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Padilla C, Ortner C, Dennis A, Zieleskiewicz L. The need for maternal critical care education, point-of-care ultrasound and critical care echocardiography in obstetric anesthesiologists training. Int J Obstet Anesth 2023; 55:103880. [PMID: 37105833 DOI: 10.1016/j.ijoa.2023.103880] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
Globally, the increase in medically complex obstetric patients is challenging the educational approach and clinical management of critically ill obstetric patients. This increase in medical complexity calls into question the educational paradigm in which future physicians are trained. Obstetric anesthesiologists, physician experts in the perio-perative planning and management of complex obstetric patients, represent an essential workforce in the strategies to address maternal mortality. Unfortunately, the development of peri-operative medicine and maternal critical care curricula has only received minor attention in most countries. Proposed guidelines and models highlight the existing need for tiered maternity care services in which critical care infrastructure plays a central role in the delivery of high-risk peripartum care. Therefore, the development of maternal critical care models designed to prepare obstetric anesthesiologists for the clinical challenges of a medically complex patient are warranted. Key critical care topics such as advanced ultrasonography, with the inclusion of quantitative echocardiographic assessments into obstetric anesthesiology educational curricula, will serve to better prepare physicians for the realities of an increasingly complex pregnant patient population, and further reinforce the critical care infrastructure detailed in the Levels of Maternal Care consensus. Despite an increasingly complex obstetric patient population, heterogeneity of maternal critical care practices exists across the globe, warranting standardization and further development of proposed curricula.
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Affiliation(s)
- C Padilla
- Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - C Ortner
- Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA, USA
| | - A Dennis
- Departments of Critical Care, Obstetrics and Gynecology, and Pharmacology, University of Melbourne, Australia
| | - L Zieleskiewicz
- Département d'Anesthésie-Réanimation, Médecine Péri-opératoire, Hôpital Nord, AP-HM Marseille, France
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Fraser EE, Ogden KJ, Radford A, Ingram ER, Campbell JE, Dennis A, Corbould AM. Exploring the psychological wellbeing of women with gestational diabetes mellitus (GDM): increased risk of anxiety in women requiring insulin. A Prospective Longitudinal Observational Pilot Study. Health Psychol Behav Med 2023; 11:2170378. [PMID: 36733299 PMCID: PMC9888455 DOI: 10.1080/21642850.2023.2170378] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Introduction Gestational diabetes mellitus (GDM) complicates ∼16% of pregnancies in Australia and has significant implications for health of both mother and baby. Antenatal anxiety and depression are also associated with adverse pregnancy outcomes. The interaction between GDM and mental health in pregnancy is poorly understood. With the aim of exploring the nuanced interaction between GDM and mental health further, we investigated whether GDM treatment modality (diet versus insulin) influenced psychological wellbeing in women with GDM. Methods Psychological wellbeing was assessed in women with GDM treated with diet (GDM-Diet, n = 20) or insulin (GDM-Insulin, n = 15) and pregnant women without GDM (non-GDM, n = 20) using questionnaires [Edinburgh Depression Scale (EDS), State-Trait Anxiety Inventory (STAI-6), and in women with GDM, Problem Areas in Diabetes (PAID)] at 24-34 weeks gestation and again at ∼36 weeks gestation. Results Women in the GDM-insulin group had significantly higher levels of anxiety than the non-GDM group at both time points. Women in the GDM-Diet group had higher levels of anxiety at 24-34 weeks gestation than the non-GDM group but did not differ at ∼36 weeks gestation. Although depression scores tended to be higher in GDM-Insulin and GDM-Diet groups than in the non-GDM group at both time points, this was not statistically significant. Diabetes-related distress was similar in the GDM-Diet and GDM-Insulin groups at both time points and did not change during pregnancy. A high proportion of the GDM-Insulin group had past/current mental illness (60%). Conclusions In this pilot study GDM was associated with differences in psychological wellbeing, specifically increased anxiety in women treated with insulin. Specialised interventions to support women with GDM should be considered, especially those requiring insulin.Trial registration: Not applicable as this was a purely observational study.
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Affiliation(s)
- Emma E. Fraser
- Department of Psychiatry, Austin Hospital, Heidelberg, Australia, Emma E Fraser Department of Psychiatry, Austin Hospital, Studley Road, Heidelberg, Victoria, 3084, Australia
| | - Kathryn J. Ogden
- School of Medicine, Faculty of Health, University of Tasmania, Launceston, Australia
| | - Andrea Radford
- John Morris Diabetes Centre, Launceston General Hospital, Launceston, Australia
| | - Emily R. Ingram
- School of Medicine, Faculty of Health, University of Tasmania, Launceston, Australia
| | - Joanne E. Campbell
- John Morris Diabetes Centre, Launceston General Hospital, Launceston, Australia
| | - Amanda Dennis
- FRANZCOG, Women’s and Children’s Service, Launceston General Hospital, Launceston, Australia
| | - Anne M. Corbould
- John Morris Diabetes Centre, Launceston General Hospital, Launceston, Australia
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Sile B, Brown KE, Gower C, Bosowski J, Dennis A, Falconer M, Stowe J, Andrews N, Amirthalingam G. Effectiveness of oral aciclovir in preventing maternal chickenpox: A comparison with VZIG. J Infect 2022; 85:147-151. [PMID: 35659543 DOI: 10.1016/j.jinf.2022.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/29/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Although often presenting as a self-limiting childhood disease, chickenpox can have serious consequences if acquired in pregnancy. Until April 2022, the UK recommendations were that varicella immunoglobulin (VZIG) should be administered intramuscularly to susceptible pregnant women exposed to chickenpox prior to 20 weeks gestation. Oral aciclovir or VZIG was recommended if exposure occurred at 20+ weeks gestation. Our objective was to compare the effectiveness of oral aciclovir to VZIG in preventing maternal and neonatal chickenpox. METHODS We identified and followed up 186 pregnant women who were exposed to chickenpox and compared their outcomes. RESULTS 171/186 (91.9%) of these women received either VZIG or oral aciclovir. Of the 145 women who received VZIG, 53/145 (36.6%) went on to develop chickenpox compared to 8 of the 26 (30.8%) women who received oral aciclovir (p=0.32). No statistical difference was found between the oral aciclovir and VZIG groups even after controlling for maternal age, gestational stage, type of exposure and IgG titre (adjusted OR:0.83; 95%CI:0.26-2.65; p=0.75). CONCLUSIONS These findings support the use of oral aciclovir as first-line prophylaxis in pregnant women exposed to varicella as they suggest its effectiveness at preventing maternal chickenpox is either better or equal to VZIG.
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Affiliation(s)
- Bersabeh Sile
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom.
| | - Kevin E Brown
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom
| | - Charlotte Gower
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom
| | - Johanna Bosowski
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom
| | - Amanda Dennis
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom
| | - Michelle Falconer
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom
| | - Julia Stowe
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom
| | - Nick Andrews
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom
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Arora N, Dennis A, Willson J, Norrie J, Tunstall M. Delivery of oxygen by standard oxygen flowmeters. Anaesthesia 2021; 76:1546-1547. [PMID: 34309005 PMCID: PMC8444714 DOI: 10.1111/anae.15548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N Arora
- University Hospitals Birmingham, Birmingham, UK
| | - A Dennis
- University Hospitals Birmingham, Birmingham, UK
| | - J Willson
- University Hospitals Birmingham, Birmingham, UK
| | - J Norrie
- University Hospitals Birmingham, Birmingham, UK
| | - M Tunstall
- University Hospitals Birmingham, Birmingham, UK
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Wilson E, Hanna F, Hyppa A, Orlowski E, Dawar HU, Sanga Z, Dennis A, Pavlov T, Khalafallah AA. Assessment of von Willebrand disease and pregnancy outcomes at regional Australian hospitals. Eur J Haematol 2021; 106:456-466. [PMID: 33289927 DOI: 10.1111/ejh.13562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/03/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND von Willebrand disease (vWD) is a heterogeneous hereditary bleeding disorder and is associated with risk of primary postpartum haemorrhage (PPH). DESIGN AND METHODS An observational study at a tertiary referral centre in Australia of 16 women with 23 deliveries with a median age of 27.5 years (range, 21-39; IQR = 9). Median gestational age at delivery was 39 weeks (range, 35-41; IQR = 1.1). RESULTS All cases had type 1 vWD, apart from one case with type 2. Patients were managed in combined obstetrics and haematology clinics. PPH occurred in ten deliveries (44%). Intravenous desmopressin was administered in 6 cases, and IV human vWF was administered in 4 cases. Two cases with mild vWD had received oral tranexamic acid. The median Apgar score at 1 and 5 min was 9 (IQR = 1.0), while the median Apgar score at 10 min was 10.0 (IQR = 0.0). One case required transfusion of blood products postdelivery. There were no other significant complications observed. CONCLUSIONS vWD was associated with a high incidence of primary PPH. Individualised treatment to restore haemostasis, according to the severity of the disease, could achieve as possible, normal haemostasis with favourable outcomes for both mothers and their infants. Further studies to confirm our findings are warranted.
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Affiliation(s)
- Emily Wilson
- Department of Obstetrics and Gynaecology, Launceston General Hospital, Launceston, TAS, Australia
| | - Fayez Hanna
- Faculty of Health Sciences, University of Tasmania, Launceston, TAS, Australia
| | | | - Ella Orlowski
- Department of Obstetrics and Gynaecology, Launceston General Hospital, Launceston, TAS, Australia
| | | | - Zar Sanga
- Augusta Medical Centre, Hobart, TAS, Australia
| | - Amanda Dennis
- Department of Obstetrics and Gynaecology, Launceston General Hospital, Launceston, TAS, Australia
| | - Toly Pavlov
- Department of Obstetrics and Gynaecology, Launceston General Hospital, Launceston, TAS, Australia
| | - Alhossain A Khalafallah
- Faculty of Health Sciences, University of Tasmania, Launceston, TAS, Australia.,Specialist Care Australia, Launceston, TAS, Australia
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Leo CA, Cavazzoni E, Leeuwenburgh MMN, Thomas GP, Dennis A, Bassett P, Hodgkinson JD, Warusavitarne J, Murphy J, Vaizey CJ. Comparison between high-resolution water-perfused anorectal manometry and THD ® Anopress anal manometry: a prospective observational study. Colorectal Dis 2020; 22:923-930. [PMID: 31994307 PMCID: PMC7496679 DOI: 10.1111/codi.14992] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/22/2020] [Indexed: 12/13/2022]
Abstract
AIM Anorectal physiology tests provide a functional assessment of the anal canal. The aim of this study was to compare the results generated by standard high-resolution water-perfused manometry (WPM) with the newer THD® Anopress manometry system. METHOD This was a prospective observational study. Conventional manometry was carried out using a water-perfused catheter with high-resolution manometry and compared with the Anopress system with air-filled catheters. All patients underwent the two procedures successively in a randomized order. Time to arrive at the resting pressure plateau, resting, squeeze, straining pressure and visual analogue scale (VAS) scores for pain were recorded. A qualitative analysis of the two devices was performed. RESULTS Between 2016 and 2017, 60 patients were recruited. The time from insertion of the catheter to arriving at the resting pressure plateau was significantly lower with the Anopress compared with WPM: 12 s [interquartile range (IQR) 10-17 s] versus 100 s (IQR 67-121 s) (P < 0.001). A strong correlation between the manometric values of WPM and the Anopress was observed. Both procedures were well tolerated, although the VAS score for insertion of the WPM catheter was significantly higher. The Anopress was easier to use and more time-efficient than the WPM. CONCLUSION The pressure values obtained with Anopress correlated well with those of conventional manometry. The Anopress has the advantage of being less time-consuming, user-friendly and better tolerated by patients.
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Affiliation(s)
- C. A. Leo
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK,Imperial College of LondonLondonUK,The Royal London HospitalLondonUK
| | - E. Cavazzoni
- Santa Maria della Misericordia HospitalUniversità degli Studi di PerugiaPerugiaItaly
| | | | - G. P. Thomas
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
| | - A. Dennis
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
| | | | - J. D. Hodgkinson
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK,Imperial College of LondonLondonUK
| | - J. Warusavitarne
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
| | | | - C. J. Vaizey
- Sir Alan Park’s Physiology UnitSt Mark’s Hospital Academic InstituteHarrowUK
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Dennis A, Manski R, O'Donnell J. Assessing research impact: A framework and an evaluation of the Society of Family Planning Research Fund's grantmaking (2007-2017). Contraception 2019; 101:213-219. [PMID: 31857077 DOI: 10.1016/j.contraception.2019.11.007] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/08/2019] [Accepted: 11/15/2019] [Indexed: 11/19/2022]
Abstract
The Society of Family Planning Research Fund (SFPRF) provides grants for research on abortion and contraception. In 2017, SFPRF conducted a retrospective evaluation of its investment in family planning research. Using a developmental evaluation approach, we created a framework for assessing research impact in family planning and applied it to an analysis of our grantmaking between 2007 and 2017. Our framework consists of 30 indicators of research impact, which span nine impact categories from building researchers' capacity to influencing individuals, communities, and systems. Through application of this framework to our grantmaking, we learned that our grantmaking has helped build the research capacity of emerging and established family planning scholars and advance the field of family planning by supporting the creation of a robust scholarly evidence base. At the same time, we identified less evidence of impact on policy and practice. The results of this analysis directed SFPRF to move towards more focused funding opportunities, including longer-term and larger investments, and to prioritize partnerships between researchers and knowledge brokers.
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Affiliation(s)
- Amanda Dennis
- Society of Family Planning and Society of Family Planning Research Fund, PO Box 18342, Denver, CO 80218.
| | - Ruth Manski
- Society of Family Planning and Society of Family Planning Research Fund, PO Box 18342, Denver, CO 80218.
| | - Jenny O'Donnell
- Society of Family Planning and Society of Family Planning Research Fund, PO Box 18342, Denver, CO 80218.
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Basaric B, Robar J, Orbovic R, Dennis A, Majcher C. EP-1891 A new hotspot correction algorithm in Modulated Electron Radiation Therapy utilizing 3D printed boli. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32311-4] [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: 10/26/2022]
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9
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Ewa I, Ewa I, DeFina R, Maeve O, Dennis A. Medical Education in the Long-Term Care Setting: Exploring Residents’ Experience of Learning in This Environment. J Am Med Dir Assoc 2019. [DOI: 10.1016/j.jamda.2019.01.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Espey E, Dennis A, Landy U. The importance of access to comprehensive reproductive health care, including abortion: a statement from women's health professional organizations. Am J Obstet Gynecol 2019; 220:67-70. [PMID: 30267653 DOI: 10.1016/j.ajog.2018.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/30/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
Barriers to women's reproductive health care access, particularly for termination of pregnancy, are increasing at the local, regional, and national levels through numerous institutional, legislative, and regulatory restrictions. Lack of access to reproductive health care has negative consequences for women's health. Twelve women's health care organizations affirm their support for access to comprehensive reproductive health care, including abortion.
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Myles PS, Myles DB, Galagher W, Boyd D, Chew C, MacDonald N, Dennis A. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth 2018; 118:424-429. [PMID: 28186223 DOI: 10.1093/bja/aew466] [Citation(s) in RCA: 445] [Impact Index Per Article: 74.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 12/16/2022] Open
Abstract
Background The 100 mm visual analog scale (VAS) score is widely used to measure pain intensity after surgery. Despite this widespread use, it is unclear what constitutes the minimal clinically important difference (MCID); that is, what minimal change in score would indicate a meaningful change in a patient's pain status. Methods We enrolled a sequential, unselected cohort of patients recovering from surgery and used a VAS to quantify pain intensity. We compared changes in the VAS with a global rating-of-change questionnaire using an anchor-based method and three distribution-based methods (0.3 sd , standard error of the measurement, and 5% range). We then averaged the change estimates to determine the MCID for the pain VAS. The patient acceptable symptom state (PASS) was defined as the 25th centile of the VAS corresponding to a positive patient response to having made a good recovery from surgery. Results We enrolled 224 patients at the first postoperative visit, and 219 of these were available for a second interview. The VAS scores improved significantly between the first two interviews. Triangulation of distribution and anchor-based methods resulted in an MCID of 9.9 for the pain VAS, and a PASS of 33. Conclusions Analgesic interventions that provide a change of 10 for the 100 mm pain VAS signify a clinically important improvement or deterioration, and a VAS of 33 or less signifies acceptable pain control (i.e. a responder), after surgery.
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Affiliation(s)
- P S Myles
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - D B Myles
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - W Galagher
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - D Boyd
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - C Chew
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - N MacDonald
- Department of Anaesthesia, Royal Women's Hospital, Parkville, Victoria, Australia
| | - A Dennis
- Department of Anaesthesia, Royal Women's Hospital, Parkville, Victoria, Australia
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12
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Meester D, Al-Yahya E, Dennis A, Collett J, Wade DT, Ovington M, Liu F, Meaney A, Cockburn J, Johansen-Berg H, Dawes H. A randomized controlled trial of a walking training with simultaneous cognitive demand (dual-task) in chronic stroke. Eur J Neurol 2018; 26:435-441. [PMID: 30308699 DOI: 10.1111/ene.13833] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to evaluate the tolerability of, adherence to and efficacy of a community walking training programme with simultaneous cognitive demand (dual-task) compared to a control walking training programme without cognitive distraction. METHODS Adult stroke survivors at least 6 months after stroke with a visibly obvious gait abnormality or reduced 2-min walk distance were included in a two-arm parallel randomized controlled trial of complex intervention with blinded assessments. Participants received a 10 week, bi-weekly, 30 min treadmill programme at an aerobic training intensity (55%-85% heart rate maximum), either with or without simultaneous cognitive demands. Outcome was measured at 0, 11 and 22 weeks. The primary assessment involved 2-min walk tests with and without cognitive distraction to investigate the dual-task effect on walking and cognition; secondary results were the Short Form Health Survey 36, EuroQol-5D-5L, the Physical Activity Scale for the Elderly (PASE) and step activity. RESULTS Fifty stroke patients were included; 43 received allocated training and 45 completed all assessments. The experimental group (n = 26) increased their mean (SD) 2-min walking distance from 90.7 (8.2) to 103.5 (8.2) m, compared with 86.7 (8.5) to 92.8 (8.6) m in the control group, and their PASE score from 74.3 (9.1) to 89.9 (9.4), compared with 94.7 (9.4) to 77.3 (9.9) in the control group. Statistically, only the change in the PASE differed between the groups (P = 0.029), with the dual-task group improving more. There were no differences in other measures. CONCLUSIONS Walking with specific additional cognitive distraction (dual-task training) might increase activity more over 12 weeks, but the data are not conclusive.
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Affiliation(s)
- D Meester
- Movement Science Group, School of Life Sciences, Oxford Brookes University, Oxford, UK
| | - E Al-Yahya
- Movement Science Group, School of Life Sciences, Oxford Brookes University, Oxford, UK.,Department of Physiotherapy, Faculty of Rehabilitation Sciences, University of Jordan, Amman, Jordan
| | - A Dennis
- Nuffield Department of Clinical Neurosciences, Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford, UK
| | - J Collett
- Movement Science Group, School of Life Sciences, Oxford Brookes University, Oxford, UK
| | - D T Wade
- Movement Science Group, School of Life Sciences, Oxford Brookes University, Oxford, UK.,UK Oxford Centre for Enablement, Oxford University Hospital NHS Trust, Oxford, UK
| | - M Ovington
- Movement Science Group, School of Life Sciences, Oxford Brookes University, Oxford, UK
| | - F Liu
- Movement Science Group, School of Life Sciences, Oxford Brookes University, Oxford, UK
| | - A Meaney
- Movement Science Group, School of Life Sciences, Oxford Brookes University, Oxford, UK
| | | | - H Johansen-Berg
- Nuffield Department of Clinical Neurosciences, Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford, UK
| | - H Dawes
- Movement Science Group, School of Life Sciences, Oxford Brookes University, Oxford, UK
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13
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Khalafallah AA, Hyppa A, Chuang A, Hanna F, Wilson E, Kwok C, Yan C, Gray Z, Mathew R, Falloon P, Dennis A, Pavlov T, Allen JC. A Prospective Randomised Controlled Trial of a Single Intravenous Infusion of Ferric Carboxymaltose vs Single Intravenous Iron Polymaltose or Daily Oral Ferrous Sulphate in the Treatment of Iron Deficiency Anaemia in Pregnancy. Semin Hematol 2018; 55:223-234. [PMID: 30502851 DOI: 10.1053/j.seminhematol.2018.04.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/11/2018] [Indexed: 11/11/2022]
Abstract
Iron deficiency anaemia (IDA) is the most common nutritional deficiency affecting pregnant women worldwide. This study aims to compare the efficacy and safety of a newly available intravenous (IV) iron preparation, ferric carboxymaltose (FCM), against IV iron polymaltose (IPM), and standard oral iron (ferrous sulphate) for the treatment of IDA in pregnancy. This is an open-labelled prospective randomised controlled trial (RCT) with intention-to-treat analysis conducted at a primary health care facility with a single tertiary referral centre in Launceston. Tasmania, Australia. A 3-arm randomised controlled trial was conducted comparing a single IV infusion of 1000mg of FCM (n = 83 patients) over 15 minutes against a single IV infusion of 1000mg of IPM (n = 82) over 2 hours against 325mg daily oral ferrous sulphate (n = 81) until delivery, for the treatment of IDA in pregnancy. A total of 246 consecutive pregnant women were recruited between September 2013 and July 2014. The median age was 28 years, with a median and mean gestation of 27 weeks. The median serum ferritin was 9µg/L, with a mean of 13µg/L. The mean haemoglobin (Hb) was 114g/L. The primary outcome was the change in ferritin and Hb levels at 4 weeks after intervention. Secondary outcomes included ferritin and Hb improvements at predelivery, safety, tolerability, quality of life (QoL), cost utility, and fetal outcomes. The mean Hb level differences between the baseline intervention time point and 4 weeks thereafter were significantly higher in the FCM versus the oral group by 4.35g/L (95% CI: 1.64-7.05; P = 0.0006) and in the IPM vs the oral group by 4.08g/L (95% CI: 1.57-6.60; P = 0.0005), but not different between the FCM and IPM groups (0.26g/L; 95% CI: -2.59 to 3.11; P = 0.9740). The mean ferritin level differences were significantly higher at 4 weeks in the FCM vs oral iron group by 166µg/L (95% CI: 138-194; P < 0.0001) and in the IPM vs oral iron group by 145µg/L (95% CI: 109-1180, P < 0.0001), but not between the 2 IV groups (21.5µg/L; 95% CI: -23.9 to 66.9; P = 0.4989). Administration of IV FCM during pregnancy was safe and better tolerated than IV IPM or oral iron. Compliance to oral iron was the lowest amongst treatment groups with one-third of the patients missing doses of daily iron tablets. Significant improvement in overall QoL scores was observed in both IV iron supplement groups by achieving normal ferritin following effective and prompt repletion of iron stores, compared to the oral iron group (P = 0.04, 95% CI: 21.3, 1.8). The overall cost utility of IV FCM and IV IPM appear to be similar to oral iron. There were no differences in the fetal outcomes between the 3 trial arms. In conclusion, this study demonstrates that a single IV iron infusion is an effective and safe option for treatment of IDA during pregnancy. FCM was more convenient than other treatments. Rapid parenteral iron repletion can improve iron stores, Hb levels and QoL in pregnant women, with ongoing benefits until delivery. Integration of IV iron for IDA in pregnancy can potentially improve pregnancy outcomes for the mother. Update of guidelines to integrate the use of new IV iron preparations in pregnancy is warranted.
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Affiliation(s)
- Alhossain A Khalafallah
- Menzies Institute for Medical Research, University of Tasmania, Launceston, Tasmania, Australia; Department of Haematology, Launceston General Hospital, Launceston, Tasmania, Australia.
| | - Annemarie Hyppa
- Department of Haematology, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Anthony Chuang
- Department of Obstetrics and Gynaecology, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Fayez Hanna
- Faculty of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Emily Wilson
- Department of Obstetrics and Gynaecology, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Christine Kwok
- Department of Obstetrics and Gynaecology, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Carl Yan
- Department of Medicine, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Zara Gray
- Department of Obstetrics and Gynaecology, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Ronnie Mathew
- Department of Medicine, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Peter Falloon
- Pharmacy Department, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Amanda Dennis
- Department of Obstetrics and Gynaecology, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Toly Pavlov
- Department of Obstetrics and Gynaecology, Launceston General Hospital, Launceston, Tasmania, Australia
| | - John Carson Allen
- Duke-NUS Medical School Singapore, Centre for Quantitative Medicine, Office of Clinical Sciences, The Academia, Singapore, Singapore
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Steventon JJ, Collett J, Furby H, Hamana K, Foster C, O'Callaghan P, Dennis A, Armstrong R, Németh AH, Rosser AE, Murphy K, Quinn L, Busse M, Dawes H. Alterations in the metabolic and cardiorespiratory response to exercise in Huntington's Disease. Parkinsonism Relat Disord 2018; 54:56-61. [PMID: 29705557 DOI: 10.1016/j.parkreldis.2018.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/02/2018] [Revised: 04/04/2018] [Accepted: 04/12/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Limited data suggests that an altered metabolic and cardiorespiratory exercise response may affect exercise performance in individuals with Huntington's disease (HD). There is no clear exploration of the response in individuals at different stages of the disease or in relation to genetic markers. This study aimed to examine the exercise response and recovery of HD participants, and the relationship to genetic and clinical markers. METHOD HD gene-positive participants (n = 31; 9 pre-manifest; 22 manifest HD) and a healthy control group (n = 29) performed an incremental exercise test until exhaustion. Performance, cardiorespiratory, metabolic and perceptual responses to exercise were determined from a maximal cycle ergometer test throughout the exercise test and during a recovery period. RESULTS During sub-maximal exercise, metabolic (lactate levels, oxygen uptake) and cardiorespiratory markers (heart rate) were elevated in HD participants compared to controls. Lactate elevation was specific to pre-manifest HD participants. Work capacity was reduced in both pre-manifest and manifest HD participants with tests terminated with no difference in metabolic, perceptual or cardiorespiratory markers. Submaximal oxygen uptake was correlated with motor score, whilst peak measures were unrelated to genetic or clinical markers. Heart rate recovery was attenuated in pre-manifest and manifest HD participants. CONCLUSIONS Our findings confirm metabolic and cardiorespiratory deficits reduce exercise performance and affect recovery from an early stage in HD, with submaximal deficits related to phenotypic expression. Exercise capacity appears to be limited by an altered movement economy, thus clinicians should consider an altered exercise response and recovery may affect prescription in HD.
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Affiliation(s)
- J J Steventon
- School of Physics and Astronomy, Cardiff University, UK; NMHRI, School of Medicine, Cardiff University, UK; CUBRIC, School of Psychology, Cardiff University, UK.
| | - J Collett
- Centre for Movement, Occupation and Rehabilitation Sciences, OxINMAHR, Oxford Brookes University, Oxford, UK; Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - H Furby
- NMHRI, School of Medicine, Cardiff University, UK; CUBRIC, School of Psychology, Cardiff University, UK
| | - K Hamana
- School of Healthcare Sciences, Cardiff University, UK
| | - C Foster
- CUBRIC, School of Psychology, Cardiff University, UK
| | - P O'Callaghan
- Cardiology Department, University Hospital of Wales, Cardiff, UK
| | - A Dennis
- FMRIB Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, OX3 9DU, UK
| | - R Armstrong
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - A H Németh
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - A E Rosser
- IPMCN, School of Medicine, Cardiff University, UK
| | - K Murphy
- School of Physics and Astronomy, Cardiff University, UK; CUBRIC, School of Psychology, Cardiff University, UK
| | - L Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, USA
| | - M Busse
- Centre for Trials Research, Cardiff University, UK
| | - H Dawes
- Centre for Movement, Occupation and Rehabilitation Sciences, OxINMAHR, Oxford Brookes University, Oxford, UK; Department of Clinical Neurology, University of Oxford, Oxford, UK
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Affiliation(s)
- H Abdulameer
- Florida Atlantic University, Boca Raton, FL; Midwestern University, Downers Grove, IL; Cook County Hospital and Health System, Chicago, IL
| | - J Swartzendruber
- Florida Atlantic University, Boca Raton, FL; Midwestern University, Downers Grove, IL; Cook County Hospital and Health System, Chicago, IL
| | - A Dennis
- Florida Atlantic University, Boca Raton, FL; Midwestern University, Downers Grove, IL; Cook County Hospital and Health System, Chicago, IL
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Mizzi D, Zarb F, Dennis A. A retrospective audit of the first screening round of the Maltese breast screening programme. Radiography (Lond) 2017; 23:60-66. [DOI: 10.1016/j.radi.2016.09.008] [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] [Received: 02/12/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 11/15/2022]
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Meadows J, Gutierrez H, Hannum CPS, Douglas-Durham E, Blanchard K, Dennis A. Mixed-methods study of women's experiences with second-trimester abortion care. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.162] [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: 10/21/2022]
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Hakeem R, Dennis A, Ogden K, Ahuja KDK, Hakeem MA. Obstetric and Perinatal Morbidity in Northern Tasmanian Aboriginal Population: A Retrospective Cohort Study. J Clin Diagn Res 2016; 10:QC06-9. [PMID: 27437307 DOI: 10.7860/jcdr/2016/20113.7768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 04/06/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Aboriginal and Torres Strait Islander women are at increased risk of maternal morbidity and mortality as compared to non-Aboriginals. Similarly, aboriginal babies are at increased risk of low birth weight and infant mortality. AIM To investigate the independent association of aboriginality with Tasmanian maternal and neonatal morbidity. MATERIALS AND METHODS A retrospective analysis of all the births (gestation more than 20 weeks) from June 2013 to May 2014 was conducted at the Launceston General Hospital, Tasmania. The study compared 66 Aboriginal (4.2% of the total births) to 1477 non-aboriginal births for maternal and neonatal morbidity. Comparisons were made using logistic regression. The outcome measures were maternal and neonatal morbidity. RESULTS Significantly higher number of aboriginal women (49% vs 19%; OR 4.15 90%CI 2.52- 6.85) smoked and used illicit drugs (15% vs 2%; OR 9.24; 95%CI 4.28-19.96) than the non-aboriginal women (both p<0.001). Maternal morbidity was not significantly different between aboriginal compared to non-aboriginal women (OR 0.64; 95%CI 0.36-1.14; p=0.13; adjusted OR 1.00; 95%CI 0.52-1.93; p=0.99). Factors positively associated with maternal morbidity included: age (OR 1.28; 95%CI 1.13-1.46; p<0.01) and BMI (OR 1.50; 95%CI 1.33-1.70; p<0.01). The unadjusted OR of neonatal morbidity for aboriginality was 1.98 (95%CI 1.17-3.34; p=0.01) and adjusted was 1.45 (95%CI 0.77-2.72; p=0.25). Factors positively associated with neonatal morbidity included smoking (OR 2.24; 95%CI 1.59-3.14; p<0.01), illicit drug use 95%CI 1.49-(OR 3.26; 95%CI 1.49-7.13; p <0.01), hypertension (OR 2.49; 95%CI 1.61-3.84; p<0.01) and diabetes (OR 1.92; 95%CI 1.33-2.78; p<0.01). CONCLUSION The composite Aboriginal maternal morbidity does not differ, however the increased rates of smoking and illicit drug use are largely responsible for neonatal morbidity. Along with strengthening strategies to decrease medical comorbidities in aboriginals, we recommend intensifying smoking and illicit drug cessation programs.
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Affiliation(s)
- Rashida Hakeem
- CMO, Department of Obstetrics and Gynaecology, Joondalup Health Campus , Joondalup Perth WA 6027 Australia
| | - Amanda Dennis
- Professor, Department of Obstetrics and Gynaecology, UTAS and Senior Staff Specialist LGH , Launceston, Tasmania 7250 Australia
| | - Kathryn Ogden
- Senior Lecturer, Launceston Clinical School
- School of Medicine , Faculty of Health Sciences, University of Tasmania, Launceston TAS 7250 Australia
| | - Kiran D K Ahuja
- Research Fellow, School of Health Sciences, University of Tasmania (UTAS) , Launceston, 7250, TAS Australia
| | - Mohammed Abdul Hakeem
- Neonatal Fellow, Department of Neonatology/Perinatology, KEMH Subiaco Perth WA 6008 Australia
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Abstract
A common problem concerns the relations between children's behaviour or characteristics at one age or in one situation, and those shown later or in another context. It is argued here that Pearson or rank order correlations may not be ubiquitously suitable for assessing such relations, primarily because independent variables (IV's) and dependent variables (DV's) may be related for only some of the children (e.g., those high on the IV may tend to be high on the DV, but for children with lower scores on the IV there may be no relation to the scores on the DV). Categorization procedures can help. It is shown that the use of Pearson correlations, multiple regression, continuous discriminant analysis and discrete discriminant analysis on the same data sets show up different types of relations between IV's and DV's. Categorization procedures can also facilitate examination of individual cases.
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Affiliation(s)
| | - Amanda Dennis
- M. R. C. Unit on the Integration and Development of Behaviour, Cambridge, U.K
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Dennis A, Blanchard K, Bessenaar T. Identifying indicators for quality abortion care: a systematic literature review. J Fam Plann Reprod Health Care 2016; 43:7-15. [DOI: 10.1136/jfprhc-2015-101427] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/09/2016] [Accepted: 04/07/2016] [Indexed: 11/04/2022]
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Burns B, Dennis A, Douglas-Durham E. Comparison of state regulations for abortion with those for other health procedures. Contraception 2015. [DOI: 10.1016/j.contraception.2015.06.054] [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: 10/23/2022]
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Simpson S, Blomfield P, Dennis A, Tabrizi S, Turner R. P04.12 Front-to-back wiping and dabbing behaviour wiping post-toilet significantly associated with anal neoplasia and hr-hpv carriage in a cohort of women with a history of an hpv-mediated gynaecological neoplasia. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.266] [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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Rutstein SE, Pettifor A, Phiri S, Pasquale D, Dennis A, Hosseinipour M, Kamanga G, Nsona D, Hoffman I, Miller WC. LB1.2 Pilot study of immediate antiretrovirals and behavioural intervention for persons with acute hiv infection: opportunity for interrupting transmission. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.207] [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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Dennis A, Fuentes L, Douglas-Durham E, Grossman D. Barriers to and Facilitators of Moving Miscarriage Management Out of the Operating Room. Perspect Sex Reprod Health 2015; 47:141-149. [PMID: 26153842 DOI: 10.1363/47e4315] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
CONTEXT Miscarriage care can safely and effectively be offered in appropriately equipped offices and emergency departments. However, it is often treated in the operating room, which limits access to timely, cost-effective and high-quality care. METHODS Between May 2013 and January 2014, in-depth interviews were conducted with 30 staff holding diverse roles at 15 medical offices and emergency departments with the aim of exploring barriers to and facilitators of offering miscarriage care, and identifying methods for expanding care. On-site observations were also conducted at four facilities. All data were transcribed, iteratively coded and analyzed using qualitative techniques. RESULTS Similar barriers to and facilitators of providing miscarriage care were identified across facility types. Barriers were physician preference for providing care in the operating room, the similarity of miscarriage management and abortion procedures, the limited availability of support staff, difficulties integrating miscarriage management into patient scheduling and flow, and uncertainty about responding to women's emotional needs. Facilitators were a commitment to evidence-based medicine, insurance coverage of miscarriage, offering other procedures of similar complexity and the minimal resources needed for miscarriage care. Resources needed to expand miscarriage services included a medically trained "champion," best practices for implementing services, persistence and patience, training, clear protocols, and systems for tracking equipment and supplies. CONCLUSIONS Miscarriage care was viewed as neither resource-intensive nor technically complex to provide. Although it may be emotionally and politically challenging to offer, effective strategies are available for expanding the scope of miscarriage care offered in multiple settings.
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Egan R, Philippe M, Wera L, Fagnard JF, Vanderheyden B, Dennis A, Shi Y, Cardwell DA, Vanderbemden P. A flux extraction device to measure the magnetic moment of large samples; application to bulk superconductors. Rev Sci Instrum 2015; 86:025107. [PMID: 25725888 DOI: 10.1063/1.4907903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report the design and construction of a flux extraction device to measure the DC magnetic moment of large samples (i.e., several cm(3)) at cryogenic temperature. The signal is constructed by integrating the electromotive force generated by two coils wound in series-opposition that move around the sample. We show that an octupole expansion of the magnetic vector potential can be used conveniently to treat near-field effects for this geometrical configuration. The resulting expansion is tested for the case of a large, permanently magnetized, type-II superconducting sample. The dimensions of the sensing coils are determined in such a way that the measurement is influenced by the dipole magnetic moment of the sample and not by moments of higher order, within user-determined upper bounds. The device, which is able to measure magnetic moments in excess of 1 A m(2) (1000 emu), is validated by (i) a direct calibration experiment using a small coil driven by a known current and (ii) by comparison with the results of numerical calculations obtained previously using a flux measurement technique. The sensitivity of the device is demonstrated by the measurement of flux-creep relaxation of the magnetization in a large bulk superconductor sample at liquid nitrogen temperature (77 K).
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Affiliation(s)
- R Egan
- SUPRATECS and Department of Electrical Engineering and Computer Science B28, Sart-Tilman, B-4000 Liège, Belgium
| | - M Philippe
- SUPRATECS and Department of Electrical Engineering and Computer Science B28, Sart-Tilman, B-4000 Liège, Belgium
| | - L Wera
- SUPRATECS and Department of Electrical Engineering and Computer Science B28, Sart-Tilman, B-4000 Liège, Belgium
| | - J F Fagnard
- SUPRATECS and Department of Electrical Engineering and Computer Science B28, Sart-Tilman, B-4000 Liège, Belgium
| | - B Vanderheyden
- SUPRATECS and Department of Electrical Engineering and Computer Science B28, Sart-Tilman, B-4000 Liège, Belgium
| | - A Dennis
- Bulk Superconductivity Group, Engineering Department, Cambridge University, Cambridge CB2 1PZ, United Kingdom
| | - Y Shi
- Bulk Superconductivity Group, Engineering Department, Cambridge University, Cambridge CB2 1PZ, United Kingdom
| | - D A Cardwell
- Bulk Superconductivity Group, Engineering Department, Cambridge University, Cambridge CB2 1PZ, United Kingdom
| | - P Vanderbemden
- SUPRATECS and Department of Electrical Engineering and Computer Science B28, Sart-Tilman, B-4000 Liège, Belgium
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Nickerson A, Manski R, Dennis A. A Qualitative Investigation of Low-Income Abortion Clients’ Attitudes Toward Public Funding for Abortion. Women Health 2014; 54:672-86. [DOI: 10.1080/03630242.2014.919984] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fuentes L, Dennis A, Douglas-Durham E, Grossman D. Exploring best practices for transitioning to outpatient miscarriage management. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.045] [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: 10/24/2022]
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Manski R, Dennis A. Perceptions of pregnancy and parenting among female teens with epilepsy. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.171] [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: 10/24/2022]
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Manski R, Dennis A. A mixed-methods exploration of the contraceptive experiences of female teens with epilepsy. Seizure 2014; 23:629-35. [PMID: 24878105 DOI: 10.1016/j.seizure.2014.04.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 04/30/2014] [Indexed: 01/30/2023] Open
Abstract
PURPOSE We explored the contraceptive experiences of female teens with epilepsy, including their knowledge and perceptions of interactions between antiepileptic drugs and hormonal contraception and contraceptive decision-making processes. METHOD From November 2012 to May 2013, we conducted one online survey (n=114) and 12 online focus group discussions (n=26) with female teens with epilepsy about their contraceptive experiences and unmet needs. Survey data were analyzed using descriptive statistics and focus group transcripts were analyzed thematically using modified grounded theory methods. RESULTS Both survey and focus group participants reported believing that interactions between epilepsy medications and hormonal contraceptives could lead to reductions in contraceptive efficacy and seizure control. However, their knowledge about these types of medication interactions was often incomplete. Many study participants viewed contraceptive decision making as a difficult process, and some participants reported avoiding hormonal contraceptives because of potential interactions with antiepileptic drugs. Study participants reported relying on health care providers and parents for contraceptive decision-making support. Focus group participants also reported they wanted health care providers to provide more in-depth and comprehensive counseling about contraception, and that they desired peer support with contraceptive decisions. CONCLUSION The ability to make informed contraceptive decisions is important for teens with epilepsy as interactions between anti-epileptic drugs and hormonal contraceptives can impact seizure occurrence and lead to an increased risk of unplanned pregnancy. Guidance for providers offering contraceptive care to this population is needed, as well as a contraceptive support tool that empowers teens with epilepsy to advocate for desired health care.
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Affiliation(s)
- Ruth Manski
- Ibis Reproductive Health, 17 Dunster Street, Suite 201, Cambridge, MA 02138, United States
| | - Amanda Dennis
- Ibis Reproductive Health, 17 Dunster Street, Suite 201, Cambridge, MA 02138, United States.
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Dennis A, Manski R, Blanchard K. Does Medicaid Coverage Matter?: A Qualitative Multi-State Study of Abortion Affordability for Low-income Women. J Health Care Poor Underserved 2014; 25:1571-85. [DOI: 10.1353/hpu.2014.0151] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chu PH, Dennis A, Fu CB, Gao H, Khatiwada R, Laskaris G, Li K, Smith E, Snow WM, Yan H, Zheng W. Searches for possible T-odd and P-odd short range interactions using polarized nuclei. EPJ Web of Conferences 2014. [DOI: 10.1051/epjconf/20146605003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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MacNeil AJ, Jiao SC, McEachern LA, Yang YJ, Dennis A, Yu H, Xu Z, Marshall JS, Lin TJ. MAPK kinase 3 is a tumor suppressor with reduced copy number in breast cancer. Cancer Res 2013; 74:162-72. [PMID: 24233520 DOI: 10.1158/0008-5472.can-13-1310] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cancers are initiated as a result of changes that occur in the genome. Identification of gains and losses in the structure and expression of tumor-suppressor genes and oncogenes lies at the root of the understanding of cancer cell biology. Here, we show that the mitogen-activated protein kinase (MAPK) MKK3 suppresses the growth of breast cancer, in which it varies in copy number. A pervasive loss of MKK3 gene copy number in patients with breast cancer is associated with an impairment of MKK3 expression and protein level in malignant tissues. To assess the functional role of MKK3 in breast cancer, we showed in an animal model that MKK3 activity is required for suppression of tumor growth. Active MKK3 enhanced expression of the cyclin-dependent kinase inhibitors p21(Cip1/Waf1) and p27(Kip1), leading to increased cell-cycle arrest in G1 phase of the cell cycle. Our results reveal the functional significance of MKK3 as a tumor suppressor and improve understanding of the dynamic role of the MAPK pathway in tumor progression.
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Affiliation(s)
- Adam J MacNeil
- Authors' Affiliations: Departments of Microbiology and Immunology, Pediatrics, Physiology and Biophysics, and Pathology, Dalhousie University; Beatrice Hunter Cancer Research Institute, Halifax, Nova Scotia, Canada; Department of Medical Oncology, General Hospital of the People's Liberation Army, Beijing; and Institute of Zoonosis, College of Animal Sciences and Veterinary Medicine, Jilin University, Changchun, Jilin, China
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Dennis A, Blanchard K, Córdova D, Wahlin B, Clark J, Edlund K, McIntosh J, Tsikitas L. What happens to the women who fall through the cracks of health care reform? Lessons from Massachusetts. J Health Polit Policy Law 2013; 38:393-419. [PMID: 23262763 DOI: 10.1215/03616878-1966351] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We investigated the impact of Massachusetts health care reform on low-income women's experiences accessing insurance and health services, specifically reproductive health services such as contraception. Our findings suggest that concentrated efforts are needed to make sure that health services are available and accessible to populations who fall through the cracks of health care reform, including immigrants, minors and young adults, and women living outside urban areas. In addition, systems changes are needed to ensure that women going through common life transitions, such as pregnancy, marriage, moving, or graduating from school, have continuous access to insurance, and therefore health services, as their lives change. These groups face barriers enrolling in and maintaining their insurance coverage as well as obtaining timely health care benefits they are eligible for through their insurance benefits or public health programs. Without intervention, many in these groups may delay or avoid seeking health care altogether, which may increase health care disparities in the long term. Family planning providers in Massachusetts have played a critical role in mitigating barriers to insurance and health care. However, recent threats to defund family planning providers call into question the ability of these providers to continue providing much-needed services.
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Corbould A, Swinton F, Radford A, Campbell J, McBeath S, Dennis A. Fasting blood glucose predicts response to extended-release metformin in gestational diabetes mellitus. Aust N Z J Obstet Gynaecol 2012. [PMID: 23205962 DOI: 10.1111/ajo.12018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Metformin is increasingly accepted as an alternative to insulin therapy in gestational diabetes mellitus (GDM). The Metformin in Gestational Diabetes (MiG) trial reported similar pregnancy outcomes for metformin versus insulin; however, supplemental insulin was required in 46% of women on metformin. AIMS We aimed to identify predictors of response to metformin monotherapy in women with GDM attending a general hospital antenatal clinic. METHODS We offered extended-release metformin to women diagnosed with GDM (ADIPS 1998 criteria) at ≥24 weeks of gestation. If glucose targets were not achieved (≤5.0 mmol/L fasting, ≤6.7 mmol/L two-h post-meal), women were changed to insulin. We carried out an audit to determine characteristics of metformin responders versus nonresponders. RESULTS Twenty-five women chose initial metformin therapy; 16 (64%) achieved satisfactory glycaemic control (responders). Nine women (36%) were changed to insulin: seven due to inadequate control (nonresponders) and two had metformin intolerance. Fasting glucose at oral glucose tolerance test (OGTT) was significantly lower in metformin responders versus nonresponders; two-h glucose and BMI did not differ. Ninety-three percent of women with fasting glucose ≤5.2 mmol/L responded to metformin: conversely, at fasting glucose >5.2 mmol/L, 33% responded (P = 0.005). Neonatal outcomes were similar in metformin responders and nonresponders, women who chose initial insulin therapy (n = 25), or were diet-controlled (n = 21). CONCLUSIONS In women with GDM, fasting glucose on OGTT predicted response to metformin: at fasting glucose ≤5.2 mmol/L, the probability of response was 93%. Antenatal clinics should determine locally relevant predictors of response to metformin in women with GDM.
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Affiliation(s)
- Anne Corbould
- John Morris Diabetes Centre, Launceston General Hospital, Launceston, Tasmania, Australia.
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Nickerson A, Manski R, Dennis A. A qualitative investigation of low-income abortion clients' attitudes toward public funding for abortion. Contraception 2012. [DOI: 10.1016/j.contraception.2012.05.025] [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]
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Dennis A. Challenges implementing informed contraceptive decisions for women with epilepsy: a qualitative investigation. Contraception 2012. [DOI: 10.1016/j.contraception.2012.05.080] [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: 11/28/2022]
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Abstract
OBJECTIVE To evaluate the implementation of state Medicaid abortion policies and the impact of these policies on abortion clients and abortion providers. DATA SOURCE From 2007 to 2010, in-depth interviews were conducted with representatives of 70 abortion-providing facilities in 15 states. STUDY DESIGN In-depth interviews focused on abortion providers' perceptions regarding Medicaid and their experiences working with Medicaid and securing reimbursement in cases that should receive federal funding: rape, incest, and life endangerment. DATA EXTRACTION Data were transcribed verbatim before being coded. PRINCIPAL FINDINGS In two study states, abortion providers reported that 97 percent of submitted claims for qualifying cases were funded. Success receiving reimbursement was attributed to streamlined electronic billing procedures, timely claims processing, and responsive Medicaid staff. Abortion providers in the other 13 states reported reimbursement for 36 percent of qualifying cases. Providers reported difficulties obtaining reimbursement due to unclear rejections of qualifying claims, complex billing procedures, lack of knowledgeable Medicaid staff with whom billing problems could be discussed, and low and slow reimbursement rates. CONCLUSIONS Poor state-level implementation of Medicaid coverage of abortion policies creates barriers for women seeking abortion. Efforts to ensure policies are implemented appropriately would improve women's health.
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Dennis A, Grossman D. Barriers to contraception and interest in over-the-counter access among low-income women: a qualitative study. Perspect Sex Reprod Health 2012; 44:84-91. [PMID: 22681423 DOI: 10.1363/4408412] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
CONTEXT Barriers to contraceptive access encourage nonuse and gaps in use, which contribute to the high prevalence of unintended pregnancy in the United States. One strategy to improve access to oral contraceptives is to make them available without a prescription. METHODS From March 2007 to January 2009, focus group discussions and in-depth interviews were conducted with 45 low-income women in the Boston area to explore how they obtain contraceptives and their opinions about making oral contraceptives available over the counter. Transcripts of the discussions and interviews were deductively and inductively coded. Data were analyzed thematically, and illustrative quotes were extracted. RESULTS Overall, participants reported ease in obtaining contraceptives, which were available at multiple accessible locations throughout Boston. However, various barriers-unaffordable copays and clinic visits, the time required for clinic visits, restrictions on the number of packs of prescription contraceptives (e.g., the ring, the pill) purchased monthly and the limited time frame in which to purchase them-deterred consistent use of preferred methods. Most participants supported over-the-counter access to oral contraceptives; however, they raised concerns about cost, as well as the safety of such access for minors, first-time users and women with medical conditions. CONCLUSION Women's concerns about over-the-counter access to contraceptives must be addressed if this approach is to improve use and potentially help reduce the unintended pregnancy rate.
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McIntosh J, Tsikitas L, Dennis A. Low-income women's access to contraception after health care reform in Massachusetts. J Am Pharm Assoc (2003) 2012; 52:349-57. [DOI: 10.1331/japha.2012.11033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Dennis A, Blanchard K. A Mystery Caller Evaluation of Medicaid Staff Responses about State Coverage of Abortion Care. Womens Health Issues 2012; 22:e143-8. [DOI: 10.1016/j.whi.2011.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 11/03/2011] [Accepted: 11/07/2011] [Indexed: 11/25/2022]
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McCarthy T, Telec N, Dennis A, Griffiths J, Buettner A. Ability of non-invasive intermittent blood pressure monitoring and a continuous non-invasive arterial pressure monitor (CNAP™) to provide new readings in each 1-min interval during elective caesarean section under spinal anaesthesia. Anaesthesia 2012; 67:274-9. [PMID: 22321084 DOI: 10.1111/j.1365-2044.2011.06996.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We compared the ability of automated non-invasive intermittent oscillometric blood pressure monitoring with a new device, CNAP(TM) (continuous non-invasive arterial pressure) to provide a new blood pressure reading in each 1-min interval between spinal anaesthesia and delivery during caesarean section. We also compared the accuracy of continuous non-invasive arterial pressure readings with non-invasive blood pressure measurements before spinal anaesthesia. Fifty-nine women participated. The non-invasive and continuous non-invasive monitors displayed new blood pressure readings in a mean of 82% (11%) and 83% (13%) (p = 0.97) of the one-minute intervals between spinal anaesthesia and delivery, respectively. Continuous non-invasive arterial pressure was more likely to fail on two or more consecutive minutes (p=0.001). From the pre-spinal readings, the mean bias, defined as non-invasive-continuous non-invasive arterial pressure, and limits of agreement (±2SD mean bias) for systolic, diastolic and mean blood pressure respectively were +1.3 (±26.0), -2.9 (±21.8) and +2.6 (±20.4) mmHg. The new monitor has disadvantages compared with conventional non-invasive intermittent blood pressure monitoring.
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Affiliation(s)
- T McCarthy
- Department of Anaesthesia, The Royal Women's Hospital, Melbourne, Australia.
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Kacanek D, Dennis A, Sahin-Hodoglugil NN, Montgomery ET, Morar N, Mtetwa S, Nkala B, Phillip J, Watadzaushe C, van der Straten A. A qualitative study of obstacles to diaphragm and condom use in an HIV prevention trial in sub-Saharan Africa. AIDS Educ Prev 2012; 24:54-67. [PMID: 22339145 DOI: 10.1521/aeap.2012.24.1.54] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Consistent condom use and the substitution of condoms with potential HIV prevention methods of lower or unknown effectiveness are important concerns in the development of new prevention technologies. This qualitative study explored obstacles to consistent condom use with the diaphragm in MIRA, an HIV prevention trial in South Africa and Zimbabwe. We conducted 26 focus group discussions (FGDs) with 206 women and 7 FGDs and 10 in-depth interviews with 41 male partners of intervention-arm women. The belief that the diaphragm/gel prevented HIV, women's difficulties negotiating condom use, and men's unawareness that using the products together was recommended were obstacles to consistent condom use with the diaphragm/gel. Concerns about protection from HIV and pregnancy, recognition that the diaphragm was not yet proven to prevent HIV or sexually transmitted infections, and the trial context were facilitators. Understanding selective study product use in HIV prevention trials may inform improved adherence counseling and male involvement strategies.
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Affiliation(s)
- Deborah Kacanek
- Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115, USA.
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Dennis A, Clark J, Córdova D, McIntosh J, Edlund K, Wahlin B, Tsikitas L, Blanchard K. Access to contraception after health care reform in Massachusetts: a mixed-methods study investigating benefits and barriers. Contraception 2012; 85:166-72. [DOI: 10.1016/j.contraception.2011.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 06/07/2011] [Accepted: 06/08/2011] [Indexed: 11/25/2022]
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Dennis A, Blanchard K, Córdova D. Strategies for securing funding for abortion under the Hyde Amendment: a multistate study of abortion providers' experiences managing Medicaid. Am J Public Health 2011; 101:2124-9. [PMID: 21940932 DOI: 10.2105/ajph.2011.300212] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated systematic barriers, identified by previous research, that prevent women from obtaining Medicaid coverage for an abortion even when it should legally be available: when the pregnancy resulted from rape or incest or threatens the mother's life. We also aimed to document strategies to improve access to federal Medicaid funding in qualifying cases. METHODS We conducted in-depth interviews from 2007 to 2009 with representatives of 49 facilities that provided abortions in 11 states. Interviews focused on participants' experiences and strategies in seeking federal Medicaid funding for abortions. We coded data both inductively and deductively and analyzed them thematically. RESULTS Common strategies described by the few participants who secured Medicaid funding for abortions in cases of rape, incest, and life endangerment were facility-level interventions, such as developing relationships with Medicaid staff, building savvy billing departments, and encouraging clients to advocate for themselves, as well as broader legal and collaborative strategies. CONCLUSIONS Multipronged state-level interventions that combine advocacy, legal, and on-the-ground resources show the most promise of increasing access to federal Medicaid funding for abortion care.
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Dennis A, Blanchard K, Córdova D, Clark J, Wahlin B, McIntosh J, Tsikitas L, Edlund K. Beyond stopping Stupak: emerging challenges to abortion access under health care reform. Contraception 2011. [DOI: 10.1016/j.contraception.2011.05.042] [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: 11/15/2022]
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Dennis A, Manski R, Blanchard K. Barriers to timely access to abortion: opportunities for immediate improvements while working for systemic change. Contraception 2011. [DOI: 10.1016/j.contraception.2011.05.040] [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: 10/17/2022]
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Foster AM, Dennis A, Smith F. Do Religious Restrictions Influence Ectopic Pregnancy Management? A National Qualitative Study. Womens Health Issues 2011; 21:104-9. [DOI: 10.1016/j.whi.2010.11.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 11/15/2010] [Accepted: 11/16/2010] [Indexed: 12/27/2022]
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