1
|
Horwood C, Haskins L, Mapumulo S, Connolly C, Luthuli S, Jensen C, Pansegrouw D, McKerrow N. Electronic Integrated Management of Childhood Illness (eIMCI): a randomized controlled trial to evaluate an electronic clinical decision-making support system for management of sick children in primary health care facilities in South Africa. BMC Health Serv Res 2024; 24:177. [PMID: 38331824 PMCID: PMC10851465 DOI: 10.1186/s12913-024-10547-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 01/02/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Electronic clinical decision-making support systems (eCDSS) aim to assist clinicians making complex patient management decisions and improve adherence to evidence-based guidelines. Integrated management of Childhood Illness (IMCI) provides guidelines for management of sick children attending primary health care clinics and is widely implemented globally. An electronic version of IMCI (eIMCI) was developed in South Africa. METHODS We conducted a cluster randomized controlled trial comparing management of sick children with eIMCI to the management when using paper-based IMCI (pIMCI) in one district in KwaZulu-Natal. From 31 clinics in the district, 15 were randomly assigned to intervention (eIMCI) or control (pIMCI) groups. Computers were deployed in eIMCI clinics, and one IMCI trained nurse was randomly selected to participate from each clinic. eIMCI participants received a one-day computer training, and all participants received a similar three-day IMCI update and two mentoring visits. A quantitative survey was conducted among mothers and sick children attending participating clinics to assess the quality of care provided by IMCI practitioners. Sick child assessments by participants in eIMCI and pIMCI groups were compared to assessment by an IMCI expert. RESULTS Self-reported computer skills were poor among all nurse participants. IMCI knowledge was similar in both groups. Among 291 enrolled children: 152 were in the eIMCI group; 139 in the pIMCI group. The mean number of enrolled children was 9.7 per clinic (range 7-12). IMCI implementation was sub-optimal in both eIMCI and pIMCI groups. eIMCI consultations took longer than pIMCI consultations (median duration 28 minutes vs 25 minutes; p = 0.02). eIMCI participants were less likely than pIMCI participants to correctly classify children for presenting symptoms, but were more likely to correctly classify for screening conditions, particularly malnutrition. eIMCI participants were less likely to provide all required medications (124/152; 81.6% vs 126/139; 91.6%, p= 0.026), and more likely to prescribe unnecessary medication (48/152; 31.6% vs 20/139; 14.4%, p = 0.004) compared to pIMCI participants. CONCLUSIONS Implementation of eIMCI failed to improve management of sick children, with poor IMCI implementation in both groups. Further research is needed to understand barriers to comprehensive implementation of both pIMCI and eIMCI. (349) CLINICAL TRIALS REGISTRATION: Clinicaltrials.gov ID: BFC157/19, August 2019.
Collapse
Affiliation(s)
- C Horwood
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - L Haskins
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - S Mapumulo
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - C Connolly
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - S Luthuli
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - C Jensen
- Health Systems Strengthening Unit, Health Systems Trust, Durban, South Africa
| | - D Pansegrouw
- KwaZulu-Natal Department of Health, Ilembe District, Stanger, South Africa
| | - N McKerrow
- KwaZulu-Natal Department of Health, Paediatrics and Child Health, Pietermaritzburg, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
2
|
Wilson TA, Hazlewood GS, Sajobi TT, Wilton SB, Pearson WE, Connolly C, Javaheri PA, Finlay JL, Levin A, Graham MM, Tonelli M, James MT. Preferences of Patients With Chronic Kidney Disease for Invasive Versus Conservative Treatment of Acute Coronary Syndrome: A Discrete Choice Experiment. J Am Heart Assoc 2023; 12:e028492. [PMID: 36892063 PMCID: PMC10111540 DOI: 10.1161/jaha.122.028492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Background Patients with chronic kidney disease (CKD) can experience acute coronary syndromes (ACS) with high morbidity and mortality. Early invasive management of ACS is recommended for most high-risk patients; however, choosing between an early invasive versus conservative management approach may be influenced by the unique risk of kidney failure for patients with CKD. Methods and Results This discrete choice experiment measured the preferences of patients with CKD for future cardiovascular events versus acute kidney injury and kidney failure following invasive heart procedures for ACS. The discrete choice experiment, consisting of 8 choice tasks, was administered to adult patients attending 2 CKD clinics in Calgary, Alberta. The part-worth utilities of each attribute were determined using multinomial logit models, and preference heterogeneity was explored using latent class analysis. A total of 140 patients completed the discrete choice experiment. The mean age of patients was 64 years, 52% were male, and mean estimated glomerular filtration rate was 37 mL/min per 1.73 m2. Across the range of levels, risk of mortality was the most important attribute, followed by risk of end-stage kidney disease and risk of recurrent myocardial infarction. Latent class analysis identified 2 distinct preference groups. The largest group included 115 (83%) patients, who placed the greatest value on treatment benefits and expressed the strongest preference for reducing mortality. A second group of 25 (17%) patients was identified who were procedure averse and had a strong preference toward conservative management of ACS and avoiding acute kidney injury requiring dialysis. Conclusions The preferences of most patients with CKD for management of ACS were most influenced by lowering mortality. However, a distinct subgroup of patients was strongly averse to invasive management. This highlights the importance of clarifying patient preferences to ensure treatment decisions are aligned with patient values.
Collapse
Affiliation(s)
- Todd A Wilson
- Department of Medicine University of Calgary Calgary Alberta Canada
| | - Glen S Hazlewood
- Department of Medicine University of Calgary Calgary Alberta Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences University of Calgary Calgary Alberta Canada
| | - Stephen B Wilton
- Department of Community Health Sciences University of Calgary Calgary Alberta Canada
- Department of Cardiac Sciences University of Calgary Calgary Alberta Canada
| | - Winnie E Pearson
- Patient and Community Engagement Research Program, O'Brien Institute of Public Health University of Calgary Calgary Alberta Canada
| | - Carol Connolly
- Patient and Community Engagement Research Program, O'Brien Institute of Public Health University of Calgary Calgary Alberta Canada
| | | | - Juli L Finlay
- Department of Medicine University of Calgary Calgary Alberta Canada
| | - Adeera Levin
- Division of Nephrology University of British Columbia Vancouver British Columbia Canada
| | - Michelle M Graham
- Department of Medicine, Division of Cardiology University of Alberta Edmonton Alberta Canada
| | - Marcello Tonelli
- Department of Medicine University of Calgary Calgary Alberta Canada
| | - Matthew T James
- Department of Medicine University of Calgary Calgary Alberta Canada
- Department of Community Health Sciences University of Calgary Calgary Alberta Canada
| |
Collapse
|
3
|
Posadas Ruiz J, Walker A, Zhu H, Bota-Rabassedas N, Wijeratne S, Connolly C, Wynes M, Sanchez-Espiridion B, Dacic S, Wistuba I, Lee J. PP01.53 Pathologic Response Assessment Tool – Architecting a Cloud-Based Tool to Streamline Logistics for Shipping, Tracking, Scoring, and Reporting. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.079] [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: 01/30/2023]
|
4
|
Bota-Rabassedas N, Wijeratne S, Connolly C, Wynes M, Sanchez-Espiridion B, Fujimoto J, Posadas J, Walker A, Zhu H, Dacic S, Travis W, Lee J, Kerr K, Glass C, Saqui A, Sholl L, Cooper W, Roden A, Poleri C, Chung JH, Lopez-Martin J, Borczuk A, Weissferdt A, Wistuba I. PP01.39 Infrastructure for Interobserver Variability Assessment of Pathologic Response (PR), in Surgical Resection Specimens Following Neoadjuvant Immune Check Point Inhibitor (ICI) Therapies in Early Stage NSCLC. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.065] [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: 01/30/2023]
|
5
|
Avila R, Krishnan K, Wynes M, Connolly C, McWilliams A, Logan J, Henschke C, Yankelevitz D, Pastorino U, Santos R, Hochhegger B, Ashizawa K, Kobayashi T, Rzyman W, Jelitto-Gorska M, Field J, Mulshine J, Lam S. EP01.04-005 Quantitative Characteristics in Global CT Lung Cancer Screening Populations Using the ELIC Distributed Database and Computation Environment. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.300] [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: 10/14/2022]
|
6
|
Avila R, Krishnan K, Wynes M, Connolly C, McWilliams A, Logan J, Henschke C, Yankelevitz D, Pastorino U, Santos R, Hochhegger B, Ashizawa K, Kobayashi T, Rzyman W, Jelitto-Gorska M, Field J, Mulshine J, Lam S. MA11.07 The ELIC Distributed Database and Computation Environment for Analyses of Lung Cancer Screening LDCTs Across the World. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
7
|
Connolly C. PL06-03 Pharmacological responses of bees to neonicotinoids. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.048] [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]
|
8
|
Connolly C, Chiang TPY, Teles M, Frey S, Alejo J, Massie A, Christopher Stine L, Werbel W, Segev D, Paik J. POS0256 CLINICAL PREDICTORS OF ATTENUATED ANTIBODY RESPONSE TO PRIMARY SARS-CoV-2 VACCINATION IN A LARGE PROSPECTIVE STUDY OF PATIENTS WITH RHEUMATIC AND MUSCULOSKELETAL DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAn attenuated humoral response to SARS-CoV-2 vaccination has been observed in some patients with rheumatic and musculoskeletal diseases (RMD) (1). We sought to identify clinical factors associated with poor humoral response following primary (two-dose mRNA or single adenoviral vector dose) SARS-COV-2 vaccination in patients with RMD on immunosuppression.ObjectivesTo identify clinical predictors of an attenuated antibody response to primary SARS-CoV-2 vaccination in RMD patients on immunosuppression.MethodsWe included patients ≥18 years old with RMD on immunosuppression who received either two-dose mRNA or single dose Janssen/Johnson and Johnson (J&J) vaccination. Demographics, diagnoses, and therapeutic regimens were collected via participant report; those with prior COVID-19 infection were excluded. One month after vaccination, participants underwent SARS-CoV-2 antibody testing on the semi-quantitative Roche Elecsys anti-SARS-CoV-2 S enzyme immunoassay, which measures antibody to the SARS-CoV-2 S-receptor binding domain (RBD) protein (ceiling >250U/mL later expanded to >2500U/mL). Associations were evaluated using Fisher’s exact and Wilcoxon rank sum tests. Logistic regression analyses were performed to evaluate for clinical factors associated with antibody response. We adapted survival methods to address right-truncation of titers; this methodology was used to calculate medians. Participants provided informed consent electronically and the study was approved by the local Institutional Review Board.ResultsWe studied 1138 RMD participants on immunosuppression; most were female (93%) and white (91%) (Table 1). One-hundred and fifteen (10%) had anti-RBD response in the negative range at a median (IQR) of 29 days (28-34) following completion of vaccine series. A greater proportion of participants with negative response were non-white, received J&J vaccine, reported use of mycophenolate, rituximab, or glucocorticoids. Antibody response differed by immunosuppressive regimen, with those receiving rituximab having poorest response (Figure 1). Use of mycophenolate (aOR 9.92, p=0.001), rituximab (aOR 56.99, p=0.001), glucocorticoids (aOR 2.99, p=0.001) or receipt of J&J (aOR 3.13, p=0.039) were associated with negative antibody response.Table 1.Clinical characteristics stratified by anti-SARS-CoV-2 RBD responseNegative (n=115)*Positive (n=1023)*p-value†Age,median(IQR)49(42, 58)47(37, 58)0.07Female sex,no.(%)108(94%)952(93%)0.78Non-white,no.(%)16(13.9%)83(8.1%)0.04Diagnosis,no.(%)Inflammatory arthritis22(19.1%)469(45.8%)<0.01SLE27(23.5%)193(18.9%)0.27Sjὅgren’s syndrome5(4.3%)46(4.5%)0.53Myositis13(11.3%)49(4.8%)<0.01Systemic sclerosis2(1.7%)9(0.9%)0.55Vasculitis12(10.4%)16(1.6%)<0.01Overlap connective tissue disease¶34(29.5%)24(23.6%)0.65
Vaccine,no.(%) Pfizer/BioNTech66(57.4%)548(53.6%)0.01Moderna38(33.0%)438(42.8%)J&J11(9.6%)37(3.6%)Non-biologic in regimen89(77.4%)725(70.9%)0.52Biologic in regimen84(73.0%)570(55.7%)0.01 Mycophenolate**56(48.7%)120(11.7%)<0.01 Rituximab54(47.0%)29(2.8%)<0.01 Glucocorticoid**61(53.0%)284(27.8%)<0.01Withheld immunosuppression18(21.2%)260(39.6%)<0.01* Negative defined as anti-RBD titer <0.8 U/mL.† Comparisons between negative and positive groups.¶ Denotes a combination of two or more of the above conditions** Mycophenolate: mycophenolic acid and mycophenolate mofetil. Corticosteroid: prednisone and prednisone equivalentsFigure 1.ConclusionUse of mycophenolate, glucocorticoids, rituximab and receipt of J&J vaccine were the strongest predictors of an attenuated antibody response to primary SARS-CoV-2 vaccination; these data support use of an additional primary dose in RMD patients.References[1]Deepak P, Kim W, Paley MA, et al. Effect of Immunosuppression on the Immunogenicity of mRNA Vaccines to SARS-CoV-2: A Prospective Cohort Study. Ann Intern Med. 2021.AcknowledgementsWe would like to acknowledge the contributions of: Brian J. Boyarsky MD, PhD, Jake A. Ruddy BS, and Jacqueline M. Garonzik-Wang MD PhD.Disclosure of InterestsCaoilfhionn Connolly: None declared, Teresa Po-Yu Chiang: None declared, Mayan Teles: None declared, Sarah Frey: None declared, Jennifer Alejo: None declared, Allan Massie: None declared, Lisa Christopher Stine Consultant of: Janssen, Boehringer-Ingelheim, Mallinckrodt, EMD-Serono, Allogene, and ArgenX., William Werbel: None declared, Dorry Segev Speakers bureau: Sanofi, Novartis, CSL Behring, Jazz Pharmaceuticals, Veloxis, Mallincrodt, Thermo Fisher Scientific, Regeneron, and Astra-Zeneca, Consultant of: Sanofi, Novartis, CSL Behring, Jazz Pharmaceuticals, Veloxis, Mallincrodt, Thermo Fisher Scientific, Regeneron, and Astra-Zeneca, Julie Paik: None declared
Collapse
|
9
|
Worlikar H, Vadhiraj VV, Murray A, O’Connell J, Connolly C, Walsh J, O’Keeffe D. Is it feasible to use a humanoid robot to promote hand hygiene adherence in a hospital setting? Infect Prev Pract 2022; 4:100188. [PMID: 35036902 PMCID: PMC8749168 DOI: 10.1016/j.infpip.2021.100188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
Healthcare associated infections (HCAI) are a prevalent preventable cause of morbidity and mortality. Improving hand hygiene adherence is important for HCAI prevention. In this feasibility study, the objective was to determine if a humanoid robot could act as a novel single reminder intervention to improve hand hygiene adherence in a hospital setting. DAVE, a social humanoid robot, improved hand hygiene adherence at the entrance to a tertiary hospital and outpatient department, which was low at baseline, by 29%. DAVE shows promise as a novel intervention to improve hand hygiene adherence.
Collapse
Affiliation(s)
- H. Worlikar
- School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91 TK33 Galway, Ireland
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, Lambe Institute for Translational Research, National University of Ireland Galway, H91 TK33 Galway, Ireland
| | - V. Vyas Vadhiraj
- School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91 TK33 Galway, Ireland
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, Lambe Institute for Translational Research, National University of Ireland Galway, H91 TK33 Galway, Ireland
| | - Aoife Murray
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, Lambe Institute for Translational Research, National University of Ireland Galway, H91 TK33 Galway, Ireland
| | - J. O’Connell
- School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91 TK33 Galway, Ireland
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, Lambe Institute for Translational Research, National University of Ireland Galway, H91 TK33 Galway, Ireland
| | - C. Connolly
- School of Education, College of Arts, Social Sciences, and Celtic Studies, National University of Ireland Galway, Galway, Ireland
- Lero, Science Foundation Ireland Centre for Software Research, National University of Ireland Galway, H91 TK33 Galway, Ireland
| | - J.C. Walsh
- Lero, Science Foundation Ireland Centre for Software Research, National University of Ireland Galway, H91 TK33 Galway, Ireland
- School of Psychology, College of Arts, Social Sciences, & Celtic Studies, National University of Ireland Galway, Galway, Ireland
| | - D.T. O’Keeffe
- School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91 TK33 Galway, Ireland
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, Lambe Institute for Translational Research, National University of Ireland Galway, H91 TK33 Galway, Ireland
- Lero, Science Foundation Ireland Centre for Software Research, National University of Ireland Galway, H91 TK33 Galway, Ireland
- Corresponding author. Address: School of Medicine National University of Ireland Galway, Clinical Sciences Institute, Costello Road, Galway, H91 V4AY, Ireland. Tel.: +353 (0)91 495960.
| |
Collapse
|
10
|
Mjwara M, Khan M, Kruse CH, Sibanda W, Connolly C. Significance of HbA1c levels in diabetic retinopathy extremes in South Africa. S Afr Med J 2021; 111:886-890. [PMID: 34949254] [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] [Received: 09/02/2021] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is one of the leading causes of blindness in sub-Saharan Africa and globally, placing a huge disease burden on patients and the public health system. DR varies in severity from non-proliferative to proliferative DR (PDR). OBJECTIVES Using a monitor of medium- to long-term blood glucose control, to determine the association between glycated haemoglobin (HbA1c) levels in patients with PDR and those with no DR. METHODS A prospective, cross-sectional study was conducted at McCord Provincial Eye Hospital in Durban, South Africa. We studied only patients diagnosed with diabetes mellitus (DM) for >1 year who had either PDR or no DR, and compared their HbA1c levels. Patients with non-proliferative DR were not included. RESULTS Patients with PDR had significantly higher HbA1c levels than those with no DR. Patients with type 1 DM had higher HbA1c levels than patients with type 2 DM in both the PDR and no-DR groups. Older patients (>70 years) had lower HbA1c levels than younger patients. Gender, race and duration of diabetes had no influence on HbA1c levels. CONCLUSIONS PDR was associated with higher HbA1c in type 2 DM in all races and age groups and was independent of duration of disease. The trend was the same for type 1 DM, but significance could not be reached, probably because of small numbers in this subset of patients.
Collapse
Affiliation(s)
- M Mjwara
- Department of Ophthalmology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | | | | | | | | |
Collapse
|
11
|
Dahim M, Mitha M, Connolly C, Nyamande K. Pulmonary hypertension: Spectrum of disease, clinical presentation and treatment outcomes at the main respiratory pulmonary hypertension clinic in KwaZulu-Natal Province, South Africa. Afr J Thorac Crit Care Med 2021; 27:10.7196/AJTCCM.2021.v27i1.118. [PMID: 34240040 PMCID: PMC8203056 DOI: 10.7196/ajtccm.2021.v27i1.118] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND There are many causes of pulmonary hypertension (PH). However, the aetiology, management and treatment outcomes in South Africa (SA), which has a high burden of HIV, are lacking in the literature. OBJECTIVES To characterise patient demographics, aetiology, clinical presentation and management of patients presenting to the only government-funded PH clinic in Durban, SA. METHODS We retrospectively reviewed electronic charts of patients with confirmed PH who attended the respiratory PH clinic between 2011 and 2018. Demographic and clinical data, symptoms, pulmonary function testing, pulmonary artery pressure on echocardiography and treatment were analysed. Patients with group 2 PH were excluded from the present study as they were managed by cardiologists. RESULTS We identified 93 patients with confirmed PH and the majority were female (82.8%; n=77). The majority of the patients were between the ages of 30 and 39 years at the time of diagnosis. Most patients were black African (64.5%; n=60), followed by Indians (26.9%; n=25) and whites (8.6%; n=8). The most common cause of PH was group 1 (75%; n=70), followed by group 4 (13%; n=12) and then group 3 (12%; n=11). HIV-associated PH accounted for 27% of all patients and was the main cause of PH in those classified in group 1 (38%; n=29). Two-thirds (66%) of patients were treated with sildenafil, the only treatment that was available. Patients on treatment showed significant improvement indicated by the World Health Organization functional class, mean 6-minute walk test and reduction in mean pulmonary artery pressure on echocardiography. CONCLUSION HIV-associated PH is the most common cause of PH in SA. Sildenafil, the only drug available in our setting, is beneficial to most patients with PH.
Collapse
Affiliation(s)
- M Dahim
- Department of Pulmonology and Critical Care, Groote Schuur Hospital, Cape Town, South Africa
| | - M Mitha
- Department of Pulmonology and Critical Care, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - C Connolly
- Department of Biostatistics, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - K Nyamande
- Department of Pulmonology and Critical Care, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| |
Collapse
|
12
|
Wilson T, Javaheri P, Finlay J, Hazlewood G, Wilton SB, Sajobi T, Levin A, Pearson W, Connolly C, James MT. Treatment Preferences for Cardiac Procedures of Patients With Chronic Kidney Disease in Acute Coronary Syndrome: Design and Pilot Testing of a Discrete Choice Experiment. Can J Kidney Health Dis 2021; 8:2054358120985375. [PMID: 33552527 PMCID: PMC7844446 DOI: 10.1177/2054358120985375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/27/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Chronic kidney disease is associated with a high incidence of acute coronary syndrome and related morbidity and mortality. Treatment choices for patients with chronic kidney disease involve trade-offs in the potential benefits and harms of invasive management options. Objective: The objective was to quantify preferences of patients with chronic kidney disease toward invasive heart procedures. Design: Design and pilot a discrete choice experiment. Setting: We piloted the discrete choice experiment in 2 multidisciplinary chronic kidney disease clinics in Calgary, Alberta, using an 8-question survey. Patients: Eligible patients included those aged 18 years and older, an estimated glomerular filtration rate < 45 mL/min/1.73 m2, not currently receiving dialysis, and able to communicate in English. Measurements: Quantification of the average importances of key attributes of invasive heart procedures. Methods: We identified attributes most important to patients and physicians concerning invasive versus conservative management for acute coronary syndrome, using semi-structured qualitative interviews. Levels for each attribute were derived from analysis of early invasive versus conservative acute coronary syndrome management clinical trials and cohort studies, where subgroups of patients with chronic kidney disease were reported. We designed the pilot study with patient partners with relevant lived experience and considered statistical efficiency to estimate main effects and interactions, as well as response efficiency. Hierarchical Bayesian estimation was used to quantify average importances of attributes. Results: We recruited 43 patients with chronic kidney disease, mean (SD) age 67 (14) years, 67% male, and 35% with a history of cardiovascular disease, of whom 39 completed the survey within 2 weeks of enrollment. The results of the pilot revealed acute kidney injury requiring dialysis and permanent kidney replacement therapy, as well as death within 1 year were the most important attributes. Measures of internal validity for the pilot discrete choice experiment were comparable to those for other published discrete choice experiments. Limitations: Discrete choice experiments are complex instruments and often cognitively demanding for patients. This survey included multiple risk attributes which may have been challenging for some patients to understand. Conclusions: This pilot study demonstrates the feasibility of a discrete choice experiment to quantify preferences of patients with chronic kidney disease toward the benefits and trade-offs related to invasive versus conservative management for acute coronary syndrome. These preliminary findings suggest that patients with chronic kidney disease may be on average similarly risk averse toward kidney replacement therapy and death. This pilot information will be used to inform a larger discrete choice experiment that will refine these estimates of patient preferences and characterize subgroups with distinct treatment preferences, which should provide new knowledge that can facilitate shared decision-making between patients with chronic kidney disease and their care providers in the setting of acute coronary syndrome.
Collapse
Affiliation(s)
- T Wilson
- Department of Community Health Sciences, University of Calgary, AB, Canada
| | - P Javaheri
- Department of Medicine, University of Calgary, AB, Canada
| | - J Finlay
- Department of Medicine, University of Calgary, AB, Canada
| | - G Hazlewood
- Department of Medicine, University of Calgary, AB, Canada
| | - S B Wilton
- Department of Cardiac Sciences, University of Calgary, AB, Canada
| | - T Sajobi
- Department of Community Health Sciences, University of Calgary, AB, Canada
| | - A Levin
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - W Pearson
- Patient and Community Engagement Research Program, O'Brien Institute of Public Health, University of Calgary, AB, Canada
| | - C Connolly
- Department of Cardiac Sciences, University of Calgary, AB, Canada
| | - M T James
- Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
| |
Collapse
|
13
|
Aung M, Konoshita T, Moodley J, Naicker T, Connolly C, Khaliq OP, Gathiram P. Aminopeptidase A (ENPEP) gene polymorphisms and preeclampsia: Descriptive analysis. Eur J Obstet Gynecol Reprod Biol 2020; 258:70-74. [PMID: 33421813 DOI: 10.1016/j.ejogrb.2020.12.051] [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: 11/12/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The etiology of preeclampsia (PE) remains elusive. Recent genome-wide association studies have identified a number of genetic variants associated with blood pressure variations in east Asians. One of the genetic variants is the aminopeptidase A (ENPEP) gene, which converts angiotensin II to angiotensin III. The C allele of rs6825911 is a risk for hypertension. The current study investigated whether genetic variants of ENPEP play a role in the pathogenesis of preeclampsia. STUDY DESIGN The study was a descriptive analysis of gene polymorphisms of ENPEP; 602 pregnant women of African ancestry [normotensive (n = 245) and PE (n = 357)] were recruited. The two groups were divided according to their HIV status. The PE group consisted of early- and late-onset sub-categories. A single nucleotide polymorphism of rs6825911 was analyzed using the TaqMan® Probe mix and by means of real time polymerase chain reaction. RESULTS The risk of C allele for PE was 1.07 (95 % CI 0.83-1.38, P = 0.589) for allele comparison and the risk for preeclampsia CC to CT/TT was 1.33 (95 % CI 0.96-1.85, P = 0.086). The sub analysis for the PE group without HIV infection the risk of C allele was 1.25 (95 % CI 0.838-1.78, P = 0.199) and the risk of PE of CC to CT/TT was 1.51 (95 %CI: 0.96-2.35, P = 0.071). CONCLUSION This is the first study in a homogenous South African population of African ancestry to show that the variant of ENPEP gene does not play a role in pathogenesis of preeclampsia.
Collapse
Affiliation(s)
- M Aung
- Department of Family Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - T Konoshita
- The Third Department of Internal Medicine, University of Fukui Faculty of Medicine Sciences, Fukui, Japan
| | - J Moodley
- Department of Women's Health and HIV Research Group, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - T Naicker
- Department of Optics & Imaging, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - C Connolly
- Department of Public Health Medicine & Biostatistics, College of Health Science, University of KwaZulu-Natal, Durban. South Africa
| | - O P Khaliq
- Department of Women's Health and HIV Research Group, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - P Gathiram
- Department of Family Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
14
|
Hillier DR, Tang M, Clark W, MacDonald C, Connolly C, Large C, King M, Singer J, Levin A, Manns B, Konvalinka A, Scholey J, Rosenblum ND. A Framework to Ensure Patient Partners Have Equal and Contributing Voices Throughout the Research Program Evaluation Process. Can J Kidney Health Dis 2020; 7:2054358120970093. [PMID: 33294204 PMCID: PMC7705288 DOI: 10.1177/2054358120970093] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 09/27/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF PROGRAM Traditionally, peer review was a closed process conducted only by individuals working in the research field. To establish a more integrated and patient-centered approach, one of Canada's largest kidney research networks (Can-SOLVE CKD) has created a Research Operations Committee (ROC) that includes patients as key members. The ROC represents one way for achieving meaningful patient-oriented research (POR). SOURCE OF INFORMATION Can-SOLVE CKD, a network created as part of the Canadian Institutes of Health Research (CIHR) Strategy for Patient-Oriented Research (SPOR). METHODS The ROC consists of patients, physicians, scientists, Indigenous partners, experts in research methodology, and a member of Can-SOLVE CKD's operational team. On an annual basis, Can-SOLVE CKD's research teams provide the ROC with a review package, which incorporates information from patient engagement check-in calls and surveys, the project's knowledge translation plan and products, and a progress report written by the project team. The ROC evaluates the review package and provides feedback and recommendations accordingly. KEY FINDINGS The transparent nature of the process, regular feedback and review, along with an overt accountability and scoring system, has been embraced by both patients and researchers. As a result of the ROC process, the number of patient leads for each project has grown over a 3-year period and more researchers have received POR and cultural sensitivity training. LIMITATIONS While anecdotal evidence suggests this approach is beneficial for achieving POR, formal mechanisms of evaluation are currently lacking. IMPLICATIONS This ROC framework ensures patients are active contributors throughout the research process and could be adopted by other organizations to achieve a more patient-centered approach to research.
Collapse
Affiliation(s)
| | - Mila Tang
- The University of British Columbia,
Vancouver, Canada
| | - William Clark
- Department of Medicine, London Health
Sciences Centre, ON, Canada
| | | | | | | | | | - Joel Singer
- The University of British Columbia,
Vancouver, Canada
| | | | - Braden Manns
- University of Calgary, AB, Canada
- Foothills Medical Centre, Calgary, AB,
Canada
| | | | - James Scholey
- University of Toronto, ON, Canada
- University Health Network, Toronto, ON,
Canada
| | - Norman D. Rosenblum
- Department of Paediatrics, The
Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
15
|
Finlay J, Wilson T, Javaheri PA, Pearson W, Connolly C, Elliott MJ, Graham MM, Norris CM, Wilton SB, James MT. Patient and physician perspectives on shared decision-making for coronary procedures in people with chronic kidney disease: a patient-oriented qualitative study. CMAJ Open 2020; 8:E860-E868. [PMID: 33303572 PMCID: PMC7867031 DOI: 10.9778/cmajo.20200039] [Citation(s) in RCA: 2] [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: 11/22/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) and heart disease face challenging treatment decisions. We sought to explore the perceptions of patients and physicians about shared decision-making for coronary procedures for people with CKD, as well as opinions about strategies and tools to improve these decisions. METHODS We partnered with 4 patients with CKD and 1 caregiver to design and conduct a qualitative descriptive study using semi-structured interviews and content analysis. Patient participants with CKD and either acute coronary syndrome or cardiac catheterization in the preceding year were recruited from a provincial cardiac registry, cardiology wards and clinics in Calgary between March and September 2018. Cardiologists from the region also participated in the study. Data analysis emphasized identifying, organizing and describing themes found within the data. RESULTS Twenty patients with CKD and 10 cardiologists identified several complexities related to bidirectional information exchange needed for shared decision-making. Themes identified by both patients and physicians included challenges synthesizing best evidence, variable patient knowledge seeking, timeliness in the acute care setting and influence of roles on decision-making. Themes identified by physicians related to processes and tools to help support shared decision-making in this setting included personalization to reflect the variability of risks and heterogeneity of patient preferences as well as allowing for physicians to share their clinical judgment. INTERPRETATION There are complexities related to bidirectional information exchange between patients with CKD and their physicians for shared decision-making about coronary procedures. Processes and tools to facilitate shared decision-making in this setting require personalization and need to be time sensitive.
Collapse
Affiliation(s)
- Juli Finlay
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Todd Wilson
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Pantea Amin Javaheri
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Winnie Pearson
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Carol Connolly
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Meghan J Elliott
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Michelle M Graham
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Colleen M Norris
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Stephen B Wilton
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Matthew T James
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta.
| |
Collapse
|
16
|
Horwood C, Haskins L, Engebretsen I, Connolly C, Coutsoudis A, Spies L. Are we doing enough? Improved breastfeeding practices at 14 weeks but challenges of non-initiation and early cessation of breastfeeding remain: findings of two consecutive cross-sectional surveys in KwaZulu-Natal, South Africa. BMC Public Health 2020; 20:440. [PMID: 32245371 PMCID: PMC7118904 DOI: 10.1186/s12889-020-08567-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 03/23/2020] [Indexed: 11/21/2022] Open
Abstract
Background KwaZulu-Natal (KZN) Initiative for breastfeeding support (KIBS) was a multipronged intervention to support the initiation and sustaining of breastfeeding, implemented between 2014 and 2017. We present results of two surveys conducted before and after KIBS implementation to assess changes in infant feeding practices in KZN over this time period. Methods Two cross-sectional surveys were conducted in primary health care clinics. Multistage stratified random sampling was used to select clinics and participants. Sample size was calculated to provide district estimates of 14-week exclusive breastfeeding (EBF) rates at baseline (KIBS1), and provincial estimates at endpoint (KIBS2). At KIBS1 the sample required was nine participating clinics in each of 11 districts (99 clinics) with 369 participants per district (N = 4059), and at KIBS2 was 30 clinics in KZN with 30 participants per clinic (N = 900). All caregivers aged ≥15 years attending the clinic with infants aged 13- < 16 weeks were eligible to participate. Data was collected using structured interviews on android devices. Multi-variable logistic regression was used to adjust odds ratios for differences between time points. Results At KIBS1 (May2014- March2015), 4172 interviews were conducted with carers, of whom 3659 (87.6%) were mothers. At KIBS2 (January–August 2017), 929 interviews were conducted which included 788 (84.8%) mothers. Among all carers the proportion exclusively breastfeeding was 44.6 and 50.5% (p = 0.1) at KIBS1 and KIBS2 respectively, but greater improvements in EBF were shown among mothers (49.9 vs 59.1: p = 0.02). There were reductions in mixed breastfeeding among all infants (23.2% vs 16.3%; p = 0.016). Although there was no change in the proportion of carers who reported not breastfeeding (31.9% vs 32.8%; p = 0.2), the duration of breastfeeding among mothers who had stopped breastfeeding was longer at KIBS2 compared to KIBS1 (p = 0.0015). Mothers who had returned to work or school were less likely to be breastfeeding (adjusted odds ratio [AOR] 3.76; 95% CI 3.1–4.6), as were HIV positive mothers (AOR 2.1; 95% CI 1.7–2.6). Conclusion Despite improvements to exclusive breastfeeding, failure to initiate and sustain breastfeeding is a challenge to achieving optimal breastfeeding practices. Interventions are required to address these challenges and support breastfeeding particularly among working mothers and HIV positive mothers.
Collapse
Affiliation(s)
- C Horwood
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.
| | - L Haskins
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - I Engebretsen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - C Connolly
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - A Coutsoudis
- Department of Paediatrics & Child Health, School of Clinical Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal Durban, Durban, South Africa
| | - L Spies
- Department of Health, Pietermaritzburg, KwaZulu-Natal, South Africa
| |
Collapse
|
17
|
Tuosto K, Johnston JT, Connolly C, Lo C, Sanganyado E, Winter KA, Roembke T, Richter WE, Isaacson KJ, Raitor M, Kosanic A, Bessone L, Heim AB, Srivastava P, Hughes PW, Aamodt CM. Making science accessible. Science 2020; 367:34-35. [PMID: 31896709 DOI: 10.1126/science.aba6129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Kristen Tuosto
- Center for the Advanced Study of Human Paleobiology, The George Washington University, Washington, DC 20052, USA.
| | - Juliet Tegan Johnston
- Department of Civil, Environmental, and Geo-Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | | | - Cody Lo
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z2, Canada
| | - Edmond Sanganyado
- Provincial Key Laboratory of Marine Biotechnology, Shantou University, Shantou, Guangdong, 515063, China
| | - Kristy A Winter
- College of Humanities, Arts, and Social Sciences, Flinders University, Bedford Park, SA 5042, Australia
| | - Tanja Roembke
- Institute of Psychology, RWTH Aachen University, Aachen, NRW 52062, Germany.
| | - Wagner Eduardo Richter
- Department of Chemical Engineering, Technological Federal University-Paraná, Paraná, Brazil.
| | - Kyle J Isaacson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Michael Raitor
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA.
| | - Aleksandra Kosanic
- Ecology Team, Department of Biology, University of Konstanz, D 78457 Konstanz, Germany
| | | | - Ashley B Heim
- School of Biological Sciences, University of Northern Colorado, Greeley, CO 80639, USA.
| | - Pragya Srivastava
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - P William Hughes
- Department of Ecology, Environment, and Plant Sciences, Stockholm University, Stockholm, 10691, Sweden
| | - Caitlin M Aamodt
- Neuroscience Interdepartmental PhD Program, University of California, Los Angeles, Los Angeles, CA 90025-4816, USA
| |
Collapse
|
18
|
Hillier D, Tang M, Clark W, Connolly C, Large C, King M, Singer J, Levin A, Manns B, Konvalinka A. SUN-214 COLLABORATIVE PEER-REVIEW MODEL: PATIENT PARTNERS AS EQUAL AND CONTRIBUTING VOICES IN PATIENT-ORIENTED RESEARCH. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.618] [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: 11/27/2022] Open
|
19
|
Truax ML, Connolly C, Winther C. Transforming a Library Service within a Provincial Healthcare Organization: Forging a New Path. J Can Health Libr Assoc 2018. [DOI: 10.29173/jchla29376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction: Prior to 2011, libraries within Alberta Health Services (AHS) operated using a variety of self-determining service models across 19 locations. Evaluation of library services demonstrated significant gaps in service delivery and access to resources, cost inefficiencies and variation in library service standards across the province. National and international trends reflected ongoing library closures and challenges to demonstrate library contributions to organizational goals and improvements in health information literacy.
Description: In January 2011, all AHS library services were aligned under the Knowledge Management Department to capitalize on the natural fit between libraries as conduits to evidence and knowledge management practices that support the use of evidence in practice. The mandate was to develop enterprise-wide library resources and services to support clinical decision-making and quality patient care under the umbrella of the Knowledge Resource Service (KRS). The Business Case for KRS Optimization guided this initiative.
Outcome: KRS is now a focal point for access to, and expertise in, healthcare information resources and services. Organization-wide evaluations conducted in 2011 and 2014 show increased user satisfaction, while utilization analytics reflect continued growth.
Discussion: The KRS Optimization Initiative was a proactive, internally driven effort to extend library services and resources beyond the traditional library space, streamline ‘back-office’ functions and allow staff to contribute to organizational initiatives. The path has been winding yet lessons learnt include the value of dedicated staff, teamwork, and maintaining a focus on improving service for all AHS staff and clinicians.
Collapse
|
20
|
Johnson M, Crowley P, Foley A, Xue C, Connolly C, Gallagher H, Buggy D. Effect of perioperative lidocaine on metastasis after sevoflurane or ketamine-xylazine anaesthesia for breast tumour resection in a murine model. Br J Anaesth 2018; 121:76-85. [DOI: 10.1016/j.bja.2017.12.043] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/05/2017] [Accepted: 01/17/2018] [Indexed: 11/16/2022] Open
|
21
|
Horwood C, Haskins L, Engebretsen IM, Phakathi S, Connolly C, Coutsoudis A, Spies L. Improved rates of exclusive breastfeeding at 14 weeks of age in KwaZulu Natal, South Africa: what are the challenges now? BMC Public Health 2018; 18:757. [PMID: 29914417 PMCID: PMC6006942 DOI: 10.1186/s12889-018-5657-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/01/2018] [Indexed: 11/10/2022] Open
Abstract
Background Increasing the rate of exclusive breastfeeding (EBF) to 50% in the first six months of life is one of six major global targets set by the United Nations Decade of Nutrition, and is essential to achieve the sustainable development goals to eradicate hunger and end malnutrition by 2030. Methods A survey using multistage random sampling design included 99 primary health care (PHC) clinics in all 11 districts in KwaZulu-Natal (KZN). All mothers and caregivers of infants 14 weeks of age attending the clinics in the study period were requested to participate in a structured interview to explore feeding practices since birth. As non-maternal caregivers may not have detailed knowledge of feeding practices, they provided limited information about current feeding practices. Respondents who consistently reported giving no other food or fluids except breastmilk since birth were classified as practising exclusive breastfeeding (EBF), and those who were currently breastfeeding but had given other food or fluids since birth were categorised as practising mixed breastfeeding (MBF). Results A total of 4172 interviews were conducted with mothers and caregivers of 14 week old infants. Among mothers 49.8% were EBF, 23.1% were MBF and 27.0% were not breastfeeding. Among non-maternal caregivers 11.8% reported EBF, 23.4% MBF and 62.3% were not giving breastmilk. Higher education (OR 0.6, 95% CI 0.4–0.8) and being in the highest socio-economic tertile (OR 0.7, 95% CI 0.6–0.9) were risk factors for not practising EBF, while returning to work (OR 0.3, 95% CI 0.2–0.3) or school (OR 0.2 95% CI, 0.1–0.3) was associated with less EBF. HIV-positive mothers were more likely to have never started breastfeeding (OR 3.6, 95% CI 2.7–4.8). However, they were similar in having stopped breastfeeding by 14 weeks (OR 1.1, 95% CI 0.9–1.4) compared to HIV-negative mothers, and, they had similar rates of EBF at 14 weeks of age (OR 1.0, 95% CI 0.9–1.3). Conclusions Estimates of breastfeeding practices at 14 weeks in KZN are higher than previously shown. However, particular challenges that should be addressed if international targets for EBF are to be achieved include improving breastfeeding practices of HIV positive mothers and supporting all mothers, particularly working or schooling mothers to continue giving breastmilk while they are away from their children.
Collapse
Affiliation(s)
- C Horwood
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.
| | - L Haskins
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - I M Engebretsen
- Centre for International Health, Department of global public health and primary care, University of Bergen, Bergen, Norway
| | - S Phakathi
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - C Connolly
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - A Coutsoudis
- Department of Paediatrics & Child Health, School of Clinical Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban, South Africa
| | - L Spies
- KwaZulu-Natal Department of Health, Pietermaritzburg, KwaZulu-Natal, South Africa
| |
Collapse
|
22
|
Moreira LDC, Connolly C, Claus JR. Vascular Rinse and Chill Effects on Meat Quality and Shelf Life of Cull Cows. Meat and Muscle Biology 2018. [DOI: 10.22175/rmc2018.094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
23
|
Connolly C, Madden SF, Buggy DJ, Gallagher HC. Expression of anaesthetic and analgesic drug target genes in excised breast tumour tissue: Association with clinical disease recurrence or metastasis. PLoS One 2017; 12:e0177105. [PMID: 28558008 PMCID: PMC5448742 DOI: 10.1371/journal.pone.0177105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 04/21/2017] [Indexed: 11/18/2022] Open
Abstract
Background Retrospective analyses suggest anaesthetic-analgesics technique during cancer surgery may affect recurrence/metastasis. This could involve direct effects of anaesthetic-analgesic drugs on cancer cells. While μ-opioid receptor over-expression in lung tumours is associated with greater metastasis, other anaesthetic-analgesic receptor targets in cancer recurrence/metastasis remain unexplored. Therefore, we evaluated the association between genetic expression of anaesthetic-analgesic receptor targets and recurrence/metastasis, using a repository of breast cancer gene expression and matching clinical data. Methods A list of 23 genes encoding for the most prominent anaesthetic-analgesic receptor targets was compiled. This was processed through BreastMark- an algorithm integrating gene expression data from ~17,000 samples and clinical data from >4,500 breast cancer samples. Gene expression data was dichotomized using disease-free survival (survival without recurrence) and distant disease-free survival (survival without metastasis) as end points. Hazard ratios were calculated by Cox-regression analysis. Enrichment for prognostic markers was determined by randomly choosing 23-member gene lists from all available genes, calculating how often >5 significant markers were observed and adjusting p-values for multiple testing. This was repeated 10,000 times and an empirical p-value calculated. Results Of 23 selected genes, 9 were significantly associated with altered rates of metastasis and 4 with recurrence on univariate analysis. Adjusting for multiple testing, 5 of these 9 genes remained significantly associated with metastasis, non with recurrence. This ratio of genes (5/23) was not significantly enriched for markers of metastasis (p = 0.07). Conclusion Several anaesthetic-analgesic receptor genes were associated with metastatic spread in breast cancer. Overall there was no significant enrichment in prognostic markers of metastasis, although a trend was observed.
Collapse
Affiliation(s)
- C. Connolly
- Dept. of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
- * E-mail: (CC); (DJB)
| | - S. F. Madden
- RCSI Population Health Sciences, Dept. of Psychology, Royal College of Surgeons, Dublin, Ireland
| | - D. J. Buggy
- Dept. of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
- Conway Institute for Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail: (CC); (DJB)
| | - H. C. Gallagher
- Dept. of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
- Conway Institute for Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| |
Collapse
|
24
|
Gilhooley E, Farrelly A, Connolly C, Tobin AM. Attitudes towards sun exposure in inflammatory bowel disease patients taking azathioprine. Ir J Med Sci 2017; 186:321-322. [DOI: 10.1007/s11845-016-1426-6] [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: 01/08/2016] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
|
25
|
Young B, Mark A, Meissner T, Amallraja A, Andrews A, Connolly C, Williams C, Leyland-Jones B. Abstract P1-05-23: Utilities and challenges of RNA-Seq based expression and variant calling in a clinical setting. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-05-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Variant calling based on DNA samples has been the gold standard of clinical testing since the advent of Sanger sequencing. The use of DNA variants has proved a great value to guide treatment in cancer patients. However, DNA based analysis will not inform about expression status of the gene harboring a particular variant. RNA has long been used to monitor expression. To this point RNA assays and analysis are confined to the research laboratory and rarely used clinically except in specifically defined gene signatures such as PAM50 and OncoType Dx. Beyond expression, RNA has the ability to confirm expression of DNA variants and identify fusion events. We hypothesize that the combination of DNA and RNA based data will allow the determination of variant specific expression status and improve clinical diagnostics. It has been previously shown that RNA sequencing (RNA-Seq) based variant calls are highly accurate and confirm DNA based variant calls. In this study we investigated the utility of RNA-Seq as a diagnostic assay integrated with DNA based sequencing data.
Materials and Methods
Targeted DNA sequencing of 321 genes was performed on 37 patient samples (FFPE), including 22 breast cancer samples by a commercial vendor. RNA-Seq on the same patient samples was performed using 100ng of total RNA. Libraries were run on the Illumina NextSeq 500 with a minimum of 75M paired 75bp reads. To evaluate RNA-seq expression reproducibility, replicates of 6 normal ovarian tissue samples (min. 50M reads) were run in sets of triplicates. STAR was used for alignment (hg19) and gene expression quantification (RefSeq). RNA-Seq based variant calling was performed using the SNPiR pipeline. Based on the results of the commercial assay, DNA based variants were examined for expression of the corresponding genes and ability to confirm variants in the RNA-Seq data.
Results
RNA expression data showed no corresponding gene expression for at least one single nucleotide variant (SNV) in 9/37 patients analyzed (24.3%). In 18/37 patients (48.6%) SNV corresponding expression was in the lowest quartile of expression values. Variant calls could be confirmed by RNA-Seq for 95/455 SNVs, with adequate coverage in 263 of the remaining 360 variant locations (median coverage: 34). Of these, a homozygous reference call was made in 166/263 SNVs. Concordance for RNA-Seq gene level expression data between replicates was > 0.995.
Conclusions
These findings suggest that RNA-Seq based data can provide clinical value when using gene expression values in combination with DNA based variant calls. We found gene level expression to be highly reproducible and will further investigate the use of spike in controls to determine clinically usable expression ranges and lower limit of expression values. To our knowledge, it has not been shown that RNA-Seq based variant calls are reproducible which is the focus of our current research as this will be one requirement for usage in a regulated environment. While our use of RNA Seq is currently limited to gene expression level data, we have demonstrated a clinically relevant benefit to using RNA Seq data as an additive feature to the current standard of DNA variant calling.
Citation Format: Young B, Mark A, Meissner T, Amallraja A, Andrews A, Connolly C, Williams C, Leyland-Jones B. Utilities and challenges of RNA-Seq based expression and variant calling in a clinical setting [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-05-23.
Collapse
Affiliation(s)
- B Young
- Avera Cancer Institute, La Jolla, CA; Avera Cancer Institute, Sioux Falls, SD
| | - A Mark
- Avera Cancer Institute, La Jolla, CA; Avera Cancer Institute, Sioux Falls, SD
| | - T Meissner
- Avera Cancer Institute, La Jolla, CA; Avera Cancer Institute, Sioux Falls, SD
| | - A Amallraja
- Avera Cancer Institute, La Jolla, CA; Avera Cancer Institute, Sioux Falls, SD
| | - A Andrews
- Avera Cancer Institute, La Jolla, CA; Avera Cancer Institute, Sioux Falls, SD
| | - C Connolly
- Avera Cancer Institute, La Jolla, CA; Avera Cancer Institute, Sioux Falls, SD
| | - C Williams
- Avera Cancer Institute, La Jolla, CA; Avera Cancer Institute, Sioux Falls, SD
| | - B Leyland-Jones
- Avera Cancer Institute, La Jolla, CA; Avera Cancer Institute, Sioux Falls, SD
| |
Collapse
|
26
|
Meissner T, Amallraja A, Mark A, Andrews A, Connolly C, Young B, De P, Williams C, Leyland-Jones B. Abstract P1-05-22: The value of RNA-Seq for the detection of clinically actionable targets in breast cancer - A small cohort analysis. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-05-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Next generation sequencing has facilitated the understanding of pathogenesis and molecular heterogeneity of breast cancer (BC) as well as accelerated the path towards precision medicine. DNA sequencing (DNA-Seq) based assays for the detection of mutations and alterations in solid and hematologic cancers are finding their way into clinical practice and are readily available as clinical products. RNA sequencing (RNA-Seq), so far being vastly applied in the research context, promises to expand the diagnostic, prognostic and therapeutic use of this technology in cancer. Beyond mutational status, RNA-Seq enables the detection of fusions, quantification of gene expression level, detection of differentially expressed genes, molecular based subtyping, and risk-stratification. In this study we analyzed RNA-Seq and copy number data from BC patients that had undergone DNA-Seq based diagnostics through commercial providers with the goal to detect additional actionable targets.
Materials and Methods
We included 18 BC patients (5/18 triple negative) that had previously undergone DNA-based targeted (321 genes) sequencing. RNA-Seq to a minimum of 75M reads (75pb) was performed using 100 ng of total RNA on the Illumina NextSeq 500 platform. STAR was used for alignment (hg19) and gene expression quantification (RefSeq). Fusions were detected using STAR-Fusion. DESeq2 was utilized to identify patient specific differentially expressed genes by analyzing samples individually against a set of 13 controls from healthy breast tissue generated in-house. Copy number variations (CNVs) were detected using the Nanostring CNV Cancer panel (89 genes) on the Nanostring nCounter platform. Differentially upregulated or amplified genes were queried against DGIdb and Gene Drug Knowledge database for suitable drug matches, limiting the queries to clinically actionable antineoplastic drugs.
Results
Analyzing the cohort of 18 BC patients, we detected on average 26 BC relevant genes (526 total, log2 FC > 2) to be upregulated per patient. Querying the upregulated genes against DGIdb, we found a total of 18 genes that had drug matches and fulfilled the criteria of being actionable antineoplastic drugs, with 17/18 samples having a minimum of two gene targets (avg: 4). Most frequent upregulated genes were TOP2A (83%), AURKA (61%), AURKB (56%), RET (39%)and FGFR3 (28%). In the case of CNVs, 12/18 patients showed at least one gene target with clinically actionable drugs associated. This was observed across 12 gene targets that were amplified (avg: 3) and 4 gene targets that underwent deletions (avg: 1). Most frequent CNVs included MYC (14%) and CCND1 (12%). 4/7 patients having an AURKA overexpression also showed an AURKA amplification on the CNV assay. 10/18 patients had fusions events, with an average of three fusions per patient, including GAB2-WNT11, PAK1-TENM4 and FGFR2-CEP55 fusions.
Conclusions
We show that RNA-Seq and copy number assays provide additional clinical value by detecting suitable drug targets beyond traditional DNA-based approaches. We are conducting further analysis on how these additionally derived drug targets could improve the current treatment schedule of those patients.
Citation Format: Meissner T, Amallraja A, Mark A, Andrews A, Connolly C, Young B, De P, Williams C, Leyland-Jones B. The value of RNA-Seq for the detection of clinically actionable targets in breast cancer - A small cohort analysis [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-05-22.
Collapse
Affiliation(s)
- T Meissner
- Avera Cancer Institute, La Jolla, CA; Avera Cancer Institute, Sioux Falls, SD
| | - A Amallraja
- Avera Cancer Institute, La Jolla, CA; Avera Cancer Institute, Sioux Falls, SD
| | - A Mark
- Avera Cancer Institute, La Jolla, CA; Avera Cancer Institute, Sioux Falls, SD
| | - A Andrews
- Avera Cancer Institute, La Jolla, CA; Avera Cancer Institute, Sioux Falls, SD
| | - C Connolly
- Avera Cancer Institute, La Jolla, CA; Avera Cancer Institute, Sioux Falls, SD
| | - B Young
- Avera Cancer Institute, La Jolla, CA; Avera Cancer Institute, Sioux Falls, SD
| | - P De
- Avera Cancer Institute, La Jolla, CA; Avera Cancer Institute, Sioux Falls, SD
| | - C Williams
- Avera Cancer Institute, La Jolla, CA; Avera Cancer Institute, Sioux Falls, SD
| | - B Leyland-Jones
- Avera Cancer Institute, La Jolla, CA; Avera Cancer Institute, Sioux Falls, SD
| |
Collapse
|
27
|
Connolly C, Miskolci O, Phelan D, Buggy DJ. End-of-life in the ICU: moving from 'withdrawal of care' to a palliative care, patient-centred approach. Br J Anaesth 2016; 117:143-5. [PMID: 27147546 DOI: 10.1093/bja/aew109] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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)
- C Connolly
- Division of Anaesthesia & Intensive Care Medicine, Mater University Hospital, Dublin 7, Ireland
| | - O Miskolci
- Division of Anaesthesia & Intensive Care Medicine, Mater University Hospital, Dublin 7, Ireland
| | - D Phelan
- Division of Anaesthesia & Intensive Care Medicine, Mater University Hospital, Dublin 7, Ireland
| | - D J Buggy
- Division of Anaesthesia & Intensive Care Medicine, Mater University Hospital, Dublin 7, Ireland School of Medicine Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland Outcomes Research Consortium, Cleveland Clinic Ohio, Cleveland, USA
| |
Collapse
|
28
|
Connolly C, Magnusson-Lind A, Lu G, Wagner PK, Southwell AL, Hayden MR, Björkqvist M, Leavitt BR. Enhanced immune response to MMP3 stimulation in microglia expressing mutant huntingtin. Neuroscience 2016; 325:74-88. [PMID: 27033979 DOI: 10.1016/j.neuroscience.2016.03.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 11/18/2015] [Revised: 03/09/2016] [Accepted: 03/11/2016] [Indexed: 11/24/2022]
Abstract
Huntington's Disease (HD) is an inherited neurodegenerative disease caused by a polyglutamine expansion in the huntingtin protein. The YAC128 mouse model of HD expresses the full-length human huntingtin protein with 128 CAG repeats and replicates the phenotype and neurodegeneration that occur in HD. Several studies have implicated a role for neuroinflammation in HD pathogenesis. Studies on presymptomatic HD patients have illustrated microgliosis (activated microglia) in brain regions affected in HD. Mutant huntingtin expressing isolated primary monocytes (human HD patients) and primary macrophages (YAC128) are overactive in response to lipopolysaccharide (LPS) stimulation. In this study we demonstrate that cultured primary microglia (the resident immune cells of the brain cells) from YAC128 mice differentially express a wide number of cytokines compared to wildtype microglia cultures in response to LPS. Furthermore, this study outlines a direct interaction between mutant huntingtin and cytokine secretion in HD microglia. Increased cytokine release in YAC128 microglia can be blocked by cannabinoid activation or by mutant huntingtin knockdown with anti-sense oligonucleotide treatment. Matrix metalloprotease 3 (MMP3), an endogenous neuronal activator of microglia, also induces increased cytokine release from YAC128 microglia compared to wildtype microglia. We found elevated MMP levels in HD CSF, and MMP levels correlate with disease severity in HD. These data support a novel role for MMPs and microglial activation in HD pathogenesis. With an improved understanding of the specific cellular processes involved in HD neuroinflammation, novel therapeutic agents targeting these processes can be developed and hold great promise in the treatment of HD.
Collapse
Affiliation(s)
- C Connolly
- Centre for Molecular Medicine and Therapeutics and Department of Medical Genetics, Child and Family Research Institute, University of British Columbia, Vancouver, BC V5Z 4H4, Canada
| | - A Magnusson-Lind
- Brain Disease Biomarker Unit, Department of Experimental Medical Sciences, Wallenberg Neuroscience Center, Lund University, S-221 84 Lund, Sweden
| | - G Lu
- Centre for Molecular Medicine and Therapeutics and Department of Medical Genetics, Child and Family Research Institute, University of British Columbia, Vancouver, BC V5Z 4H4, Canada
| | - P K Wagner
- Centre for Molecular Medicine and Therapeutics and Department of Medical Genetics, Child and Family Research Institute, University of British Columbia, Vancouver, BC V5Z 4H4, Canada
| | - A L Southwell
- Centre for Molecular Medicine and Therapeutics and Department of Medical Genetics, Child and Family Research Institute, University of British Columbia, Vancouver, BC V5Z 4H4, Canada
| | - M R Hayden
- Centre for Molecular Medicine and Therapeutics and Department of Medical Genetics, Child and Family Research Institute, University of British Columbia, Vancouver, BC V5Z 4H4, Canada
| | - M Björkqvist
- Brain Disease Biomarker Unit, Department of Experimental Medical Sciences, Wallenberg Neuroscience Center, Lund University, S-221 84 Lund, Sweden
| | - B R Leavitt
- Centre for Molecular Medicine and Therapeutics and Department of Medical Genetics, Child and Family Research Institute, University of British Columbia, Vancouver, BC V5Z 4H4, Canada.
| |
Collapse
|
29
|
Lan NTN, Thu NTN, Duc NH, Lan NN, Lien TTX, Dung NH, Taburet AM, Laureillard D, Borand L, Quillet C, Lagarde D, Pym A, Connolly C, Lienhardt C, Rekacewicz C, Harries AD. The ethics of a clinical trial when the protocol clashes with international guidelines. Public Health Action 2015; 3:97-102. [PMID: 26393009 DOI: 10.5588/pha.13.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/21/2013] [Indexed: 11/10/2022] Open
Abstract
Due to their nature and complexity, clinical trials often take some time to launch after the protocol has been designed and ethics approval obtained. During this time, there may be changes in international treatment guidelines and recommendations that result in a conflict between study protocol and recommended international best practice. Here, we describe the situation that arose in a pharmacokinetic study on the use of two different doses of rifabutin in patients with human immunodeficiency virus-associated tuberculosis who initiated antiretroviral therapy (ART) with a lopinavir-ritonavir-based regimen in South Africa and Viet Nam. The study protocol specified that ART should be started 10 weeks after the start of anti-tuberculosis treatment. The study in South Africa was approved in June 2008, went ahead as scheduled and was completed in August 2010. The study in Viet Nam was approved in October 2008 and was started in June 2010. A few weeks later, the World Health Organization released their 2010 guidelines for adult ART; one of its strong recommendations (with moderate quality of evidence) was that ART should be started 2-8 weeks after the start of anti-tuberculosis treatment. Emerging scientific evidence also supported this recommendation. The investigators felt that the Viet Nam study protocol was in conflict with recommended international best practice, and the trial was stopped in October 2010. An amended study protocol in which ART was started at 2 weeks was developed and implemented. The ethics issues around this decision and the need to change the study protocol are discussed in this article.
Collapse
Affiliation(s)
- N T N Lan
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam
| | - N T N Thu
- Institut Pasteur, Ho Chi Minh City, Viet Nam
| | - N H Duc
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam
| | - N N Lan
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam
| | - T T X Lien
- Institut Pasteur, Ho Chi Minh City, Viet Nam
| | - N H Dung
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam
| | - A-M Taburet
- Clinical Pharmacy Department, Bicêtre Hospital, Kremlin-Bicêtre, France
| | - D Laureillard
- Agence Nationale de Recherches sur le SIDA (ANRS), Ho Chi Minh City, Viet Nam
| | - L Borand
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - C Quillet
- Agence Nationale de Recherches sur le SIDA (ANRS), Ho Chi Minh City, Viet Nam
| | - D Lagarde
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A Pym
- TB Research Unit, Medical Research Council, Durban, South Africa
| | - C Connolly
- Biostatistics Unit, Medical Research Council, Durban, South Africa
| | - C Lienhardt
- World Health Organization Stop TB Department, Geneva, Switzerland
| | | | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
30
|
Essa ZI, Essack SY, Connolly C. Staphylococcus aureus from public hospitals in KwaZulu—Natal, South Africa—infection detection and strain—typing. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/10158782.2009.11441332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Z I Essa
- School of Pharmacy and Pharmacology, University of KwaZulu-Natal
| | - S Y Essack
- School of Pharmacy and Pharmacology, University of KwaZulu-Natal
| | - C Connolly
- Biostatistics Unit, Medical Research Council
| |
Collapse
|
31
|
Leidhin CN, Heeney A, Connolly C, Swan N, Foster A, Geraghty J. A Rare Case of BRCA2-Associated Breast Cancer in Pregnancy. Ir Med J 2015; 108:217-218. [PMID: 26349355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 30-year old woman was referred to our department with symptomatic breast cancer at 35 weeks gestation. Genetic testing revealed a pathogenic BRCA2 mutation. Labour was induced at 38 weeks. Mastectomy and axillary clearance were performed with a view to adjuvant chemotherapy, radiation and hormonal therapy. Multidisciplinary involvement is crucial for management of BRCA-associated breast cancer, especially in the context of pregnancy. Bilateral mastectomy may be indicated given the increased risk of ipsilateral and contralateral breast cancers. Tamoxifen may lower contralateral breast cancer risk in those in whom risk-reducing surgery is not performed.
Collapse
|
32
|
Abstract
Nowadays, 70 % of global monogastric feeds contains an exogenous phytase. Phytase supplementation has enabled a more efficient utilisation of phytate phosphorous (P) and reduction of P pollution. Trace minerals, such as iron (Fe), zinc (Zn), copper (Cu) and manganese (Mn) are essential for maintaining health and immunity as well as being involved in animal growth, production and reproduction. Exogenous sources of phytase and trace elements are regularly supplemented to monogastric diets and usually combined in a premix. However, the possibility for negative interaction between individual components within the premix is high and is often overlooked. Therefore, this initial study focused on assessing the potential in vitro interaction between inorganic and organic chelated sources of Fe, Zn, Cu and Mn with three commercially available phytase preparations. Additionally, this study has investigated if the degree of enzyme inhibition was dependent of the type of chelated sources. A highly significant relationship between phytase inhibition, trace mineral type as well as mineral source and concentration, p < 0.001 was verified. The proteinate sources of OTMs were consistently and significantly less inhibitory than the majority of the other sources, p < 0.05. This was verified for Escherichia coli and Peniophora lycii phytases for Fe and Zn, as well as for Cu with E. coli and Aspergillus niger phytases. Different chelate trace mineral sources demonstrated diversifying abilities to inhibit exogenous phytase activity.
Collapse
Affiliation(s)
- T Santos
- Alltech Ireland, European Bioscience Centre, Dunboyne, Co. Meath, Ireland,
| | | | | |
Collapse
|
33
|
Dilraj A, Bristow CC, Connolly C, Margot B, Dlamini S, Podewils LJ. Validation of sputum smear results in the Electronic TB Register for the management of tuberculosis, South Africa. Int J Tuberc Lung Dis 2014; 17:1317-21. [PMID: 24025384 DOI: 10.5588/ijtld.12.0904] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The accuracy of tuberculosis (TB) surveillance systems is paramount in TB control. In South Africa, information from the laboratory is not directly linked to the Electronic TB Register (ETR). OBJECTIVE To validate smear results recorded in the ETR with those recorded in the laboratory. METHODS A retrospective evaluation was conducted among all sputum smear-positive TB patients recorded in the ETR during the fourth quarter of 2009 in KwaZulu-Natal Province. RESULTS Of 1036 smear-positive patients recorded in the ETR, 683 (65.9%) had positive results recorded in the laboratory register. Only 364 (53.2%) had their smear results recorded in the ETR at the end of the intensive phase of treatment; of 326 (89.6%) recorded as converted to smear-negative, 224 (61.5%) were confirmed as smear-negative in the laboratory. Of 331 patients with end-of-treatment results in the ETR, 302 (91.2%) were recorded as cured, but only 105 (34.8%) were confirmed in the laboratory. CONCLUSIONS Over a third of TB patients registered as smear-positive in the ETR could not be confirmed based on laboratory results. Many patients did not have a laboratory record, lending to uncertainty as to the validity of the smear results and treatment outcomes recorded in the ETR.
Collapse
Affiliation(s)
- A Dilraj
- South African Medical Research Council, Durban, KwaZulu-Natal, South Africa
| | | | | | | | | | | |
Collapse
|
34
|
Kohler F, Connolly C, Sakaria A, Stendara K, Buhagiar M, Mojaddidi M. Can the ICF be used as a rehabilitation outcome measure? A study looking at the inter- and intra-rater reliability of ICF categories derived from an ADL assessment tool. J Rehabil Med 2013; 45:881-7. [PMID: 23979649 DOI: 10.2340/16501977-1194] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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] Open
Abstract
PURPOSE The categories of the International Classification of Functioning , Disability and Health (ICF) could potentially be used as components of outcome measures. Literature demonstrating the psychometric properties of ICF categories is limited. OBJECTIVE Determine the agreement and reliability of ICF activities of daily living category scores and compare these to agreement and reliability of the Functional Independence Measure (FIM) item scores. METHOD Two investigators independently reviewed the clinical notes to score the ICF activities of daily living cate-gories, of 100 patients using ICF qualifiers with additional scoring guidelines. The percentage agreement, interrater and intrarater reliability were compared with the matched FIM items scored by a separate set of two investigators using the same methodology. Kappa Statistic was calculated using Med Calc. RESULTS ICF interrater reliability as indicated by Kappa values ranging from 0.42 to 0.81 was moderate or better for the eleven self care and mobility categories. The language ICF categories and problem solving generally have fair agreement, with Kappa values ranging from 0.21 for receiving verbal messages to 0.44 for basic social interactions. Absolute agreement was above 72% for all categories. Reliability and agreement of the FIM items was generally lower than the corresponding ICF categories. CONCLUSION The inter-rater and intra-rater reliability and agreement of the ICF activities of daily living categories were comparable or better than the corresponding FIM items. The results of this study provide an indication that the ICF categories could be used as components of rehabilitation outcome measures.
Collapse
Affiliation(s)
- Friedbert Kohler
- School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney, Australia. ,
| | | | | | | | | | | |
Collapse
|
35
|
Kohler F, Connolly C, Sakaria A, Stendara K, Buhagiar M, Mojaddidi M. Response to letter to the Editor by Gunnar Grimby and Ã…sa Lundgren-Nilsson, on ‘Comments on the article “Can the ICF be Used as a Rehabilitation Outcome Measure? A study looking at the inter- and intra-rater reliability of the ICF categories derived from an ADL assessment tool.â€â€™. J Rehabil Med 2013; 45:931. [DOI: 10.2340/16501977-1222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
36
|
Abstract
Digital acrometastases as a primary presentation of hepatocellular carcinoma (HCC) is rare. A 66-year-old man with no history of malignancy presented to the plastic surgery department with two skin lesions, one on the bridge of his nose and one on distal phalanx of left little finger. A working diagnosis of cutaneous metastases was made. Immediately prior to admission for excision of these lesions he was admitted with right upper quadrant pain and a jaundiced discolouration of the skin. The lesions were excised as planned and histopathological examination revealed metastatic HCC. A subsequent magnetic resonance imaging showed a lobulated mass consistent with primary HCC.
Collapse
Affiliation(s)
- M S Rauf
- Ninewells Hospital, NHS Tayside, Dundee, Scotland, UK
| | - L Motta
- Salford Royal NHS Foundation Trust, Salford, England, UK
| | - C Connolly
- Plastic Surgery, NHS Tayside, Dundee, Scotland, UK
| |
Collapse
|
37
|
Connolly C, Sanghera P, Glaholm J, Hartley A. EP-1202 NASOPHARYNGEAL CANCER AND P16 EXPRESSION: A NEW DISEASE ENTITY ARISING IN CAUCASIAN PATIENTS? Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71535-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
38
|
Connolly C. A nasty hex on chromosome 9 causes FTD/ALS. Clin Genet 2011; 81:126-7. [PMID: 22129088 DOI: 10.1111/j.1399-0004.2011.01820.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C Connolly
- Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, 950 West 28th Avenue, Vancouver, BC, Canada V5Z 4H4.
| |
Collapse
|
39
|
Connolly C, Chan KK, Singh K, Sundar S, Luesley D, Anwar MS, Fernando IN. Outcomes following interval debulking surgery in primary peritoneal carcinoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
40
|
Horowitz T, Wolfe J, Keehn B, Connolly C, Joseph R. Is superior visual search in autism due to memory in search? J Vis 2010. [DOI: 10.1167/7.9.712] [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: 11/24/2022] Open
|
41
|
Moodley M, Lindeque G, Connolly C. Human papillomavirus (HPV)-type distribution in relation to oral contraceptive use in women with cervical intraepithelial neoplasia, Durban, South Africa. EUR J GYNAECOL ONCOL 2010; 31:278-283. [PMID: 21077468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To determine HPV-type distribution among women with cervical dysplasia in relation to oral contraceptive usage. METHODS Prospective cross-sectional study of four groups of patients according to oral contraceptive usage: non-users, users of less than five years duration, users of between five years and ten years, and users of more than ten years duration. Swabs of the cervix were analysed for HPV DNA using the polymerase chain reaction method. RESULTS A total of 124 women were recruited for the study. There were 75 patients who were HIV-infected (seroprevalence 61%). There were 102 patients who were HPV positive (82%), of which 79 patients had high-risk HPV DNA (78%). In terms of the four oral contraceptive groups, high-risk HPV DNA was detected in 70% (n = 21), 79% (n = 22), 90% (n = 21) and 71% (n = 15) of patient, respectively. The odds of having HPV DNA was six times higher for the combination of contraceptive users of less than five years duration/non-users (OR 5.9, 95% CI: 1.87-18.77). There was no change when adjustment was made for age (OR 6.1, 95% CI: 1.9-19.4). HPV DNA type 16 and/or 18 was present in a total of 21 patients (49%) (non-contraceptive users and users < 5 years duration) versus 15 patients (42%) (oral contraceptive users of more than 5 years duration) (p = 0.524). HPV type 16 was the commonest HPV type detected (20.2%) and HPV type 58 was the next commonest hihg-risk HPV type (16.1%). HPV types 58 and 33 were detected in a much greater percentage of our population and HPV 16 in a much smaller percentage of our population compared with a non-South African population. CONCLUSION The findings of this study demonstrate an interesting distribution of HPV types in a South African population.
Collapse
Affiliation(s)
- M Moodley
- Department Obstetrics & Gynaecology, Gynaecological Oncology, Nelson R Mandela School of Medicine, Durban, South Africa.
| | | | | |
Collapse
|
42
|
Kohler F, Dickson H, Redmond H, Estell J, Connolly C. Agreement of functional independence measure item scores in patients transferred from one rehabilitation setting to another. Eur J Phys Rehabil Med 2009; 45:479-485. [PMID: 20032905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM Classification and payment systems that incorporate a functional measure used in routine clinical practice can only be as accurate as the underlying functional measure. The test-retest reliability in clinical practice of the individual item scores of the Functional Independence Measure (FIM), a functional measure used in classification and payment systems has been investigate. The aim of this study was to analyse paired measurements of FIM item scores carried out in routine clinical practice for patients transferred from one Rehabilitation Unit to another, and to determine the interrater reliability using standard measures of agreement and bias. METHODS Patients who were transferred between two rehabilitation units between August 2006 and October 2007 had a FIM scored on discharge from the original unit and a FIM scored on admission to the second unit. A short time between score and re-score reduced the probability of significant functional change. A retrospective analysis was performed. RESULTS Paired FIM item scores from143 patients were included in the review. Raw agreement between the two scores for each FIM item was low, with a mean of 54 + 18 pairs (%) matching. The range of difference between scores was wide. Weighted kappa values were generally in the fair agreement range as were the intraclass correlation coefficients. Tests for bias and homogeneity showed that just over half of the items had significant differences in the two sets of scores. Weighted k showed only fair agreement for FIM items. Contributing factors for this could include incomplete FIM training of some staff, insufficient attention to accurate scoring, actual clinical changes, differences between patient performance in different settings, and variation in scoring because of the large number of staff involved in scoring the FIM in the multidisciplinary team within our settings. CONCLUSIONS Caution needs to be exercised when utilizing the FIM individual item scores in clinical practice as part of clinical or funding classifications or in benchmarking as this study indicates only fair inter-rater reliability of these scores in clinical practice.
Collapse
Affiliation(s)
- F Kohler
- School of Public Medicine and Community Health, University of NSW, Sydney, Australia.
| | | | | | | | | |
Collapse
|
43
|
Bagratee JS, Regan L, Khullar V, Connolly C, Moodley J. Reference intervals of gestational sac, yolk sac and embryo volumes using three-dimensional ultrasound. Ultrasound Obstet Gynecol 2009; 34:503-509. [PMID: 19852047 DOI: 10.1002/uog.7348] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To create reference intervals of gestational sac volume (GSV), yolk sac volume (YSV), embryo volume (EV), crown-rump length (CRL) and gestational sac diameter (GSD) in the first trimester of pregnancy using three-dimensional ultrasound. METHODS Women in the first trimester of pregnancy were invited to participate in the study. Inclusion criteria were well-established dates, and that the women were non-smokers and healthy, without any medical disorders. Three-dimensional ultrasound volumetric data (GSV, YSV, EV) were collected together with standard two-dimensional measurements of CRL and GSD. For each measurement separate regression models were fitted to estimate the mean and SD at each gestational age. The 5(th), 50(th) and 95(th) centiles were derived using a combination of these regression models. RESULTS One hundred and sixty-six women at between 6 and 12 weeks' gestation were scanned once. The mean ( +/- SD) maternal age was 29.4 ( +/- 5) years. There were no miscarriages and no congenital abnormalities were noted. Mean gestational age at delivery was 39.3 ( +/- 1.4) weeks and mean birth weight was 3.3 ( +/- 0.4) kg. The CRL centiles fitted a cubic model and the GSD centiles fitted a linear model. The centiles for YSV fitted a quadratic model on the modified log-transformed data. The centiles for GSV and EV were modeled using quantile regression. CONCLUSION Reference intervals and centile charts for first-trimester GSV, YSV and EV have been created in addition to CRL and GSD using rigorous methodology.
Collapse
Affiliation(s)
- J S Bagratee
- Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of Kwa-Zulu Natal, South Africa.
| | | | | | | | | |
Collapse
|
44
|
Jacobson S, Kelleher I, Harley M, Connor D, Clarke M, Blanchard M, Connolly C, O'Hanlon E, McNamara S, Donohoe G, Cannon M, Garavan H. An MRI Examination of Cognitive Control and Brain Volumetrics in Schizophrenia Patients and a Community Based Sample of Adolescents with Psychotic Symptoms. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71657-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
45
|
Abstract
The study investigates the risk exposure to HIV infection among South African children aged 2-9 years served by public health services. Together with their biological mothers, 3471 children and were recruited from inpatient and outpatient children in the Free State Province. Blood samples were taken by professional nurses and a history taken of exposure factors associated with HIV transmission. DNA testing was used to confirm biological maternity where the child was HIV-positive and the mother HIV-negative. Mother-child pairs were stratified by mother's HIV status. Exposure factors related to the child's HIV status were examined in each stratum using a chi-square test. Independent factors were then included in a multiple logistic regression model. Having an HIV-positive mother was strongly related to HIV infection in children (OR: 310; 95%CI: 148-781). However, seven HIV-positive children had HIV-negative mothers. Transmission in this group was significantly associated with breastfeeding by a non-biological mother (OR: 437; 95%CI: 53-5020), being fed with expressed breast milk from a milk room (OR: 37.6; 95%CI: 6.2-259.0), dental injection history (OR: 31.5; 95%CI: 4.5-189.4) and visits to a dentist (OR: 26.9; 95%CI: 4.4-283.5). Although mother-to-child-transmission is shown to be the primary mode of HIV transmission in South African children, the few HIV-positive children infected by other modes of transmission suggest a potential risk of non-vertical HIV infections. These infections can be prevented through education and improved infection-control procedures.
Collapse
Affiliation(s)
- O Shisana
- Human Science Research Council, Cape Town, South Africa.
| | | | | | | | | |
Collapse
|
46
|
Cunningham CJ, Walsh JB, Coakley D, Walsh C, Connolly C, Murphy M, Murphy C. Survival of patients discharged to long term care. Ir Med J 2008; 101:305-307. [PMID: 19205140] [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: 05/27/2023]
Abstract
Data on the life expectancy of elderly people in long term care facilities will be important for effective service planning and monitoring quality of care. To date there are no such data from an Irish perspective. A random sample of patients discharged to long term care between Jan 1st 1997 and December 31st 2003 from a single Dublin hospital was studied. Death by January 1st 2005 was ascertained through the register of births deaths and marriage. Median survival was calculated and factors associated with mortality were determined in a logistic regression. Mean (sd) age was 82 (11) years and 61 (29%) were female. Median survival was 30.3 (95%CI 22.4-45.0) months (mean Irish life expectancy at this age is about 78 months). Three factors were independently associated with death by 2 years: age (Odds ratio 1.11 [95%CI 1.05-1.17, F ratio 15.1, p=0.0001] per year), male gender (Odds ratio 1.52 [95%CI 1.05-3.68, F ratio 5.2, p=0.024]) and discharge to continuing care (Odds ratio 1.96 [1.05-3.68, F ratio 4.4, p=0.037]). These results (which are the first such Irish data) show that patients discharged to long term care are a frail group with a reduced life expectancy. Encouragingly survival for this cohort (25% at 1 year) was similar to that seen in other countries. Data on nursing home survival will allow more accurate planning of long term residential services and help monitor quality of care.
Collapse
Affiliation(s)
- C J Cunningham
- MedEL Directorate and Mercer's Institute for Research in Ageing, St James's Hospital, James's St, Dublin.
| | | | | | | | | | | | | |
Collapse
|
47
|
|
48
|
Patel VB, Burger I, Connolly C. Temporal evolution of cerebrospinal fluid following initiation of treatment for tuberculous meningitis. S Afr Med J 2008; 98:610-613. [PMID: 18928039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE Clinicians often perform follow-up lumbar punctures (LPs) on patients with tuberculous meningitis (TBM) to document changes occurring in the cerebrospinal fluid (CSF). Normalisation of the CSF then serves as indirect confirmation of the diagnosis. However, changes occurring in CSF following the initiation of anti-tuberculosis (TB) treatment are not well described. We undertook a retrospective study to determine the temporal evolution of CSF in patients with TBM on anti-TB treatment in an attempt to provide a more rational basis for the interpretation of repeat LPs. METHODS Patients diagnosed with TBM at King George V Hospital in Durban from 1994 to 2003 were identified. Demographic, clinical, laboratory and radiological data were recorded. We examined the change in CSF lymphocyte cell count, polymorphonuclear (PMN) cell count, glucose concentration and protein concentration. Initially, scatter plots of the data modelled over time were produced and random effects models were then used to model the predicted changes in CSF over time. RESULTS Ninety-nine patients were identified, and a total of 327 LPs were done. The average number of LPs per patient was 3 (range 3 - 9). Statistically significant changes in all four variables (lymphocytes, PMN cells, glucose and protein) were demonstrated, with a p value < 0.001. The predicted models showed that lymphocyte count and protein concentration change slowly over time. PMN cells and glucose concentration changed rapidly in an exponential manner. CONCLUSIONS Our results demonstrate the tendency for CSF to normalise over time. The slow change in lymphocyte count and protein concentration limits clinical use. The rapid change in PMN cells and glucose concentration allows us to make reasonable clinical decisions. If a repeat LP does not show definite improvement in these two parameters, it should be considered atypical for TBM.
Collapse
Affiliation(s)
- V B Patel
- Department of Neurology, University of KwaZulu-Natal, Durban
| | | | | |
Collapse
|
49
|
Colvin M, Bachmann MO, Homan RK, Nsibande D, Nkwanyana NM, Connolly C, Reuben EB. Effectiveness and cost effectiveness of syndromic sexually transmitted infection packages in South African primary care: cluster randomised trial. Sex Transm Infect 2006; 82:290-4. [PMID: 16723363 PMCID: PMC2564711 DOI: 10.1136/sti.2005.019240] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness and cost effectiveness of syndromic sexually transmitted infection (STI) packages on appropriate treatment and preventive management during primary care consultations. METHODS Cluster randomised trial of 37 Durban primary care clinics randomised to use syndromic packages (containing antibiotics, condoms, partner notification cards, and written information) or not. We assessed outcomes using simulated patients who reported STI symptoms and recorded how they were managed, before and after implementation (269 and 256 simulated patient consultations). We adjusted for baseline values and intra-clinic correlation of outcomes statistically. We used health department information to estimate the extra resources needed to provide the packages to 20 clinics for 1 year and their costs. RESULTS Simulated patients in intervention clinics were more likely to receive appropriate syndromic STI management (correct treatment plus condoms offered plus partner notification cards offered; prevalence rate ratio 2.3; 95% confidence intervals (CI) 1.6 to 3.0) and to receive more STI advice and information (odds ratio 1.5; 95% CI 1.01 to 2.1). Women were less likely to receive appropriate syndromic STI management. The intervention increased STI information provision in women more than in men. The extra cost per extra patient appropriately managed was $1.51. CONCLUSIONS Syndromic packages improved syndromic STI management at a reasonable cost and should be used more widely.
Collapse
Affiliation(s)
- M Colvin
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
| | | | | | | | | | | | | |
Collapse
|
50
|
Kharsany ABM, Connolly C, Olowolagba A, Abdool Karim SS, Abdool Karim Q. TB treatment outcomes following directly-observed treatment at an urban outpatient specialist TB facility in South Africa. Trop Doct 2006; 36:23-5. [PMID: 16483424 DOI: 10.1258/004947506775598770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/18/2022]
Abstract
The treatment of 450 consecutive new patients with pulmonary TB was evaluated to determine outcome following directly-observed treatment. In all, 176 (39.1%) patients were cured, 23 (5.1%) completed treatment, 80 (17.8%) defaulted treatment, 24 (5.3%) died, 54 (12.0%) were lost to follow-up and 93 (20.7%) were transferred out. Increasing age was significant for death. Males were more likely to default and those with negative pretreatment sputum smears and those who were unemployed were more likely to be lost to follow-up. The overall treatment success rate remains low. Our data suggests that greater emphasis is needed to improve TB treatment success.
Collapse
Affiliation(s)
- A B M Kharsany
- CAPRISA-Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | | | | | | | | |
Collapse
|