spontaneous enteric eradication at 8 weeks. Further testing of VREF isolates revealed that a significant number (n=22, 76%) were resistant to bacitracin and that patients may have been colonized with multiple different VREF strains. Although bacitracin was not effective in the enteric eradication of VREF, the high rates of spontaneous eradication suggest that other host and environmental factors are more important in achieving long-term suppression or elimination of VREF colonization.
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Affiliation(s)
- K E Mondy
- Division of Infectious Diseases, Washington University School of Medicine, 660 S. Euclid, St. Louis, MO 63141, USA
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Bowcock AM, Shannon W, Du F, Duncan J, Cao K, Aftergut K, Catier J, Fernandez-Vina MA, Menter A. Insights into psoriasis and other inflammatory diseases from large-scale gene expression studies. Hum Mol Genet 2001; 10:1793-805. [PMID: 11532989 DOI: 10.1093/hmg/10.17.1793] [Citation(s) in RCA: 194] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Approximately 2% of the Caucasian population is affected by psoriasis (PS); a chronic inflammatory skin disease triggered by both genetic and environmental risk factors. In addition to a major contribution from the HLA class I region, PS susceptibility loci have been mapped to a number of regions including 1q21, 3q21, 4qter, 14q31-q32, 17q24-q25, 19p13.3 and 20p. Some of these overlap with loci implicated in other autoimmune/inflammatory diseases. Global gene expression studies are beginning to provide insights into the etiology of these and other complex diseases. We used Affymetrix oligonucleotide arrays comprising approximately 12 000 known genes to initiate a more comprehensive analysis of the transcriptional changes that occur in involved and uninvolved skin of 15 psoriatic patients versus six normal controls. Expression levels of the transcripts detected on the arrays were first used to determine the relationship of samples to each other using hierarchical clustering. This analysis clearly differentiated involved psoriatic skin from uninvolved and normal skin. Clusters of differentially expressed genes with similar expression patterns in the same samples were then identified. Six out of 32 clusters contained a total of 177 transcripts that were differentially expressed in involved psoriatic skin versus normal skin. These differences were independent of the gender, age, skin site and HLA class I status of the patient. Ten of the 177 genes were also differentially expressed in uninvolved skin, and several mapped to regions previously shown to harbor psoriasis susceptibility loci.
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Affiliation(s)
- A M Bowcock
- Department of Internal Medicine, Washington University School of Medicine, St Louis, MO 63110, USA.
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11
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Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001; 285:2864-70. [PMID: 11401607 DOI: 10.1001/jama.285.22.2864] [Citation(s) in RCA: 3528] [Impact Index Per Article: 153.4] [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] [Indexed: 11/14/2022]
Abstract
CONTEXT Patients who have atrial fibrillation (AF) have an increased risk of stroke, but their absolute rate of stroke depends on age and comorbid conditions. OBJECTIVE To assess the predictive value of classification schemes that estimate stroke risk in patients with AF. DESIGN, SETTING, AND PATIENTS Two existing classification schemes were combined into a new stroke-risk scheme, the CHADS( 2) index, and all 3 classification schemes were validated. The CHADS( 2) was formed by assigning 1 point each for the presence of congestive heart failure, hypertension, age 75 years or older, and diabetes mellitus and by assigning 2 points for history of stroke or transient ischemic attack. Data from peer review organizations representing 7 states were used to assemble a National Registry of AF (NRAF) consisting of 1733 Medicare beneficiaries aged 65 to 95 years who had nonrheumatic AF and were not prescribed warfarin at hospital discharge. MAIN OUTCOME MEASURE Hospitalization for ischemic stroke, determined by Medicare claims data. RESULTS During 2121 patient-years of follow-up, 94 patients were readmitted to the hospital for ischemic stroke (stroke rate, 4.4 per 100 patient-years). As indicated by a c statistic greater than 0.5, the 2 existing classification schemes predicted stroke better than chance: c of 0.68 (95% confidence interval [CI], 0.65-0.71) for the scheme developed by the Atrial Fibrillation Investigators (AFI) and c of 0.74 (95% CI, 0.71-0.76) for the Stroke Prevention in Atrial Fibrillation (SPAF) III scheme. However, with a c statistic of 0.82 (95% CI, 0.80-0.84), the CHADS( 2) index was the most accurate predictor of stroke. The stroke rate per 100 patient-years without antithrombotic therapy increased by a factor of 1.5 (95% CI, 1.3-1.7) for each 1-point increase in the CHADS( 2) score: 1.9 (95% CI, 1.2-3.0) for a score of 0; 2.8 (95% CI, 2.0-3.8) for 1; 4.0 (95% CI, 3.1-5.1) for 2; 5.9 (95% CI, 4.6-7.3) for 3; 8.5 (95% CI, 6.3-11.1) for 4; 12.5 (95% CI, 8.2-17.5) for 5; and 18.2 (95% CI, 10.5-27.4) for 6. CONCLUSION The 2 existing classification schemes and especially a new stroke risk index, CHADS( 2), can quantify risk of stroke for patients who have AF and may aid in selection of antithrombotic therapy.
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Affiliation(s)
- B F Gage
- Division of General Medical Sciences, Washington University School of Medicine Campus, Box 8005, 660 S Euclid Ave, St Louis, MO 63110, USA.
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Garbutt JM, Goldstein M, Gellman E, Shannon W, Littenberg B. A randomized, placebo-controlled trial of antimicrobial treatment for children with clinically diagnosed acute sinusitis. Pediatrics 2001; 107:619-25. [PMID: 11335733 DOI: 10.1542/peds.107.4.619] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.3] [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: 11/24/2022] Open
Abstract
OBJECTIVE Although antimicrobial treatment for children with acute sinusitis is used commonly, it is unclear whether it offers significant clinical benefit. The purpose of this study was to evaluate the effectiveness of antimicrobial treatments for acute sinusitis as they are used in community pediatric practice. METHODS We conducted a randomized, placebo-controlled trial in 3 community pediatric practices in St Louis, Missouri. A total of 188 patients who were between the ages of 1 and 18 years and who had had 10 to 28 days of persistent sinus symptoms and a clinical diagnosis of acute sinusitis were randomized to receive 14 days of amoxicillin (40 mg/kg/d in 3 daily doses), amoxicillin-clavulanate (amoxicillin 45 mg/kg/d in 2 daily doses), or placebo. Change in sinus symptoms was assessed both by a quantitative symptom score (the S5 score) and subjectively by the parent. Secondary outcomes included adverse effects of treatment and recurrence or relapse of sinus symptoms. Outcomes were assessed by telephone interviews over a 2-month period. RESULTS Of the 161 patients who were included in the analysis, 58 received amoxicillin, 48 received amoxicillin-clavulanate, and 55 received placebo. Day 14 improvement rates were 79%, 81%, and 79%, respectively. There were no differences in the 14-day change in S5 score among treatment groups. The rates of adverse events (amoxicillin, 19%; amoxicillin-clavulanate, 11%; placebo, 10%), relapse (amoxicillin, 12%; amoxicillin-clavulanate, 13%; placebo, 13%), and recurrence (amoxicillin, 9%; amoxicillin-clavulanate, 13%; placebo, 13%) of sinus symptoms were similar among treatment groups. CONCLUSION Neither amoxicillin nor amoxicillin-clavulanate offered any clinical benefit compared with placebo for children with clinically diagnosed acute sinusitis.
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Affiliation(s)
- J M Garbutt
- Division of General Medical Sciences, Washington University School of Medicine, St Louis, Missouri, USA.
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Cullen A, Kiberd B, Devaney D, Gillan J, Kelehan P, Matthews TG, Mayne P, Murphy N, O'Regan M, Shannon W, Thornton L. Concentrations of antimony in infants dying from SIDS and infants dying from other causes. Arch Dis Child 2000; 82:244-7. [PMID: 10685932 PMCID: PMC1718263 DOI: 10.1136/adc.82.3.244] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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: 11/03/2022]
Abstract
OBJECTIVES Raised concentrations of antimony have been found in infants dying of sudden infant death syndrome (SIDS). The presumed source of this antimony is toxic gases generated from fire retardants that are present in cot mattresses. The aim of this study was to determine the role of antimony in SIDS. DESIGN Samples of liver, brain, serum, and urine were collected from all patients dying from SIDS and a group of aged matched control infants who had died of other causes. SETTING Nationwide study in Ireland. SUBJECTS 52 infants dying from SIDS and 19 control infants aged > 7 days and < 1 year. RESULTS The median concentration of antimony in the liver and brain of infants dying of SIDS was < 1 ng/g, with no difference detected between the infants dying from SIDS and the control infants. The range of antimony in the serum of infants dying of SIDS was 0.09-0.71 microg/litre (median, 0.26). Although no difference was found between infants dying from SIDS and control infants, SIDS infants were found to have higher concentrations when compared with healthy infants in the 1st year of life, probably as a result of release of antimony into serum after death. Urine antimony concentrations in infants dying from SIDS were < 3.91 ng/mg (corrected for creatinine) and similar to values found both in control infants and healthy infants. CONCLUSION There is no evidence to support a causal role for antimony in SIDS.
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Affiliation(s)
- A Cullen
- Department of Paediatrics, University College Dublin, The Children's Hospital, Temple Street, Dublin 1, Republic of Ireland
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Brook AD, Ahrens TS, Schaiff R, Prentice D, Sherman G, Shannon W, Kollef MH. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 1999; 27:2609-15. [PMID: 10628598 DOI: 10.1097/00003246-199912000-00001] [Citation(s) in RCA: 764] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare a practice of protocol-directed sedation during mechanical ventilation implemented by nurses with traditional non-protocol-directed sedation administration. DESIGN Randomized, controlled clinical trial. SETTING Medical intensive care unit (19 beds) in an urban teaching hospital. PATIENTS Patients requiring mechanical ventilation (n = 321). INTERVENTIONS Patients were randomly assigned to receive either protocol-directed sedation (n = 162) or non-protocol-directed sedation (n = 159). MEASUREMENTS AND MAIN RESULTS The median duration of mechanical ventilation was 55.9 hrs (95% confidence interval, 41.0-90.0 hrs) for patients managed with protocol-directed sedation and 117.0 hrs (95% confidence interval, 96.0-155.6 hrs) for patients receiving non-protocol-directed sedation. Kaplan-Meier analysis demonstrated that patients in the protocol-directed sedation group had statistically shorter durations of mechanical ventilation than patients in the non-protocol-directed sedation group (chi-square = 7.00, p = .008, log rank test; chi-square = 8.54, p = .004, Wilcoxon's test; chi-square = 9.18, p = .003, -2 log test). Lengths of stay in the intensive care unit (5.7+/-5.9 days vs. 7.5+/-6.5 days; p = .013) and hospital (14.0+/-17.3 days vs. 19.9+/-24.2 days; p < .001) were also significantly shorter among patients in the protocol-directed sedation group. Among the 132 patients (41.1%) receiving continuous intravenous sedation, those in the protocol-directed sedation group (n = 66) had a significantly shorter duration of continuous intravenous sedation than those in the non-protocol-directed sedation group (n = 66) (3.5+/-4.0 days vs. 5.6+/-6.4 days; p = .003). Patients in the protocol-directed sedation group also had a significantly lower tracheostomy rate compared with patients in the non-protocol-directed sedation group (10 of 162 patients [6.2%] vs. 21 of 159 patients [13.2%], p = .038). CONCLUSIONS The use of protocol-directed sedation can reduce the duration of mechanical ventilation, the intensive care unit and hospital lengths of stay, and the need for tracheostomy among critically ill patients with acute respiratory failure.
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Affiliation(s)
- A D Brook
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Petersen DL, Murphy DE, Jaffe DM, Richardson MS, Fisher EB, Shannon W, Sussman L, Strunk RC. A tool to organize instructions at discharge after treatment of asthmatic children in an emergency department. J Asthma 1999; 36:597-603. [PMID: 10524543 DOI: 10.3109/02770909909087297] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Asthma exacerbations continue to be a major cause of visits to emergency departments (ED). Comprehensive care in the outpatient setting, with planning for early intervention for exacerbations, can reduce emergency visits. Thus, a major goal of ED intervention is to establish a link between the patient and the provider of ongoing asthma care, where complete education can be achieved and reinforced over time. When designing the Asthma 1-2-3 Plan discharge teaching tool for the ED, consideration was given to educational format, readability, patient population, and setting in which education was to be delivered. To evaluate use of the plan, ED records of patients enrolled in a separate asthma study, the Neighborhood Asthma Coalition (NAC), were audited for two 8-month intervals, May-December 1993 (before initiation of the plan) and May December 1994 (starting 1 month after completion of pilot testing on the plan in the ED). To evaluate effectiveness of the plan, records of physicians who cared for children in the NAC were evaluated. The database was reviewed for the date of the first visit for planned review of asthma that occurred after the acute asthma ED visit. After introduction of the plan, the proportion of children told to return to the physician for follow-up increased from 54% to 81%. The proportion of children given advice to return to their physician within the recommended 3 days or less increased from 11% to 54%. Chi2 Analyses showed that these changes were both statistically significant (p<0.0001). The plan was not effective in achieving increased follow-up visits for regular asthma care, in that 7% returned for follow-up within 7 days after an ED visit before the plan and only 6% returned for such a visit after the Plan. Successful initiation of a focused discharge teaching tool into the routine of the ED increased appropriate advice given at time of discharge from the ED. Although unsuccessful in increasing appropriate follow-up, the present intervention uses the ED not as a base for asthma education, but as a point for contacting patients in need of regular care and education, and for promoting access to that regular care.
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Affiliation(s)
- D L Petersen
- Department of Respiratory Care, St. Louis Children's Hospital, Missouri 63110, USA.
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Abstract
OBJECTIVE To identify clinical predictors for tracheostomy among patients requiring mechanical ventilation in the intensive care unit (ICU) setting and to describe the outcomes of patients receiving a tracheostomy. DESIGN Prospective cohort study. SETTING Intensive care units of Barnes-Jewish Hospital, an urban teaching hospital. PATIENTS 521 patients requiring mechanical ventilation in an ICU for >12 hours. INTERVENTIONS Prospective patient surveillance and data collection. MEASUREMENTS AND MAIN RESULTS The main variables studied were hospital mortality, duration of mechanical ventilation, length of stay in the ICU and the hospital, and acquired organ-system derangements. Fifty-one (9.8%) patients received a tracheostomy. The hospital mortality of patients with a tracheostomy was statistically less than the hospital mortality of patients not receiving a tracheostomy (13.7% vs. 26.4%; p = .048), despite having a similar severity of illness at the time of admission to the ICU (Acute Physiology and Chronic Health Evaluation [APACHE] II scores, 19.2 +/- 6.1 vs. 17.8 +/- 7.2; p = .173). Patients receiving a tracheostomy had significantly longer durations of mechanical ventilation (19.5 +/- 15.7 days vs. 4.1 +/- 5.3 days; p < .001) and hospitalization (30.9 +/- 18.1 days vs. 12.8 +/- 10.1 days; p < .001) compared with patients not receiving a tracheostomy. Similarly, the average duration of intensive care was significantly longer among the hospital nonsurvivors receiving a tracheostomy (n = 7) compared with the hospital nonsurvivors without a tracheostomy (n = 124; 30.9 +/- 16.3 days vs. 7.9 +/- 7.3 days; p < .001). Multiple logistic regression analysis demonstrated that the development of nosocomial pneumonia (adjusted odds ratio [AOR], 4.72; 95% confidence interval [CI], 3.24-6.87; p < .001), the administration of aerosol treatments (AOR, 3.00; 95% CI, 2.184.13; p < .001), having a witnessed aspiration event (AOR, 3.79; 95% CI, 2.30-6.24; p = .008), and requiring reintubation (AOR, 2.21; 95% CI, 1.54-3.18; p = .028) were variables independently associated with patients undergoing tracheostomy and receiving prolonged ventilatory support. Among the 44 survivors receiving a tracheostomy in the ICU, 38 (86.4%) were alive 30 days after hospital discharge and 31 (70.5%) were living at home. CONCLUSIONS Despite having longer lengths of stay in the ICU and hospital, patients with respiratory failure who received a tracheostomy had favorable outcomes compared with patients who did not receive a tracheostomy. These data suggest that physicians are capable of selecting critically ill patients who most likely will benefit from placement of a tracheostomy. Additionally, specific clinical variables were identified as risk factors for prolonged ventilatory assistance and the need for tracheostomy.
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Affiliation(s)
- M H Kollef
- Department of Medicine, Washington University School of Medicine, St.Louis, MO, USA
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Murphy AW, McSweeney M, O'Dowd TC, Bury G, Shannon W, Bradley CP. Using email for abstracts submitted for conference was unexpectedly labour intensive. BMJ 1998; 317:543. [PMID: 9712622 PMCID: PMC1113773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Murphy AW, McSweeney M, O'Dowd TC, Bury G, Shannon W, Bradley CP. Using email for abstracts submitted for conference was unexpectedly labour intensive. West J Med 1998. [DOI: 10.1136/bmj.317.7157.543] [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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Kollef MH, Eisenberg PR, Shannon W. A rapid assay for the detection of circulating D-dimer is associated with clinical outcomes among critically ill patients. Crit Care Med 1998; 26:1054-60. [PMID: 9635655 DOI: 10.1097/00003246-199806000-00027] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine whether the results of a rapid, semiquantitative assay for the detection of circulating D-dimer in whole blood (SRDD assay) are associated with the occurrence of clinical outcomes among critically ill patients. DESIGN Prospective, blinded, single-center study. SETTING Medical intensive care unit (ICU) of Barnes-Jewish Hospital, St. Louis, MO, a university-affiliated teaching hospital. PATIENTS Three hundred twenty-three adult patients admitted to a medical ICU. INTERVENTIONS Collection of blood samples within 24 hrs of ICU admission. MEASUREMENTS AND MAIN RESULTS The main outcome measures evaluated included vascular thrombosis, hospital mortality, and the development of multiorgan dysfunction. Fifty (15.5%) patients were found to have increased concentrations of D-dimer as detected by the SRDD assay within 24 hrs of ICU admission. The concentrations of plasma D-dimer simultaneously measured by an enzyme immunoassay based on the same antibody were significantly greater among patients with a positive SRDD assay compared with patients with a negative SRDD assay (1214+/-483 vs. 405+/-407 ng/mL; p< .001). The hospital mortality rate was significantly greater among SRDD-positive patients compared with SRDD-negative patients (32.0% vs. 15.0%; p=.004). SRDD-positive patients also had significantly greater frequencies of acquired multiorgan dysfunction (48.0% vs. 17.6%; p < .001), severe sepsis or septic shock (56.0% vs. 20.9%; p< .001), and vascular thrombosis (14.0% vs. 4.0%; p=.005) compared with SRDD-negative patients. Multiple logistic regression analysis identified the presence of increased concentrations of D-dimer, detected by a positive SRDD assay, as being independently associated with vascular thrombosis (adjusted odds ratio 5.06; 95% confidence interval 2.96 to 8.65; p=.003) and the development of multiorgan dysfunction (adjusted odds ratio 1.51; 95% confidence interval 1.28 to 1.78; p=.012). CONCLUSIONS Our preliminary investigation suggests that the results from a rapid whole blood assay for the semiquantitative detection of circulating D-dimer are associated with clinical outcomes among patients admitted to a medical ICU. In addition, the use of D-dimer to identify the presence of active intravascular thrombosis may identify patients likely to benefit from antithrombotic therapies in the ICU setting.
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Affiliation(s)
- M H Kollef
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
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Kollef MH, O'Brien JD, Zuckerman GR, Shannon W. BLEED: a classification tool to predict outcomes in patients with acute upper and lower gastrointestinal hemorrhage. Crit Care Med 1997; 25:1125-32. [PMID: 9233736 DOI: 10.1097/00003246-199707000-00011] [Citation(s) in RCA: 122] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To develop an outcome prediction tool (BLEED: ongoing bleeding, low systolic blood pressure, elevated prothrombin time, erratic mental status, unstable comorbid disease) for clinical use in patients with either acute upper or acute lower gastrointestinal (GI) hemorrhage. DESIGN A cohort study. SETTING Barnes Hospital and Jewish Hospital, two private university-affiliated teaching hospitals in St. Louis, MO. PATIENTS Four hundred sixty-five patients with either acute upper or acute lower GI hemorrhage admitted from the emergency department. INTERVENTIONS Admission of patients to the intensive care unit or hospital ward was determined by emergency department physicians, without use or knowledge of BLEED criteria. Patients meeting any BLEED criteria at their initial assessment in the emergency department were classified as "high-risk." All other patients were classified as "low-risk." MEASUREMENTS AND MAIN RESULTS The main outcome measure was the occurrence of an inhospital complication, defined as recurrent GI hemorrhage, surgery to control the source of hemorrhage, and hospital mortality. Patients classified as high-risk had significantly greater rates of inhospital complications at both Barnes Hospital (relative risk, 2.47; 95% confidence interval, 1.38 to 4.44; p < .001) and Jewish Hospital (relative risk, 8.94; 95% confidence interval, 3.92 to 20.41; p < .001) compared with patients classified as low-risk. Patients classified as high-risk at either hospital were significantly more likely to develop additional organ system derangements, require a greater number of transfused units of packed red blood cells, and have longer hospital stays compared with patients classified as low-risk (p < .006). The BLEED classification also identified a greater frequency of intensive care admission for both low-risk (RR, 4.21; 95% Cl, 2.24 to 7.89) and high-risk (relative risk, 1.58; 95% confidence interval, 1.23 to 2.02) patients at Barnes Hospital compared with those patients at Jewish Hospital, although no beneficial effects on patient outcome were reported. CONCLUSIONS The BLEED classification, applied at initial emergency department evaluation and before admission, predicts hospital outcomes for patients with acute upper or lower GI hemorrhage. This outcome prediction tool also identified variations in intensive care utilization between two hospitals.
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Affiliation(s)
- M H Kollef
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
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Kollef MH, Shapiro SD, Silver P, St John RE, Prentice D, Sauer S, Ahrens TS, Shannon W, Baker-Clinkscale D. A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med 1997; 25:567-74. [PMID: 9142019 DOI: 10.1097/00003246-199704000-00004] [Citation(s) in RCA: 525] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare a practice of protocol-directed weaning from mechanical ventilation implemented by nurses and respiratory therapists with traditional physician-directed weaning. DESIGN Randomized, controlled trial. SETTING Medical and surgical intensive care units in two university-affiliated teaching hospitals. PATIENTS Patients requiring mechanical ventilation (n = 357). INTERVENTIONS Patients were randomly assigned to receive either protocol-directed (n = 179) or physician-directed (n = 178) weaning from mechanical ventilation. MEASUREMENTS AND MAIN RESULTS The primary outcome measure was the duration of mechanical ventilation from tracheal intubation until discontinuation of mechanical ventilation. Other outcome measures included need for reintubation, length of hospital stay, hospital mortality rate, and hospital costs. The median duration of mechanical ventilation was 35 hrs for the protocol-directed group (first quartile 15 hrs; third quartile 114 hrs) compared with 44 hrs for the physician-directed group (first quartile 21 hrs; third quartile 209 hrs). Kaplan-Meier analysis demonstrated that patients randomized to protocol-directed weaning had significantly shorter durations of mechanical ventilation compared with patients randomized to physician-directed weaning (chi 2 = 3.62, p = .057, log-rank test; chi 2 = 5.12, p = .024, Wilcoxon test). Cox proportional-hazards regression analysis, adjusting for other covariates, showed that the rate of successful weaning was significantly greater for patients receiving protocol-directed weaning compared with patients receiving physician-directed weaning (risk ratio 1.31; 95% confidence interval 1.15 to 1.50; p = .039). The hospital mortality rates for the two treatment groups were similar (protocol-directed 22.3% vs. physician-directed 23.6%; p = .779). Hospital cost savings for patients in the protocol-directed group were $42,960 compared with hospital costs for patients in the physician-directed group. CONCLUSION Protocol-guided weaning of mechanical ventilation, as performed by nurses and respiratory therapists, is safe and led to extubation more rapidly than physician-directed weaning.
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Affiliation(s)
- M H Kollef
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
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22
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Bailey TC, Ritchie DJ, McMullin ST, Kahn M, Reichley RM, Casabar E, Shannon W, Dunagan WC. A randomized, prospective evaluation of an interventional program to discontinue intravenous antibiotics at two tertiary care teaching institutions. Pharmacotherapy 1997; 17:277-81. [PMID: 9085319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To evaluate a program to discontinue intravenous antibiotics at two teaching hospitals, 102 inpatients meeting eligibility criteria were randomly assigned to two groups. In one group, patients' physicians were contacted by pharmacists with recommendations to discontinue intravenous antibiotic therapy; in the other, patients were simply observed. Measured outcomes were antibiotic costs, length of stay, need to restart intravenous antibiotics, in-hospital mortality, and 30-day readmissions. The intervention significantly reduced mean antibiotic costs per patient ($19.82 vs $35.84, p = 0.03), but related labor costs exceeded this benefit. Readmissions were significantly more frequent in the intervention group than in the control group (29% vs 9.8% p = 0.02), but they were not infection related. No impact was demonstrated on the other measured outcomes. Institutions considering such programs or with one in place should conduct similar evaluations.
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Affiliation(s)
- T C Bailey
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
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Murphy AW, Siriwardena R, McGrogan K, Shannon W. Insomnia: tablets for thought. Ir Med J 1997; 90:54. [PMID: 9105124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Gilula LA, Manske PR, Yin Y, Shannon W. Arthrography of the wrist. Assessment of the ligaments in young asymptomatic adults. J Bone Joint Surg Am 1997; 79:312-3. [PMID: 9052552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Hickey AM, Bury G, O'Boyle CA, Bradley F, O'Kelly FD, Shannon W. A new short form individual quality of life measure (SEIQoL-DW): application in a cohort of individuals with HIV/AIDS. BMJ 1996; 313:29-33. [PMID: 8664768 PMCID: PMC2351443 DOI: 10.1136/bmj.313.7048.29] [Citation(s) in RCA: 306] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Quality of life is an increasingly important outcome measure in medicine and health care. Many measures of quality of life present patients with predetermined lists of questions that may or may not be relevant to the individual patient. This paper describes a brief measure, the SEIQoL-DW, which is derived from the schedule for evaluation of individual quality of life (SEIQoL). The measure allows respondents to nominate the areas of life which are most important, rate their level of functioning or satisfaction with each, and indicate the relative importance of each to their overall quality of life. Given its practicality and brevity, the measure should prove particularly useful in clinical situations where patient generated data on quality of life is important. This article describes the first clinical application of the measure, assessing the quality of life of a cohort of patients with HIV/AIDS managed in general practice.
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Affiliation(s)
- A M Hickey
- Department of General Practice, University College Dublin, Coombe Healthcare Centre, Republic of Ireland
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26
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O'Mahony B, Culhane A, Rouse JM, Ryan F, Shannon W. Keeping up to date--a challenge for teaching practices. Ir Med J 1995; 88:170-171. [PMID: 8575907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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27
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Harrington P, Woodman C, Shannon W. Childhood immunisation uptake in the Republic of Ireland. Ir Med J 1995; 88:153-154. [PMID: 8575901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Conroy M, Shannon W. Clinical guidelines: their implementation in general practice. Br J Gen Pract 1995; 45:371-5. [PMID: 7612343 PMCID: PMC1239302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
In recent years the development of clinical guidelines has received increasing attention from medical educators and those involved in standard setting, and has been initiated at both central and local levels. This review article outlines the current state of knowledge with regard to clinical guideline implementation in medical practice. It deals with the main aspects of the current guideline debate, such as, clinical freedom and doctor autonomy, the importance of ownership in guideline implementation, the effectiveness of guidelines in changing practice and, in particular, the strategies needed to implement clinical guidelines in general practice. Mechanisms of behavioural change that have been recognized as being important for implementation are also discussed. If implementation strategies are not treated as an integral part of the development process then clinical guidelines may fail to achieve their potential in changing clinical practice.
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Affiliation(s)
- M Conroy
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin
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Bradley F, Bury G, O'Kelly F, Shannon W, Hickey A, Mulcahy F. Analysis of care of HIV positive patients: hospital and general practice components. Ir Med J 1995; 88:98-100. [PMID: 7635689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Fifty-seven HIV positive adults (mostly injecting drug users) attending two inner city Dublin general practices were followed for one year to identify the general practice and hospital components of their care. Many patients had advanced disease; during the year 10/57 (17.5%) died. The group made a median of seven visits to general practice (range 0-35) and two visits to hospital HIV clinics (range 0-21). A quarter of the group (14/57) was seen only in general practice and did not attend hospital; only two patients did not attend either the HIV Clinic or the GP during the year. Hospital admission was needed for 15/57 (26.3%) patients on a total of 31 occasions with an average length of stay of 10 days per admission; 80% of these admissions were generated by 10 patients with AIDS. The indication for almost all admissions was serious physical illness or diagnostic or therapeutic procedure. Patients with symptomatic or advanced HIV disease required a higher level of care than those with asymptomatic disease. It is essential that the agencies involved in meeting this level of demand be adequately resourced and that they liaise closely.
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Affiliation(s)
- F Bradley
- HIV Primary Care Research Unit, Coombe Healthcare Centre, Dublin
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Harrington P, Williams N, Conroy R, Shannon W. Employing a practice nurse: what sort of GP? Ir Med J 1995; 88:28-9. [PMID: 7737839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The general practitioners employing all 102 nurses known to be practising as practice nurses in the Republic of Ireland were sent a questionnaire for completion anonymously. A response rate of 51% was obtained. Practices employing practice nurses were found to be mostly single handed (28/52) in a town/rural setting (39/52) and participating in the General Medical Services (GMS) Scheme (49/51)*. A substantial minority of practices (16/51)* derived more than 75% of their income from the GMS. Eighty five percent of practices felt that their practice "gained or would gain financially" through the employment of a practice nurse. (* = one non-respondent)
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Affiliation(s)
- P Harrington
- Department of General Practice, Royal College of Surgeons in Ireland, St. Stephens Green, Dublin
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31
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Bradley F, Bury G, Mulcahy F, O'Kelly F, Shannon W, Langton-Burke D. Attitudes towards and experience of general practice among HIV-positive patients in the Republic of Ireland. Int J STD AIDS 1994; 5:327-31. [PMID: 7819349 DOI: 10.1177/095646249400500508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In order to study their attitudes to and experience of general practitioner care, 150 attenders at the only HIV specialist clinic in the Republic of Ireland were asked to complete an anonymous, self administered questionnaire. (81%) of respondents reported having a regular GP and 94% of those indicated that the GP was aware of their HIV diagnosis. The majority (64%) of patients with a regular GP reported seeing their doctor on more than 5 occasions during the previous year. Most patients were satisfied with the support which they received from their GPs. Even so, the majority of patients (72%) would go directly to the hospital clinic for any problem which they perceive to be HIV related.
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Affiliation(s)
- F Bradley
- HIV Primary Care Research Project, Dublin, Ireland
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Abstract
All 102 nurses known to be practising as practice nurses in the Republic of Ireland were sent a questionnaire for completion anonymously. A response rate of 56% was obtained. Over half the respondents had commenced practice nursing since the new General Medical Services contract in 1989 following a career break, the median duration of which was 5.5 years. Two thirds had completed midwifery training but only one was a qualified Public Health Nurse. An examination of the tasks performed by the respondents suggests that Irish practice nurses are already filling an extended role beyond their treatment room duties with 46% involved in smoking counselling, 74% in counselling on cholesterol and 37% involved in asthma care. Nurses providing antenatal care or taking cervical smears were not, however, more likely to have completed midwifery training.
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Affiliation(s)
- P Harrington
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin 2
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Friberg D, Bryant J, Shannon W, Whiteside TL. In vitro cytokine production by normal human peripheral blood mononuclear cells as a measure of immunocompetence or the state of activation. Clin Diagn Lab Immunol 1994; 1:261-8. [PMID: 7496960 PMCID: PMC368246 DOI: 10.1128/cdli.1.3.261-268.1994] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Measurements of cytokine levels in serum may not adequately reflect the cytokine-producing potential of immune cells because of the short half-lives of cytokines and the presence of various inhibitors in human sera. In vitro cytokine production by peripheral blood mononuclear cells (PBMCs) can be an important and reliable measure of immunocompetence. Also, spontaneous in vitro release of cytokines by PBMCs may serve as a measure of their activation in vivo. In the present study, normal ranges for the in vitro production by PBMCs of interleukin-1 beta (IL-1 beta), tumor necrosis factor alpha (TNF-alpha), IL-2, and gamma interferon (IFN-gamma) were established; the feasibility of using cryopreserved PBMCs for assays of in vitro cytokine production was evaluated; and spontaneous (unstimulated) versus induced production of cytokines by fresh and cryopreserved PBMCs from healthy donors was compared. Supernatants obtained from paired fresh and frozen PBMCs were quantitated for IL-1 beta, TNF-alpha, IL-2, and IFN-gamma by using enzyme-linked immunosorbent assay or a radioimmunoassay standardized against World Health Organization cytokine standards. Fresh or cryopreserved PBMCs activated with lipopolysaccharide produced comparable levels of IL-1 beta. However, the mean levels of stimulated production of TNF-alpha, IFN-gamma, and IL-2 were significantly higher in cryopreserved versus fresh PBMCs (P < or = 0.0004). Correlations between the level of production of each cytokine by fresh versus cryopreserved in vitro-stimulated PBMCs were statistically significant, although of moderate magnitude. Spontaneous cytokine release by fresh versus cryopreserved cells was not significantly different.
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Affiliation(s)
- D Friberg
- Department of Pathology, University of Pittsburgh, Pennsylvania, USA
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Schwartz WJ, Takeuchi J, Shannon W, Davis EM, Aronin N. Temporal regulation of light-induced Fos and Fos-like protein expression in the ventrolateral subdivision of the rat suprachiasmatic nucleus. Neuroscience 1994; 58:573-83. [PMID: 8170538 DOI: 10.1016/0306-4522(94)90082-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We measured c-fos messenger RNA levels and Fos protein immunoreactivity in the suprachiasmatic nucleus of rats as a function of light and time of day. Immunohistochemistry demonstrated a daily rhythm of immunoreactive Fos in the ventrolateral subdivision of the suprachiasmatic nucleus of animals entrained to a 12 h/12 h light-dark cycle; expression was low during the dark phase, peaked about 2 h after light onset at dawn, and remained elevated at an intermediate level for the remainder of the light phase. Immunoblots of nuclear extracts showed a 54,000 mol. wt band that increased in density from the dark phase to the early light phase and decreased again during the late light phase. In situ hybridization using a radiolabeled cDNA probe revealed a c-fos messenger RNA signal that was detected as early as 15 min after dawn, prominent at 30 min, and absent by 2 h. The expression of c-fos messenger RNA and Fos immunoreactivity in the suprachiasmatic nucleus depended on the presence of ambient light. In rats entrained to two daily 1-h light pulses corresponding to dawn and dusk ("skeleton" photoperiod) instead of the complete light-dark cycle, immunoreactive Fos was elicited by the dawn pulse alone and was less persistent than during the complete photoperiod. In rats free-running in constant darkness, c-fos messenger RNA and Fos immunoreactivity were stimulated by 2-h light pulses administered only during the subjective night and early subjective day, but not by light pulses during the middle or late subjective day or in the absence of light pulses.
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Affiliation(s)
- W J Schwartz
- Department of Neurology, University of Massachusetts Medical School, Worcester 01655
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35
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Logan TF, Shannon W, Bryant J, Kane P, Wolmark N, Posner M, Kirkwood JM, Ernstoff MS, Futrell JW, Straw LD. Preparation of viable tumour cell vaccine from human solid tumours: relationship between tumour mass and cell yield. The Tissue Bank, Pittsburgh Cancer Institute. Melanoma Res 1993; 3:451-5. [PMID: 8161884 DOI: 10.1097/00008390-199311000-00008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Active specific immunotherapy for cancer often requires the use of autologous or allogeneic tumour cells as immunizing antigen. Tumours were obtained for such a protocol. However, estimation of viable cell yield from pre-processed fresh tumour mass was difficult, and initially there did not appear to be a direct relationship between pre-processed tumour mass and viable cells obtained after processing. We therefore analysed all of 293 tumour specimens processed to attempt to discern such a relationship. Of these 137 were melanoma, 14 were sarcoma, 48 were adenocarcinoma, 59 were renal cell carcinoma and 35 were classified as other. A positive correlation was found between pre-processed tumour mass and viable cell yield, with Spearman correlation values varying from r = 0.49 (adenocarcinoma) to r = 0.84 (melanoma). For all tumours the Spearman correlation was r = 0.70 (p = 0.0001). Not surprisingly, the most frequent site of removal associated with bacterial contamination was bowel. In conclusion, this study provides useful curves for predicting viable tumour cell yield from pre-processed tumour mass of given histology.
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Abstract
Recent reports have shown that the nuclear phosphoprotein Fos is induced by light in a mammalian circadian clock, the suprachiasmatic nucleus. To learn how light and circadian phase affect the binding of Fos to DNA, we analyzed the photic and temporal regulation of immunoreactive Jun protein expression and AP-1 DNA-binding activity in the rat suprachiasmatic nucleus. Immunohistochemistry and gel mobility shift assays suggest that AP-1 activity during the night and after a light pulse consists of constant, as well as variable, protein components; JunD could be identified as a constituent of both dark- and light-activated binding complexes, whereas binding by JunB and Fos could be implicated only after photic stimulation. Since JunD or JunB could be colocalized with Fos in individual suprachiasmatic nucleus cell nuclei, light may be acting in at least some suprachiasmatic nucleus cells by altering AP-1 protein composition rather than binding site occupancy.
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Affiliation(s)
- J Takeuchi
- Department of Neurology, University of Massachusetts Medical School, Worcester 01655
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37
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Bradley F, Bury G, O'Kelly FD, Shannon W. Irish general practice and the human immunodeficiency virus. Ir Med J 1993; 86:152-3. [PMID: 8225918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Over a quarter (499) of general practitioners in the Republic of Ireland were sent a questionnaire on the human immunodeficiency virus (HIV) infection. Two hundred and fifty eight (51.7%) general practitioners returned completed questionnaires. Ninety six respondents (37.2%) had seen at least one HIV positive patient in their practice. In Dublin two thirds (67%) of respondents had seen HIV positive patients. A large majority (77.6%) of HIV positive people identified by the survey were attending general practitioners in the Eastern Health Board area. Most (61.2%) respondents favour the involvement of general practitioners in the future care of patients with HIV.
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Affiliation(s)
- F Bradley
- HIV Primary Care Research Unit, Dublin
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Doherty E, McGee HM, O'Boyle CA, Shannon W, Bury G, Williams A. Communication skills training in undergraduate medicine: attitudes and attitude change. Ir Med J 1992; 85:104-7. [PMID: 1399473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The importance of communication skills training in undergraduate medical education is now widely accepted. However little is known about student attitudes towards their own communication skills and whether their attitudes changes as a result of participating in communication skills courses. The aim of the present study was to identify these attitudes prior to commencing such a course and to further evaluate changes in these attitudes on completion of the course. Results demonstrated an improvement in perceived confidence regarding a number of specific communication skills. The study provides further evidence of the value of such courses in undergraduate medical training.
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Affiliation(s)
- E Doherty
- Dept of Psychology, Royal College of Surgeons in Ireland, Dublin
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Shannon W. Dr. Donal Burke Memorial Lecture. The place of academic general practice in a medical school. Ir J Med Sci 1992; 161:551-5. [PMID: 1428776 DOI: 10.1007/bf02940556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- W Shannon
- Department of General Practice, Royal College of Surgeon, Ireland
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Shannon W. Jacarandas and smoke. Interview by Lianne E. Clenard. Emerg Med Serv 1992; 21:32-7. [PMID: 10120271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- W Shannon
- Charles R. Drew University of Medicine and Science, UCLA
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Axelson JF, Shannon W, Van Leeuwen FW. Immunocytochemical localization of estrogen receptors within neurotensin cells in the rostral preoptic area of the rat hypothalamus. Neurosci Lett 1992; 136:5-9. [PMID: 1321967 DOI: 10.1016/0304-3940(92)90634-j] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In situ hybridization procedures indicate that estrogen selectively increases neurotensin and neuromedin (NT/N) mRNA levels in the rostral preoptic area of the rat hypothalamus (RPH). Using the co-localization procedures of Axelson and Van Leeuwen, J. Neuroendocrinol., 2 (1990) 209-216, the present study examined whether NT cells in the RPH contained estrogen receptors (ER). Vibratome sections of brains from adult ovariectomized, colchicine-treated rats were first incubated with estrogen receptor antibody and stained with diaminobenzidine (DAB)-Ni+ producing a blue-black nucleus. Subsequently, NT antisera were used to provide a brown reaction product with DAB as chromogen. Approximately 25% of the NT cells in the RPH contained ER. These data support the hypothesis that NT cells in the RPH that play a role in luteinizing hormone release from the pituitary are, in part, influenced directly by estrogen feedback via nuclear ER and may act as interneurons controlling luteinizing hormone releasing hormone turnover.
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Affiliation(s)
- J F Axelson
- Department of Psychology, Holy Cross College, Worcester, MA 01610
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Abu-Elmagd KM, Fung J, Draviam R, Shannon W, Jain A, Alessiani M, Takaya S, Venkataramanan R, Warty VS, Tzakis A. Four-hour versus 24-hour intravenous infusion of FK 506 in liver transplantation. Transplant Proc 1991; 23:2767-70. [PMID: 1721271 PMCID: PMC2955417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- K M Abu-Elmagd
- Department of Surgery, University of Pittsburgh, PA 15213
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Abu-Elmagd KM, Fung JJ, Alessiani M, Jain A, Takaya S, Venkataramanan R, Warty VS, Shannon W, Todo S, Tzakis A. Strategy of FK 506 therapy in liver transplant patients: effect of graft function. Transplant Proc 1991; 23:2771-4. [PMID: 1721272 PMCID: PMC2974307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- K M Abu-Elmagd
- Department of Surgery, University of Pittsburgh, PA 15213
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Doherty E, O'Boyle CA, Shannon W, McGee H, Bury G. Communication skills training in undergraduate medicine. Ir Med J 1990; 83:54-6. [PMID: 2391210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Good communication with patients is now recognised as the cornerstone in effective medical practice. Medical students do not automatically acquire the art of good communication through clinical training. A new course to promote the development of communication skills at undergraduate level is described. The course was provided at the juncture between pre-clinical and clinical training. Course evaluation illustrated the value of the course as perceived by students themselves and highlighted the areas of greatest need for students in communication skills training.
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Affiliation(s)
- E Doherty
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin
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Shannon W. A review of the factors affecting consultations in general practice. Ir Med J 1984; 77:298-9. [PMID: 6480333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Comber H, Shannon W, Boland M. Consultation rates in a group of West Cork general practitioners. Ir Med J 1984; 77:294-6. [PMID: 6480332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Comber H, Shannon W, Boland M. Psychotropic drug prescribing in Irish general practice: a study in peer-group continuing education. Ir Med J 1984; 77:147-50. [PMID: 6735683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Fennelly JJ, Maurer B, Bourke GJ, Dempsey EJ, McNicholl B, Fitzgerald MJT, Breathnach CS, Shannon W. Book reviews. Ir J Med Sci 1978. [DOI: 10.1007/bf02939385] [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: 10/21/2022]
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Shannon W, Price JS, Angell JC. Clinics in General Practice. A case of right iliac fossa pain. Br Med J 1977; 1:1066-9. [PMID: 858049 PMCID: PMC1606107 DOI: 10.1136/bmj.1.6068.1066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Shannon W. The general practitioner in Ireland present state and future needs. Ir Med J 1976; 69:272-5. [PMID: 950271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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